I need two hundred ice bags…..

I was bored. We were waiting in the Trauma Ambulance around 2 miles from the Mumbai Airport in small side road. I lazily looked out of the window at the traffic. I cursed myself for not having brought something to read.

The Prof had called for me on a December morning. “Shirahatti, you will be on duty today till late night. You and an anesthesia registrar will accompany the cavalcade in the SA1” Who is coming Sir, I wanted to know. “Don’t you read the news? The PM is visiting Mumbai. She is expected to land by 11 AM. She will drive in a cavalcade to the Raj Bhavan, the Governor’s residence. She will spend the whole day and return late in the evening. We have been tasked to provide any medical help should a medical emergency arise. I have instructed the kitchen to provide you with sandwiches. You will also be carrying a cold box with O negative blood. Keep in touch with me over the radio if you need help,” He dismissed me.

Sara, the anesthesia registrar, two nurses and two attendants made up the team. In the confusion to start on time to the airport, I had forgotten to pick up an interesting read.

At 11 AM sharp, we were given instruction to move slowly to join the PM’s cavalcade. The procession of cars was nearly half a mile long. There were cars with blackened windows, police cars with sirens and flashing beacons and a couple of Black Marias carrying police commandos. We were the very last vehicle. The whole cavalcade moved at a fast clip along sanitized roads. I had never before seen the Mumbai Roads so empty of traffic. We reached the Governor’s bungalow in 30 minutes flat, a distance that would take over an hour and a half in normal traffic conditions.

The ambulance driver was given instructions to park at the fire station inside the compound of the bungalow and wait for further instructions. We got out of the ambulance and lolled on battered sofas that littered the fire station. The fire station had fallen into disuse. There were no fir tenders to be seen. I strolled around the fire station. The Raj Bhavan, an imposing structure was nearby. Twenty years later, Naina were invited for a ‘at home’ by the Governor. I had pointed the fire station to Naina, but she was enthralled by the bonsai garden that the Governor had developed.

It was a beautiful December day. Mumbai weather was simply invigorating. There were huge peepul trees that cast dappled shadows. I spied a large grand piano in front of the station. Here was some entertainment! I went across to it. It was a huge instrument, possibly a relic of the British times. It had certainly seen better days. Several keys were missing, making the piano look like an old man with missing teeth. I pulled a stool and tried to play.

Surprisingly the piano was still tuned properly. I tried to play Fur Elise. Could manage play the intro  though there were gaps in the music. “Guru, stop it. You are murdering a lovely piece of music. Beethoven would be turning in his grave  ” Sara admonished me. There was no way I could have played anything more complex with the very few keys at my disposal. So I ploughed on.

Sara and I sat on the grass and made a picnic out of the sandwiches and coke that Prof had provided. The sun had just set and the sky was full of stars.

Suddenly the radio in the ambulance crackled to life. “SA1, this is Fire Brigade Control. Proceed to the Raj Bhavan main entrance.  Keep your head lights off. Repeat, lights off. Do you copy? Over” Both Sara and I looked at each other with excitement. Something was up! There was a medical emergency that needed Superman Shirahatti to the rescue! We piled into the ambulance and drove to the main entrance.

If this was indeed an emergency, it was the most unexciting and prosaic thing. Where was the hustle and bustle? We could just a lonely uniformed figure on the steps of the Raj Bhavan. He waved us to a stop and gestured to us to get down. I went up to the man. As I neared him, I gave a gasp of recognition. It was Commander Zakaria, a couple of years senior to me from my college. He too recognized me and bounded down the steps. We shook hands warmly and slapped each other on the shoulders.

“I say Zak, what the devil are you doing here?” I inquired. Turned out that he was the ADC to His Excellency, the Governor. “Look at me, Guru, flying a blasted desk. A uniformed lackey if there was ever one. I would love to exchange places with you any day.”

“OK Zak, who is the patient? the Guv or God forbid, the PM? Should I call for help?” I asked with mounting excitement. “No such luck, Guru. I asked for the ambulance as we need some supplies urgently. Can you keep your mouth shut?” Mum’s the word, I assured him.

