Daaktuur

I am not very fond of you Surgery. But it's not your fault, I just like medicine more. I like eliciting a knee jerk more than I would like fixing a broken knee. But this post is not about surgery per se, it's about a patient that I have recently come across in the ESR. Actually, his relative is what I am going to write about.

Abusive, violent, short tempered, drunk..... he isn't any of those. It's Saturday evening. (I always end up in units which have Saturday emergencies. No Sundays for me!! But, I also have my entrance classes on Saturday and Sunday, which I end up either missing inevitably or reaching them so dead tired and sleep deprived, I wonder if I should just ask for a refund. Hmmmmm..... no digressing, back to the topic.)

So, it's Saturday evening. My engineering friends are probably out in bars and discotheques partying hard after having worked harder through the week, probably gulping down shots of tequila till they can no longer stand on their own two feet. Well, why shouldn't they, they can afford. I am a teetotaller, but I know that one shot costs 1700 and taxes extra. 1700, is what an intern's stipend was two years ago. Then it increased, courtesy my seniors who went on a strike. But, it hasn't increased that much either, one can now probably afford 3 shots. And, here I am inserting IV lines, Folley's catheters, Ryle's tubes, and suturing drunkards who've fallen by the roadside and cracked their skulls open. All work, no study. Sorry, I digress.

So, it's a Saturday evening. I've missed one more class. Today has a heavier than usual. Around 9.30 pm one more fellow wheels in. I ready my set of IV lines, one pink and one blue, to be chosen on the condition of his veins, the three way connector and saline flush and adhesive tape. 3 red vials for viral markers, two purples for blood grouping and cross matching and HbCBC. All is done at spinal level. 

His relative approached me. From his attire, he seems like a Koli (Fisherman). His eyes are red shot, not of liquor, but of exhaustion, a lot of which overflows on his face as well. I take a look at him. He is barefoot. After explaining to him where to take the blood samples and all other things that we require before admissions, he goes away and I get busy with other patients.

At about 1.30 am the flow of patients has ebbed. The lecturer has taken his rounds of the esr and has gone to operate. The houseman has fallen asleep on a stool (wooden), the exhaustion of 18 straight hours taking a toll. He won't sleep long, the next patient will come up in 10 min. His head fallen back weirdly, he'll surely have a sprain tomorrow morning. Somehow, he isn't falling off the table.

I too think of catching a 5 min power nap. I look around for any place where I can rest my head and where there isn't blood stain or some such infective secretion. My back has already started getting spasms. Or should I just solve a few mcqs? The 3 mcqs that I'll manage in 5 min, may be the decider between me getting a seat or spending one more year preparing. I do not enjoy reservations either, so maybe I should go for the mcqs.

"Sir, uuu bluuud banka se khun ka report aa gaya." My thoughts are broken by the fisherfolk. I look at his blood group and tell him to attach the report in his file.

He smiles back. Even though his smile is laboured, and his teeth stained, it is still full of warmth and friendliness.

"Array suno!" I call out to him.
"Aise hospital me bina chappal ke mat ghoomo. Khoon vagaira neeche gira hua rehta hai. Needle, kaanch bhi niche rehta hai. Pair me lag jaayega. Bimar pad jaaoge."

He just smiled back again.

"Kidhar se aaye ho?" I ask.

He smiles even brighter, the exhaustion suddenly disappearing.

"Virar ke aage Arnala aata hai." 

I remember Arnala. When I was a kid we had once gone to celebrate holi at the Arnala beach. Back in those days it wasn't so famous and a lot of families only used to come there. We would board a train to Virar from Dadar. Then take a shuttle to Arnala and then there would be rickshaws to take us to the beach. About 2 hours fun packed journey.

"Haan. Mallom hai." I reply.

"Udhar Shivaji ka killa hai!"

"Acchha! Ye nahi maloom tha mujhe. Mai to sirf beach pe hi aaya hu."

"Udhar se hi killa pe jaate hai. Wo beach se ferry karke jaate hai. Killa pe jaane ka hai bolo. Le ke jaate hai. Do ferry hota hai din me. Ek sakali jaata hai aur ek sandyakali wapas aata hai."

"Algi baar gaya Arnala tab jata hu kille pe."

"Aaap aao hamare ghar pe. Taja taja macchli pakadte hai hum. Dega aapko."

"Array mai non-veg nahi khata."

"Koi baat naahi. Hamara ghar k bahar choota bagicha bhi hai. Aao tum. Taja shabji deta hai tumko."

"Lekin aapka ghar kaise milega mujhe?"

