There was an air of expectancy. It was just before 8 AM. The Prof was to make his appearance. Sister Eapen bustled about, tucking in a bed sheet here, arranging a pillow there.
My day had started at 530 AM. I had tumbled out of bed, shaved, showered, thrown on some clothes and hurried to the ward with Prakash. “Did the burn patient go to Guntakal?”, Prakash wanted to know. I filled him with the outlines of what had happened last night. “Wow! your first death? how does it feel to look at the grim reaper?”, Prakash’s rabbit eyes bulged. I told him that I was shocked that we didn’t attempt to resuscitate. I will ask the Prof about it, I told him. “Holy shit! you have the death wish don’t you? Let me know when you commit suicide. I will be there to administer the last rites” he giggled.
Sister G Eapen was a formidable woman. She was short, around five feet tall but looked taller. She was one of the most senior nurses as evidenced by her yellow belt. Ward nurses wore a blue belt while the in charge nurses wore red. Sister Eapen was so attached to her patients that she had refused the promotion to Matron. No flying desks for me, was her reason. Her assistant Rosamma hovered about her. The nurses were in awe of Eapen.
“New residents! Wish I could do without you. All you people do is to mess up the ward and try to seduce my girls. However, I suppose I will have to tolerate you. No eating, drinking or putting up your feet at the nurses station. If you need something, ask Rosamma. No chatting up nurses. Keep your beady eyes away from my girls”, was Sister Eapen’s greeting to us. “What a battle axe”, whispered Prakash when her back was turned. I noticed that Sister Eapen was very gentle with our patients. Patients were awestruck by her but seemed to like her.
Rajesh had spent the morning showing us how to examine patients and write our findings and orders. “Prof is a fanatic about the SOAP”, he told us. SOAP? what on earth is that? I asked. “Jargon, dear Guru. Better get wise to it fast. SOAP stands for Subjective, Objective, Assessment and Plan. Makes it easier to read and follow. Prof prefers only WHO abbreviations. He is very particular about documentation. Listen up twits, woe betide you if a patient complains about you to the Prof. You may as well kiss your dreams of being a surgeon”
Prof swept into the ward at the stroke of eight. The caravan started. Leading the procession was Prof and Ajay Shah, the lecturer. Rajesh and the two of us followed just behind. We were followed by a ward attendant carrying a bowl of disinfectant and a pristine white towel draped on his forearm like a butler. The rear of the procession was brought up by Eapen and Rosamma, who pushed what looked like a tea table on wheels piled up with patient files. Rajesh would present the case. Prof would listen, quickly examine the patient and advise change in treatment if warranted. He would then dip his hands in the disinfectant and dry them with the towel. I had an insane urge to giggle. This act reminded me of Pontius Pilate washing his hands off Jesus. Prof’s manner with the patients was very short, but his examining hands were very gentle. ‘Heart of a Lion, hands of a woman’ indeed.
We were at Ramu’s bed. He had undergone hernia repair the previous day. “Patient is stable.But he has had two spikes of fever this morning” Rajesh started. The Prof whirled around. His eyes transfixed me like a beetle on a sharp needle. “You! Shirahatti, right? what is the cause of fever in this patient?” I would investigate for wound, lung or urinary tract infection, I volunteered. “So you will ask for urine and blood cultures, white cell count and an x ray chest. Spend about one thousand rupees that the patient or the hospital can ill afford. Most post operative fevers in the first 24 hours are due to the trauma of the operation itself. Don’t waste precious resources. Just give an injection for the fever and observe. If the fever continues beyond 24 hours, investigate” Wow! I had learnt something new on the very first day.
And so it went on. As an intern, you are generally ignored by all. This was new. As a house surgeon, I actively participated in the round. We did not put a step wrong. The Prof seemed satisfied with our performance. But the death on the previous night still weighed heavily on my mind.
We had ended up in the female surgical. Rajesh informed the Prof about the death of the woman with burns. The Prof merely grunted. We had completed the ward and the Prof turned to leave. It was now or never.
“Can I have a word with you sir?” I asked the Prof. I was quaking in my shoes. But I had to get it off my chest. Ajay and Rajesh looked aghast at my presumption. “A house surgeon is merely to be seen, not heard. So keep your mouth shut and your other orifices open. The old Pete hates loquacious residents” Rajesh had warned us in the morning. I could feel his angry eyes boring into my back. I did not care.
The Prof’s eyebrows knitted. “Make it short, Shirahatti. I have an important meeting to attend” he told me brusquely. I stammered about yesterday’s patient. “Why did we not try to resuscitate her sir? isn’t this cruel and unprofessional?”, I asked. The Prof’s face changed. There was sympathy in his eyes. “Your first meeting with Death, young man?”
“You are right in a way. We have all taken an unwritten oath to save patients. But some occasions demand masterly inactivity. Even if you had been able to bring her out of this arrest, she would have arrested again after an hour or two. Due to tissue damage, there is high circulating levels of potassium that are cardiotoxic that would have lead to repeated cardiac stand still. You would have merely prolonged her agony. She is better off dead. I know that no amount of my explanations will convince you today. When you see patients on their death bed, your prime duty is to allow them to die in dignity. God knows you will see plenty of death and suffering. You must learn to be objective. It is not your fault that she had severe burns. The best treatment for burns of this magnitude is to sedate them heavily so that they don’t feel the pain and allow them to slip away.” He left.
I felt a little better, but still unconvinced. “Smart ass” was Ajay Shah’s comment. “Keep an eye on this idiot, Rajesh. Talks too much. May turn out to be trouble” He too turned and left the ward. Prakash and I trooped back to the male surgical. We had to fill up discharge summaries, fill up forms for investigations, do dressings; we had our hands full. I sat at the nurses station, my head resting on my forearms. I was confused, my mind a whirl.
“Doctor, have you had breakfast?” Eapen asked me. I hadn’t, I admitted. “How can you youngsters be so careless? Don’t you know that breakfast is the most important meal of the day? Work can wait for the moment. Step into my office and have some tea”
There was a heap of cucumber sandwiches on Sister Eapen’s table. I suddenly was ravenous. Both Prakash and I wolfed down the sandwiches and slurped down piping hot tea. Yesterday’s death seemed to be very faraway……