It was common knowledge that the Governor was seriously ill for sometime. The PM had come visiting him. He had passed away an hour ago.

“I need 200 ice bags, Guru. And I need it like yesterday. Can you help?” Zak asked me. Why the ice bags? I inquired. It would seem that they wanted to announce his demise only the next morning. The funeral was to be held the next day so that his relatives could travel to Mumbai. “Lead me to a telephone, Zak. I will get your ice bags for you”

I sat at the desk of the ADC to the Governor. It felt great. I called up the Dean of the government hospital. The man almost collapsed with shock when I told him on the phone “I am Dr Shirahatti speaking from the Raj Bhavan. I need two hundred ice bags immediately. I will send an ambulance to pick them up” “I am sorry Sir. We have only 50 bags. May I suggest that you contact other hospital?” he stammered.

I tried the Prof next. He didn’t seem surprised at the unusual request. “Give me half an hour Guru. We will send someone to buy these bags. I will send them across” Half an hour later, the bags were on their way.

“I owe you a big one Guru. Ask your hospital to send the bill of sale for the bags to me. I will make sure that the hospital is paid.” Zak was grateful. We drove back to the hospital in silence mulling over the anticlimax.

The bill of sale was duly sent to the Raj Bhavan. Zak got himself transferred out to the INHS Ashwini. The bills remained unpaid.

“Sir, should we remind the Raj Bhavan that they owe us 4000 rupees? It is more than twenty years” Mrs Desai asked me mischievously.  I merely smiled at her…..

Scene from Dante’s Hell……

I was settling down as the Dean. The work was extremely challenging.Every day would bring in a new problem that needed a solution ‘right here, right now’ In the initial days I found it overwhelming but had gradually grown into the job. Making on the spot decisions had become a routine. The hospital employees, doctors and nurses seem to accept me and actually looked to me to usher in a new era.

It was a gloomy rainy day in August. The hospital seemed to be sullenly quiet. It was mid morning. The MICU in-charge called me. “Sir, We have had five patients of some kind of food poisoning admitted in the last hour. All of them are in respiratory paralysis. We have put them on ventilators. The ambulance person who brought them has warned me that there are more than hundred patients who are being transported. We have a capacity to admit only five more patients. I cannot transfer any patient out of MICU. I need urgent advice.” I told my secretary to cancel all my appointments and rushed to the MICU.

The scene in the MICU was one of utter chaos. Since the phone call, ten more patients had arrived crowding the MICU. I took in the scene. The patients were all in their thirties, evidently laborers. They were in a state of severe delirium with rolling eyes and flailing limbs. Five were inert, on ventilators. We had used up all the ventilators that we had in the MICU. Their pupils were dilated and fixed. Their skin was very hot to touch and their pulse was racing.

“All these patients have been transferred from Bhiwandi, Sir” Dr Bhise informed me. Bhiwandi is a township around 200 kilometers from Mumbai. It is famous for the hand loom factories. The employees were migrants from Uttar Pradesh who lived alone, far away from their families. They would have their food in a common canteen called the ‘Bhissi’ On the fateful day, many had their lunch in the canteens and fallen seriously ill. One of the Bhissi owner had tasted the food after some customers complained of an odd taste. He too had been affected, and tragically died.

I needed a place to treat these patients as the MICU was overwhelmed. I gave orders that the ENT ward be emptied forthwith and all Bhiwandi patients to be shifted there. Since the ventilators were in short supply, residents were bagging the patients. We needed ventilators fast. Fortunately, we had around twenty ventilators that had been brought in by various companies for demonstration and trial. We were in the process of purchasing extra ventilators for the MICU and the Trauma ward. All the companies that I contacted agreed to loan the ventilators till the emergency blew over.

Dr Bhise, Dr Gokhale our microbiologist, and I held a conference. At first glance, it looked like Dhatura poisoning. Delirium, involuntary movements, dilated pupils were classical signs. Dhatura is a plant that has been known to ancient India as a potent poison. Unwary travelers were poisoned by thugs by mixing dhatura seeds with sweets and other food. At the same time there were signs that did not fit in. Most patients went into respiratory paralysis, which suggested a neurotoxin. Was this botulism?