"Wo kuch nahi. Aake kisko bhi poocho, 'DAAKTUUR' ka ghar kidhar hai. Koi bhi leke aayega. Hamara idhar daaktuur nahi hai. To fir koi bhi bimar padta to mai ich sab ko leke jaata illaz ko. Karke sab log mere ko ich daaktuur bulate."

He grinned again from ear to ear.

It's barely been 4 months since we've passed our final MBBS and taken the Hippocrates oath.

"Do no harm" is supposed to be our motto. But some of my colleagues have brushed it aside already! I too feel sometimes that I should take a few liberties and short cuts as well. Eventually, my future is going to be decided by my score in the exams and not by how well I have behaved with someone or how honestly and meticulously I have done my job.

"We are interns. Nobody's life depends on us." Says one of them as he sometimes (which is now becoming everytime) underfills samples in vials so that he can quickly finish his set of blood collections and rush away to the library. "Even if the lab sends sample inadequate, the houseman will send another sample in the evening to the elab. Nobody's life depends on you."

Now I have an existential dilemma, who is a doctor?
One who's declared that nobody's life depends on him or one who is the only source of hope to sick man on a desolate islet?

Perhaps the latter isn't. He will only be a daaktuur at best.

"Wo mera godhali dekha tumne? Hara tha. Idhar rakh ke gaya tha tabhi. Mil nahi raha. Raat ko soneko laya tha.Leke gaya koi lagata hai. Aise hi sona padega abhi. Dekho tumko milega to. Idhar hi rakhke gaya tha mai. Pccccchhhhhhh......"

Rural Postings for Doctors : Their resistance is illogical and futile.

One of the reasons I voted for the BJP, other than of course the fact that Narendra Modi had caught my imagination (the fact that I used to be a Modi hater from 2002 to 2012 notwithstanding), was the ass-licking appeasement policies of the previous government which I felt were anti-doctors in addition to, of course, being anti national.

My world view has evolved a great deal over the course of my 5 year journey in MBBS. From being a strong supporter of socialism (perhaps that's why I took up medicine in the first place), almost being a borderline communist sympathiser at times, to recently becoming a little right leaning. A part of this transition has been the realisation that the world we live in is not ideal, ideologies falter and collapse when personal benefits come in conflict, and that a logical argument can easily be distorted to shield a particular individual or group of individual's self interests and selfish intensions in the name of larger hardships of community; which, therefore, will always continue to persist and the gaps will always ever widen. Internship, of course, was the turning point, but the process may have begun earlier.

Facebook discussions now-a-days have gone from being one liner, pull your leg-blow my trumpet comments to literally large - Long answer monologues and discourses. This may partly be a sign of our individual maturity or we may probably have learnt to use the platform for appropriate and relevant matters with age.

When the proposal for compulsory rural postings came up last year, the Gymkhana organised a debate. I was a part of the team that was "against". We were supporting not serving poor people, not giving health to the diseased, running away from responsibilities, not repaying the debt of the society. In short, being selfish, immoral and arrogant and defending it too.

But, lecture hall debates end up in lecture halls and have no more importance.

I had a end stage full blown AIDS patient in the ward. Sending his blood work would be a very frightening experience. I am not judging him or chastising him, but just the amount of precautions to be taken and the anxiety of an accidental prick would make it all the more difficult. But, it was managed. Accidents do not happen if one is careful.

Then one day there was someone who looked like a priest by the patient.  I was happy to see him. Nothing consoles a patient more than a reading from a holy scripture when he knows that his time is running out. I was more happy, that his family members had accepted him, knowing full well the social stigma associated with his disease.

As I continued with the blood collections I couldn't help but be astonished by his mutterings.

"Shaitan is ke shareer se nikal jaa. Holy spirit kehta hai iske shareer se nikal jaa!" And these were the only 2 sentences he kept on repeating for all the ten minutes that I was by his bed side. I between the feeble man would try and say "Nikal Jaa!!"

 I felt like telling him, that your CD 4 count is only 24. Is baar to shaitan nahi nikalega, agli baar shaitani mat karna! I don't judge him for an act in his past, but this is and should be unacceptable.

Was it an exorcism being performed in a hospital? I have seen discovery channel documentaries about such things being done, especially in case of rabies, trying to force feed water to a person who had lost the ability to drink. The discomfort then would, logically be extrapolated as resistance by the devil. But, in 2014?

A few years ago I had seen a patient with herpes. He had taken medicine for a week and so would obviously be cured. But his sister took him to some Baba who swept a broom over his vesicles and then when they went away she proclaimed that the Baba had cured him. So much for our Acyclovir!

