It was 2 AM and we were in the male surgical ward. It was our call day when all emergency admissions would be seen and treated by our unit. It was a particularly heavy call day with a steady stream of patients coming in. Patients would be wheeled in from the casualty with cuts, abscesses, burns; the whole spectrum of emergency problems. Prakash and I would clerk the patients, write orders, do minor procedures and shift them to the OR if anesthesia was needed. Both of us had been worked off our feet and nearly at the end of our tether.
A thirty year old laborer was wheeled in. A strong smell of cheap liquor assailed our nostrils ten feet away. He was rolling in agony in his bed. He told us that he had agonizing pain in the upper part of the tummy. He had been paid that day and had promptly hit the speakeasies that littered Dharavi. He was drunk as a lord but miserable as a sick puppy.
I examined him. His abdomen was tight in its upper part. He jumped up in pain when I tried to examine his abdomen. It was very clear that the cheap booze had caused an inflammation of his pancreas. Yes, the diagnosis was very clear: Acute alcoholic pancreatitis. I gave him a shot of pethidine to reduce pain and started an IV line. Now I had to pass a nasogastric tube through his nostril into the stomach to decompress it its vile contents. I informed the patient that I would have to introduce the tube down his nose into his stomach. I reassured him that it wouldn’t hurt and that he would have to swallow it just once and it would slip into his stomach.
The man cringed. “No way, Doctor Baba”, he whined. “I have a very sensitive throat and vomit very easily. Can’t you give an injection to knock me off and then pass the damn thing?” I wheedled and cajoled, but he was adamant. I threw down the tube on to his bed and sat at the nurses’ station trying to collect my patience to try again. Rajesh was busy writing notes.
Prakash walked in. He took the scene at a glance. I saw that he was feeling masterful. “OK, Guru, I will take it from here. I have passed three tubes in the female surgical. It’s a cinch” I told him that the patient was all his and that I owed him one. Rajesh had heard our exchange. He stopped writing and sat up to watch. Both of us watched Prakash as he swaggered to the patient. I could hear Prakash bullying the patient into compliance.
“BLLRRRRRGH”, the patient chucked up his entire stomach contents. A vile smell of cheap booze and old fish filled the ward. Prakash made a desperate leap backwards. He was too late. The vomit sputtered all over him. He was bathed in it. I was fascinated at the outcome. Rajesh was bent over, laughing hard to bust his gut.
“OK,Twit, go to your room and wash up. You’re sinking to high heaven. Guru and I will do the needful” Prakash didn’t need to be told again. He left the ward in a run, trailing toxic fumes behind him. The nurses cleaned up the patient and Rajesh expertly passed the tube. The patient kept grumbling, but you could see that his pain had lessened. There was lull in the patient flow.
“OK, Guru, I will catch some shuteye. Wanna come?”, Rajesh was at the door. I hesitated. “Go on, I’ll follow you. Got some forms to fill”, I turned back to my work. The ward fell silent. The pancreatitis seemed to be better and had already started snoring. It was a hypnotic sound. I too dozed off, with my head on the table.
The Nurse shook me awake. “New admission, Doc” I groaned and sat up. This was a middle aged man with pain and distension of abdomen. He had not passed stools or gas since the morning. The Casualty officer had done a x ray abdomen. I took a look at it. It was clear that I was dealing with an intestinal obstruction. I passed a nasogastric tube, started an IV line and called up Rajesh who walked in sleepily after 15 minutes. He agreed with my diagnosis. “He requires surgery, Guru. I think I better call Ajay and ask him to give me a hand. I haven’t done intestinal obstructions before”, Rajesh went to call Ajay Shah, our lecturer, while I called up the OR and asked them to send a trolley to shift the patient.
Ajay walked into the ward. He was in a grumpy mood, being woken up at the unearthly hour. He took a look at the x ray. Rajesh filled him in with the patient’s story. “Let’s take a look at the patient. Have you examined him?”, he asked Rajesh. No, Guru has. I have seen the x ray and it is clear that he requires surgery. Ajay pulled down the patient’s pajamas. The patient had a large hernia. It was very painful to touch.
“Missed it altogether, right, Shirahatti?” Ajay snarled at me. Thanks to your carelessness We would have done an unnecessary surgery on this patient . This patient has an irreducible hernia leading to his complaints. Give him a sedative and we’ll reduce the hernia. There is no need for surgery. Rajesh, how do you rely on the findings of a new resident? You should from now on double-check every findings of this idiot. Shirahatti, the first thing you do in abdominal cases is to examine the genitalia. I will forgive you this once. If you repeat the same thing again, I will keep you nil by hand for two weeks” He reduced the hernia and stalked off. Keeping one ‘nil by hand’ meant that you did not get to operate. It was the most humiliating punishment to a resident. I felt broken. Rajesh patted me on the back and told me to perk up.”Don’t mind the sanctimonious prick. He is going away to start his practice in three month’s time.” I went back to my forms.
Next morning, I felt as though I had been through a wringer. My eyes felt gritty and I had a bad taste in my throat due to acidity. We were on the morning rounds with the Prof. So far, the rounds had gone OK.
“What is this patient?”, Prof asked. “He is a middle aged homeless person brought in by the police after he was hit on the head. He was fully conscious on admission and smelled strongly of alcohol. I asked for an x ray skull, kept him nil orally and started an IV line”, I presented the case. “His consciousness level has deteriorated since admission. I think he is in withdrawal”, I finished.
The Prof shone a torch into his eyes. His manner changed. “Ajay, intubate him fast. I will call Feroz. I think we have an extradural” He snapped. Dr Feroz Khan was the attending Neurosurgeon. Dr Feroz sauntered into the ward. “Spot on, PJ. Not bad for a Cowboy. It is indeed an extradural. No time to do a carotid angiogram. We’ll do a craniotomy. Can you spare your resident? Mine has gone off to get married, the fool.” Dr Feroz was a tubby genial guy.
“Since you missed the extradural, it’s only right that you assist Dr Feroz”, Prof told me. I accompanied Dr Feroz to the OR. “Come here, Guru. Take a look at the x ray skull. There is a linear fracture of the temporal bone. Can you see it? It is crossing the middle meningeal vessel right here, tearing it. Never underestimate head injuries. If Your Prof had not recognized the dilated pupil and alerted me, this guy would have died.”
Dr Feroz did a craniotomy and showed me the blood clot on the brain. We suctioned it out and ligated the middle meningeal. Dr Khan let me close. It was much after lunchtime by the time we finished. I hurried back to the hostel,ate the bilge that passed off for lunch and dropped into my bed, fully dressed. I dreamt that my parents were in the room and could actually feel my dad’s hand on my head. I smiled in my sleep.
” Hey Guru! wake up you bugger, It’s time for the evening rounds”, Rajesh was shaking me awake. I swam into wakefulness. “Let me wash my face. Join you in a minute” I went to the bathroom. When I returned Rajesh was was wolfing down some cake. “Lovely cake this”, he said between mouthfuls. “Didn’t tell me that it is your birthday, twit” He broke out into “Happy Birthday to You” in a high falsetto. “By the way, I found this note and the fifty buck note by your pillow” Rajesh handed me the money and the note.
It was in my father’s neat handwriting. ‘Your mother and I had come to wish you on your birthday. Your mother stopped me from waking you. You looked so exhausted. Anyway, Happy Birthday, Son! Use the fifty bucks for dinner tonight”
Yikes! it was my twenty fourth Birthday!