By next morning, we had around 100 patients in the wards. Nearly three fourths were seriously ill. Around thirty were on ventilatory support. Only a handful were stable and were fit for discharge.

The press and the other media descended in full force. Each day, I had to give out medical bulletins and answer the same questions: What was the cause? Have we managed to diagnose? How many patients died?

By the next two days, we had lost nearly one fourth of our patients. The  postmortems were of no help. The toxicology laboratories from Mumbai and Delhi could not tell us the cause. By this time, Dr Bhise and Dr Gokhale agreed that this was not a pure Dhatura poisoning. They were very strongly inclined to believe that this was possibly Botulism. “We need the botulinum antitoxin, Sir. Though we have no proof that botulinum is involved, we will give the antitoxin empirically. If it is indeed botulinum,we would have hit upon the cure” Dr Bhise told me. The main problem was that no one manufactured botulinum antitoxin in India. Dr Gokhale triumphantly produced a printout about a company from Poland who could supply it. We immediately wired them the order and the money. It would arrive the next day. By this time, we had lost thirty patients. The antitoxin was duly administered after two days. It was a dud.

There were plenty of armchair diagnosticians. “This is toluene poisoning, Guru. It must have contaminated the cooking oil” was the advice from one of the senior physicians who had not even visited the hospital. I assured him that we would seriously consider the possibility. One local Ayurveda physician offered to treat them with Ayurveda medicines that were guaranteed to cure. I informed him that I would call him back.

Dr Gokhale was to travel to Atlanta, stopping in London on the way. We collected samples of blood and requested her to get a tox screen run on them at the Tropical Diseases Center in London and the CDC in Atlanta. She had to smuggle them in as they were bio-hazardous material. She called back after two days to inform me that both centers were unable to isolate any possible toxin and that they were equally mystified. The story had even made it the New York Times.

At the end of one week, we had lost more than fifty patients. The rest seemed to be recovering, but still had twitches and ticks that wouldn’t go away. The police had arrested the owners of the Bhissis on suspicion of poisoning their customers. They too had struck a wall.

I had a visitor. He was resplendent in his ocher robes that proclaimed that he was a  God man. “Child,” he intoned, this is Kaliyug. “People have become sinners. This is the result of profligacy and ungodliness. You should conduct a Mahapuja to propitiate the Gods.” I assured him with a straight face that his suggestion would be given the most serious consideration and that I would write a proposal to the Municipal Commissioner to get funds sanctioned for the event….

The Prologue……..

It was my first day behind the desk of the Dean. It was a fine March morning with brilliant sunshine outside. During my drive from home to the hospital, I was filled with anticipation mixed with a little uncertainty. I was new to the intricacies of administration and would have to manage on the run and learn the ropes while being on the job. I had heard horror stories of problems that crop up that need immediate attention. Being a surgeon, I was used to making swift decisions but this was in a different league altogether. The glare of the media would always be on the hospital with every little mishap making headlines.

I had a steady stream of visitors. The old timers were very happy that one of their ‘boys’ had risen to become the Dean. Several local politicians dropped in. I could see that they were curious to meet the former resident of Sion hospital who would now be at its helm. Several visitors brought in bouquets of flowers. The Dean’s office was filled with the fragrance of roses and champa. Mrs Desai had plonked a huge pile of correspondence that needed attention on the table. I immersed myself in the administrative jargon of the Municipal Corporation missives.

“Excuse me Sir, Sister Thomas is waiting outside. She wants to meet you for a moment.” Mrs Desai informed me. I told her to usher her in. Sister Thomas looked frail and old. She peered nearsightedly about her. It was obvious that she had undergone a cataract surgery recently. Her eyes were magnified behind her thick glasses. She carried a small bouquet of roses.

I went around the desk to greet her, but ended up giving her an affectionate hug. Her eyes were moist. “These are tears of joy, Dean Sir” was her greeting. Please call me doctor as you did when I was a resident, I begged her. “You are the Dean now, Sir. I will not show disrespect to the chair. My God shower his blessings on you Dean Sir. I hope you achieve great things in that chair,” was her reply. She had a cup of tea with me, chatted about inconsequential things and left.