A man would stand outside the KEM arthritis opd entrance with "Bhallo ka baal and Whale ki haddi". As patients would crawl out with their painful joints he would entice them, dupe them and tie a Bhalloo ka baal around their arm and a Whale ki Haddi around their throat. If only it was that easy, wouldn't all pharma companies market bear hair? All natural and no side effects.

These are instances where they only eat away our credit, at least patients take the treatment. But, there are many other instances where such beliefs prove counter productive especially in psychiatric illnesses. Psychiatric illnesses where time of patient contact is perhaps the most important determinant of successful outcome. People would rather kill their patients doing woo-doo and what not, but never take them to a psychiatrist. And it is not just the poor, but rich (cast, community, creed, colour, gender no bar) more often who engage in such hoolabaloos.

Indians are spiritual. And our spirituality is often misguided, as much as Hitler's nationalism was misguided.

Its been a year since Dr. Dabholkar, an anti superstition activist was murdered. No arrests have been done. More importantly, no anti-superstition law has been passed. Communities take to roads demanding reservations, cities come to a standstill fighting corruption, police commissioners get transferred if a rape occurs in a remote corner of their jurisdiction, but no noise is raised, rather political parties shout down a legislation that would have corrected a very wrong that is routed in the community.

"Matters of belief"  is a very wide based argument, misused often. May be reintroduce Sati, hadn't Britishers interfered with out faith then?

When I hear the argument that every Indian is Hindu, I don't feel like refuting it.Don't they walk with a mouthful of saffron and spit and colour every corner available in shades of orange to red. Perhaps, it's animal instinct, just as dogs can't let go of their affinity for car tyres.

As much as you tell a patient that he has to throw the cotton swab in the red bag, even be polite enough to point it out to them. Yet, you can always see from the corner of your eye that it goes right under their cot. Blood soaked cotton swab, the most fertile medium for the most notorious germs to grow, stocked up under 70 beds in each ward.

We raised points of unavailability of medicines, of poor security conditions (especially for our female colleagues), the fact that resident doctors go on a strike almost 4-5 times in a year because some short tempered relative vents his ire on a treating doctor. Such instances occur in civic hospitals with in-house security cops, the rural scenario is left to one's imagination. We've all had experiences with those guys with running noses demanding 'INJJESHUN'. And last, but not the least, also about bad roads and no ambulances in rural areas. 

The persistent counter from the jury was "So isn't that your responsibility? Will you run away?"

Non-medicos (except medico's parents, spouses, children and immediate kin) have unexceptionally high expectations of social service from medicos. Partly our seniors have been responsible for that. They managed to keep high moral standards when everyone around was faltering. It is expected that the police will not lodge an FIR even if a murder takes place without first taking Gandhiji's blessings. But, doctors have always sacrificed their personal lives for the sake of strangers and made their sufferings their own.

Today, these expectations have sky rocketed to unreal heights perhaps infringing into administrative and executive domains. Thinking that doctors going to the villages will bring medicines and roads is perhaps acknowledging us for more than what we can do. Dr. Dabholkar was a Medical doctor, not a Ph. D. in sociology. Forget his life, did the society stand with him in his death?

This is why I feel, that the medico's resistance to rural postings is illogical. Without the periphrenalia that we require, we will be useless. But, it may not be wrong to look at it as a year long paid vacation in the greenery and heart of nature. We have been living sleep deprived existence since we were 15, perhaps this is our gift at 24!

Its true that our opposition is because we can foresee that this exercise will be futile, that it will breed in more corruption into the field, that sending demotivated cadres will in fact be counter productive, that the nation will eventually loose its cream to the brain drain.

But, when people want only to be beaten by broom sticks, tie Bhaloo ka baal and Whale ki haddi, and look towards us a potential tool to win them elections, so be it.

So guys, just chillax!

Of Sex Education, Phone Calls and Karyakram!

The only session in "Ahem Education" that I had in school was a 1 hour lecture a few weeks after we had appeared for the Xth board exams. And, that too was held because either the Education Department or the BMC or someone else mandated it. What they spoke, even they had no clue about.I think now, that bees know more.

"What is STD?" one asked.

Being a  studious, sincere student, I proudly raised my hand (as all geeks in schools do!)
"Subscriber Trunk Dialing" I answered, with a smile grinning from ear to ear.

"No, it is Sexually Transmitted Diseases." came the reply.

And that was it. STD is Sexually Transmitted Diseases, full stop.
What? How? Where? When? You were free to figure out by yourself.

Luckily, I took up biology in college and managed to enter medicine. At least now, there is some authentic knowledge. I read about a couple of things that some advertisements in trains and a few websites proclaim. All non-sense! Unfortunate!

