At the mercy of a deaf system
The year 1995. Our Unit was on emergency duty that Saturday. I was posted in the ward, while my seniors managed the casualty. Around five in the evening, a group of around eight or nine patients were brought to the ward. Apparently a Trax had turned turtle on a nearby highway. And these patients who were on a pilgrimage to some local temple were the victims of that accident. Almost all of them were safe. Though they seemed stunned by the accident, there were no major fractures. They had suffered several bruises and abrasions, but were out of danger.
All except one 20 year old man. He had suffered major head injury and was convulsing constantly. It turned out that he was the only earning son of a widowed mother. He was comatose and the senior doctors explained the dismal prognosis to his mother. He had suffered major damage to his brain, and didn’t look like he was going to get any better. A tracheostomy was also performed that evening. It was tragic to see a life so young on the verge of being curtailed.
It turned out that some of these patients were affiliated to a political group. You have to understand that except for this young man on bed number 1, the rest of the patients were quite alright. The only reason they were even in the ward was to keep them under observation. That evening from 6 until almost 11 pm, the number of visitors to see these patients kept growing. Each bed was surrounded by almost 8-10 people and after a while it was impossible for the nurses to work in that crowd. Our many polite requests to the visitors to leave the ward were ignored. I was the lone resident in the ward and we were finding it difficult to even track which patient had received medication, as the relatives sat on the beds meant for the patients. When things turned unmanageable, I called the security men in. They ushered some of them out, but minutes after they left, the crowd came back inside. The next time we called in security, they didn’t bother to respond. We had no option but to go on just like that. It was a busy night with all the medicolegal paper work, recording all the injuries, plus taking care of this young man.
On Sunday, the senior doctors came for their morning rounds and discharged most of these patients. More paper work. And ill-mannered relatives who wanted their discharge papers immediately. Just as he left, my registrar ordered a repeat CT Scan for the young man with the head injury.
I called up the resident radiologist on call that Sunday, and he gave me an appointment for 12 noon. On Sundays, we work with limited staff and by the time I had to shift the patient to the radiology department, the sole attendant in the ward had been sent on some other urgent errand. Not willing to miss the CT appointment, I looked around for help. The nurses said that since there were several able-bodied men with that patient, there should not be any problem shifting the patient to Radiology.
So, with the help of the nurses and the patient’s friends, we shifted him to a stretcher and began to move him from our ward on the second floor of the hospital to the ground floor where the CT Scan could be done. The patient, of course, was critical and so we hurried as fast as we could. I pulled the stretcher from one end, and a friend of the patient took care of the other end. As we moved down the ramp, I realized that a group of around 30 young men, began following the stretcher. They had been loitering in the corridor all through that Sunday morning. They looked rather rough, several with saffron scarves wrapped around their neck. But what struck me was that they didn’t seemed concerned with the patient. A series of ribald jokes were being cracked. Slowly the jokes turned to poor taste, first targetting nurses and female doctors, and then me in particular. It wasn’t something anyone would want to hear. As we almost reached the radiology department, one of the men came uncomfortably close to me and whispered in my ears, “Madam, if something happens to this patient, I will not be able to control my boys.” A chill ran down my spine but I didn’t think it was wise to respond. There were more important tasks at hand. I presumed that once the doors of the CT room were shut, I would be safe. How wrong I was.
As we readied to shift the patient to the CT table, he began convulsing again. It was the kind of situation you simply didn’t want to be in. The radiology resident helped me manage the patient, while I made the urgent phone calls. My immediate senior was perhaps enjoying his siesta and did not pick up my call. Sensing the urgency, I directly called my Unit incharge. I was directed to shift the patient to the ICU which was closer, rather than go all the way to the second floor ward. The attendant from Radiology and I literally ran as we pushed the stretcher into the ICU. And all I remember even today is that mob of thirty odd men rushing behind me baying for my blood.
The patient was managed in the ICU. But he turned worse, and after an hour or so, he succumbed to his injuries. My senior colleagues were there in time, but there was hardly anything we could have done. Outside the ICU rumours thrived, and a mob was waiting to assault me. I was given strict instructions not to step out of the ICU. I stayed in there till around 6 pm, when some nurses slipped me out of a side door. I was quickly told to go to my hostel room and stay there. That evening I received a message from a nurse in my ward telling me not to come for the evening rounds. The mob had returned with some local politicians. It had resorted to slogan shouting and broken some furniture in the ward. Politics when shaken with grief can make a very potent cocktail.
I was completely shaken by the whole sequence of events. I hadn’t slept for over 36 hours at a stretch. I had been running around for this patient. And then this. Had I been negligent? No. Could anything have changed the fate of this patient? No. Had the relatives been explained how critical he was? Yes. I don’t know what I could have done differently. Maybe if I had a better support system, rather than being left on my own that Sunday morning, things could have been dealt better. I returned to work on Monday morning, and some of my seniors laughed at me, saying I could have got my name published in the local newspapers. It was not just frustrating, it was humiliating.
Residents and interns are the people who are at the lowest rung of the health system. The interns do all the scut work. As an intern, I remember doing everything from carrying patient specimens to labs, to running around for reports, to ferrying blood bags. It was a joke that except for the laundry, I had seen all the sections of the hospital.
The number of residents available to handle the volumes of patients that the government hospitals receive is woefully low. And they are the backbone of this system. In India there are no rules unlike the West regarding the number of hours they can be asked to work for. There is little regard for comfort or convenience. Remember, they are in the best years of their life, and many have families to support. Yet there is hardly any time to look at life which seems to be rushing past you. And beyond clinical care, they have serious studying to do. For there are exams, which as any medical student will tell you, are never easy. These are the most stressed-out species in the health system.
And yet, when disaster strikes, as we see in Bengal, the junior-most doctors suffer the brunt of all mishaps. The system that we work in needs major upheaval. Where is support from the administration when we need it most? The junior doctors are the easiest targets to threaten. Sometimes they threaten to cancel your registration, and at others to fail you in the examinations, or worse, throw you out from the hostel.
Streamline duty hours, provide support and security, allay stress, and most of all, be there for them when you are needed. Immediately. That is the minimum that these hard working men and women who work in appalling conditions deserve. Some empathy for their well-being will be a silver lining. But that is perhaps asking for too much from a callous society which is otherwise so easily swayed by Whatsapp forwards.