I remembered Sister Thomas in her heydays. She was an absolute martinet. Her ward was always spotlessly clean and won the award for being the cleanest in the hospital every year. In her ward, shortages of stuff was a rarity. She ran the ward with an iron fist. The fresh residents were terrified of her acidic tongue but soon realized that her hard exterior hid a very soft heart. She would shield them from the bludgeoning manner of the Prof. She would not take any nonsense from the patient and ticked them off if they acted ‘fresh’. She would make it a point to know everything about her patients; where they lived, what did they do for a living, how many relatives visited them, in short, the entire family and social history. She loved her ward so much that she would drop in on Sundays as well. We would see her after the morning service at the local church, dressed in a starched white sari comforting the really ill patients.

She had retired some years before I became the Dean. She had volunteered to help out at the newly established rehab center for the addicts. She would spend the entire day at the center listening to them, solving their minor problems, in short being a mother figure. She was totally involved with the junkies. Several of her friends warned her not to get too involved with the addicts. Most of the junkies were discards from the society and almost amoral. She knew that she was being used, but didn’t care. She would lend them small amounts of money to buy things. It was open knowledge that her only son, a teenager had died of a drug overdose. I suppose that she saw him in every addict that she came across.

Sister Thomas was not seen for several days at the De-addiction  center. Her colleagues supposed that she must be down with the  flu and would appear again.

“Have you seen the news today?” Naina asked me. She looked upset. “Retired Nurse murdered in her bed” screamed the headline. “Georgina Thomas, a retired nurse from the Sion hospital was found murdered in her flat. Her body was discovered in a state of advanced decomposition. She had been dead for several days. The neighbors noticed a foul smell coming from her flat. When the door was broken open, the woman was found dead with multiple stab  wounds. The flat had been burgled. The suspect, a drug addict who knew her from the rehab center of the Sion hospital has been arrested in this connection.”

I felt a gripping numbness. I recalled the days of my residency. Prof, Sister Thomas, Dr Joshi and even Prakash had passed on to the great beyond. My mind went back to the day when my journey had begun……..

I am coming to you from the cockpit of a 737….

I was reclining on an easy chair in the balcony of the Dean’s bungalow engrossed in the saga of Sir William Halstead’s biography ‘Cancer Cocaine and Courage’. A steaming cup of coffee stood on the small table next to me. I was engrossed by Halstead’s fight against his cocaine addiction. He had gone on a cruise to the Caribbeans to get rid of the curse of addiction. On one of the islands he diagnosed a boy with a ruptured appendix. There were no surgeon on the island and finally Halstead operated on the boy miraculously saving his life. Very gripping stuff. My coffee was forgotten, getting cold….

“Hi luv, there is a call for you,” Naina called out to me. I reluctantly abandoned the book to answer the call.

“Is that Doctor Shirahatti?” The voice over the phone inquired. The Irish brogue was very prominent but familiar. It is he, I admitted. “Guru! this is John from Sheffield.” informed the voice. For a moment I had no clue as to the caller. Suddenly it hit me! It was John O’Brien from Liverpool. We had met during a training course in Liverpool two years ago. We had hit it off instantaneously, joshing each other about our accents and trading insults. He was a Senior Registrar in Liverpool and was due for a consultant’s post. I was in England for my Commonwealth Fellowship.

“I bet you can’t guess where I am speaking from!” John said. Not from heaven, surely, I responded, tongue in cheek. “Close enough boyo, I speak to you from close to 40000 feet in the air. I come to you dear boyo, from the cockpit of a British Airways 737”

John was flying from Liverpool to Beijing to attend a conference. While they were flying over Iran when a man sitting next to him just keeled over and collapsed. John, if nothing, is a first rate physician. He felt for the pulse and found it to be irregular and very weak. The man was sweating profusely.