Somethings so bizzare as, STDs are cured with sex with virgins! That perhaps explains the society's obsession with the V word. (Poor virgins! They be plagued for life.)

The reason why I am reminded of this incidence is the current string of rapes and sexual assaults that the media is highlighting. And one of the reasons I feel that the trend will not be curbed in any foreseeable future, is because of the element of ignorance.

When educated people are ignorant, what about the already illiterate frustrated unemployed youths?

I had the fortune of studying in a boy's school and therefore there is some first hand information of the endless limits to which the adolescent boy can dream. We used to share!

The problem is less of perversion. 

What is the greatest human attribute? The ability to reproduce in any season? The opposable thumb? The discovery of fire? No, it is the ability to think.

The problem is more of curiosity. What differentiates humans from monkeys and chimpanzees and orangutans, is among other things, our curiosity.

Chimps, our closest relatives, can only think about thinking! We can actually think. Plus, we have curiosity! Added benefits!

Curiosity, not adversity, is the mother of all inventions. We are curious about the stars, the moon, the mars and also the nucleus of the atom. About life, pre-life and after-life!

We are curious of the past as also of the future. We try to satisfy our curiosity by finding answers. Where we can, we do. Where we can't we refer to the greatest invention of the human species: GOD.

(Of course, then we fight and kill over it as well.)

So, God created two humans, a male and a female. And each is curious about the other as well. And that is where the problem starts.

We have the answers to most of the querries, but somehow, God once again is forbidding disseminating them, this time via the instrument of Morality and Decency and such other things conjured out of the thin air.

About six months ago, I was doing my night shift in the casualty.
Suddenly a group of about 14 men and women entered. No big deal! Bring 'em on. But, there was no trolley, no blood, no screaming patient nor a crying mother. They all were, however, surprisingly hold battery-torches. My first impression would have otherwise been that maybe a wall had fallen on someone in the dark night. I was curious.

"Sir, these two kids ran away from the house at 6 pm." said one. Apparently, they were neighbours.
"Sir, we caught them now 10 minutes ago in a garden without clothes." He added. The time was 2.15 am.

Torches, explained!

"So, what's the problem?" I asked.

"Sir, aamhala watatay, hyaannee KARYAKRAM kela aahe! Tumhi fakt check karun sanga."

"Bol, or else the doctor will anyway find out." Said a female to the girl. I presume that it should have been her mother.

One of the benefits of internship was that one would not handle such sticky situations. So, gleefully I referred them to the senior MO on call and watched how he dealt with it.

It was a clearly medico-legal case. The kids were pretty young. And if the girl would have been under 16, and if, they had indeed performed the karyakram,  the dude would be charged with statutory rape, consensuality not withstanding.

Well, from what ever that transpired, neither parties were willing to file a police case, let alone even getting an official casualty paper issued.

The families had no objections to the fact that they were run away lovers, neither was there any sense of animosity apparent between them. There greater concerns were whether the karyakram had been conducted or no. The mothers and the aunts were sweet talking the kids to confess, the fathers and the uncles playing "the bad cops" - Confess or the Doctor will find out.

Door gaon me jab koi baccha sota nahi, to uski maa us se kehti hai, ki so jaa, nahi to Gabbar aa jaayega!  Something, on those lines.

But they went away eventually, us being unable to comply to their requests without them willing to do appropriate procedures.

The kids were lucky (pun not intended), that their families were cajoling them. A few hundred kilometers away, in Uttar Pradesh their bodies would otherwise have been found suspended from a banayan tree with a noose around their necks.

Dr. Harsh Vardhan, the current Union Health Minister is the man responsible for eradicating polio from India. I read recently, that now he tends for Kala Azar to meet the same fate. And he will succeed, undoubtedly.

But, even the views of such a visionary on "Ahem" Education are medieval. When Sunny Leone is starring as lead heroine in film after film, a simple Google Image search from even a naive fan, is bound to reveal more than he expected to see.

How more graphic could your text books get sir?

The knowledge is for dissipation! We are medical professionals and men of science. At least, such we shouldn't feel ashamed and embarrassed when discharging our duties.


Science has to replace shame, and in this scenario we are the most well equipped to do so.

Coming back to the kids in discussion, it was a shameful loss for Indian Culture, but Curiosity won!

Curiosity always wins, just that sometimes the collateral damages become unacceptable. One can't curb curiosity........ its impossible ......... but one can channel it for sure. You can't make monkeys of humans, so let the sapiens blossom.


(P. S.- Ahem in Hindi, means important)

Had the MO given in to their requests, would they have said," Mandal aaple aabhari aahe!" ?