“It gave me real bluidy shock, I tell ye. Here I was, enjoying an after dinner brandy and this guy does the collapsing act! I think he has a myocardial. Needs urgent ICU admission and possibly intervention. The situation was grim. The Air Hostess, a very pretty lass, was wringing her hands. The captain came out of the cockpit. There was a midair conference. The upshot of all this was that the plane would be diverted to the nearest airport and the passenger offloaded. Then I remembered that you had become something of a big noise in Mumbai. I offered to speak to you and get things organized on the ground. So get your brown backside off and rush an ambulance to the airport. We are landing in Mumbai in about an hour’s time. I trust you Indians can do something this simple?” John chortled on the phone.

“OK, you Irish freak, the ambulance will be there. You owe me one. If you welsh, I will set the sassenachs on you!” I disconnected.  I fell into thinking. We had no equipped cardiac van to transport patients. I pulled on some clothes and rushed to the ICU.

We rigged up our ordinary ambulance with an ECG monitor, oxygen cylinder and defib machine. I asked the cardio registrar to stock up the ambulance with cardiac resuscitation meds. I requested the anaesthesia HOD to send a registrar to travel in the ambulance, kitted out with tubes and an ambu bag. I called Dr Kale, our cardiologist and asked him to come down and get the angiogram suite ready. We worked feverishly and the ambulance was ready in less than half an hour.

When the plane landed in Mumbai, our ambulance was waiting on the tarmac. The patient was loaded into the ambulance. He was intubated in the van and oxygenated.  He was rushed to the ICU. An ECG confirmed an anterolateral infarct. He was pushed into the angiogram suite, where Dr Kale was waiting. He underwent an emergency angioplasty. The whole thing from the cockpit call to the angio suite had taken less than three hours.

The next day, I visited the patient. He was sedated, but stable. The danger had passed. We transferred him to a private hospital for further management. I felt a glow of a job well done. It was possible after all to save lives by timely evacuation and treatment. I felt proud of myself. Many people congratulated me. I started to believe that it was possible to provide emergency care that could rival the best in the world.

I opened the newspaper the next day and my euphoria evaporated. “Doctor from Sion Hospital almost bleeds to death on the platform!” screamed the banner headline. One of our lecturers was traveling to the hospital by the fast local. The compartment was packed to the rafters. Prashant was hanging on to dear life. Suddenly the train gave a lurch and he was thrown out. Both his legs were crushed by the merciless wheels of the train. Someone pulled the alarm chain, bringing the train to a stop. Helping hands loaded Prashant into the luggage compartment, which was uncluttered. He was offloaded onto the next station, bleeding profusely all the while. He lay on a stretcher in the far corner of the platform while the police and the station master argued about whose responsibility it was to evacuate him. Finally, it was a porter who took matters into his own hands, loaded Prashant onto the next train and brought him to the trauma ward. Prashant was brought in the nick of time. He was in severe shock and needed several transfusions. One leg had to be amputated but we managed to salvage the other. I went to visit him. He was still groggy but conscious.

“I almost died there, Sir” he told me weakly. “I kept telling those idiots that I was a doctor and that they should get me a rope, a belt, anything that could have been used as a touriquet. But they were more concerned about whose jurisdiction did the accident happen and who was responsible for me. I thought I would die forgotten in that godforsaken corner. Someone told me about your evacuation of a patient from the airport yesterday. Can we not set up something similar for railway accidents?” I had no answer……

 

The case of a baby snatcher…..

The staff of the delivery ward of Sion hospital were tense, on edge.  It had been an unusually heavy period for the ward with a large number of deliveries that had taken place. After delivery, the babies had their foot prints taken, a tag with the mother’s name and the gender of the baby were tied to the infant’s ankle. All newborns were kept in a nursery located within the delivery ward. The mothers would breastfeed them in the nursery or the nurse would bring the baby to the mother, if she was not ambulant. One  neonate from the nursery had been snatched from the nursery the previous week. It was suspected that the act had taken place during the visiting hours when there is usually a big rush. A police complaint had been registered.

As the Dean, I was at my wit’s end. We did not have cameras and close circuit TVs that are commonplace now. There was a senior student nurse on duty when the kidnapping had occurred. She had left the ward for a very short while to take a baby to her mother. The absence of the neonate was noticed three hours later, during the change of shift baby count. By that time, the trail had gone cold. Banner headlines on the newspaper blamed the hospital administration for laxity in security.

“Sir, this has to be an insider’s work. It is impossible to spirit away a baby from a ward full of people. I am sure that either a nurse or a female attendant is involved,” Sambhaji Pawar, our security chief told me. Pawar was a beefy man with a luxurious handlebar mustache, a relic of his army days. He had retired as a Subedar from the Maharashtra Light Infantry, a legendary unit of the Indian Army. He had a mercurial temper, but was also known to be a sharp investigator. His words made sense to me. Only an insider would know that the ward would be crowded during the visiting hours and it would be easy to pick up a baby and saunter out. ” Pawar Sab, keep a sharp eye on the delivery ward from now on. We don’t want a repeat” I told him. “I have already attended to it Sir. I have posted two lady security guards in  mufti outside the ward round the clock. I am sure we’ll nab whoever is responsible,” He assured me, getting up.

A week passed by uneventfully. The police had reassured me that a special team was on the case and that they would soon crack it. Given their workload, I was skeptical that anything positive would emerge.

One evening I was on the evening rounds. Pawar had accompanied me. It had become my habit to drop into the delivery ward and spend some time there during the visiting hours. Most  relatives happily met the new mothers and their precious bundles. Several came up to me to express anxiety over the kidnapping. I reassured them that the incidence was behind us now and that the security had been tightened.

The visiting hours had gone and the ward and the nursery were empty of relatives and visitors. I came out of the ward, to go home. It was after sunset and darkness had fallen suddenly.

I spotted a woman sitting in the corridor in front of the ward. She looked like a homeless person. She was thin and emaciated and clutched a bundle of filthy baby’s clothes wrapped in a filthier baby blanket. She smiled at me and I could see that her teeth were blackened. She was not obviously a patient or a visitor. Pawar pounced on her, ordering her out. She merely cowered in her place, clutching her bundle closer to her. “What are you women doing? don’t you realise that we have had a snatching incidence? How did you allow this thing to be here without any reason?” Pawar bellowed at the female guards on duty. They promptly grabbed the woman by her arms to evict her. The woman set up a piercing scream after scream that brought the nurses pelting out of the ward.

“Leave her well alone, she is no trouble. I can vouch for her,” Sister Mary Kurien, the in charge nurse of the delivery ward pushed the guards aside. She was a tough as nails woman, but I noticed that her eyes were full of tears. “Pawar, let the woman go, Sister, I want an explanation for your behaviour. We will go to my office” I snapped at her.

Hesitantly, Sister Mary told me the story of the woman. Asha (that was her name), was a regular visitor to the delivery ward. She had been married into a well to do family from North India. She had delivered several still born babies in this very ward earlier. Her husband’s family believed that she was cursed to be childless. Finally, she delivered a live baby girl. The husband’s family promptly disowned her and threw her out of the house. She had no one to turn to as her parents had died shortly after her marriage. Sadly, the little child died soon after due to jaundice. Since then, she lived on the footpath opposite the hospital. She would spend the whole day sitting outside the delivery ward, crooning a lullaby to the bundle that she always carried. “She is totally harmless Sir. I would not want this to happen to my worst enemy” Sister Mary was sobbing. I comforted her and asked her to return to the ward and that Asha would not be harmed. I called Pawar aside and  told him to keep a sharp eye on Asha, just in case, as she seemed mentally unsound. When I told Naina about it at bed time, she was distressed. “You know, I just can’t stomach the cruetly that human beings can show to one another. You should not have told me this at bed time. I will definitely not get sleep for a long time thinking about this unfortunate woman”

“There has been an incidence in the delivery ward Sir,” informed the Deputy Dean. I quickly hurried to the ward.  There was a large crowd of relatives and visitors surrounding Asha. My heart sank. I thought that this crazy woman had either snatched a baby or done something worse. Surprisingly, the crowd seemed to be praising the poor woman. I was nonplussed.

Asha had sat at her usual place that evening. She noticed an ayah hurrying from the ward carrying a bundle covered by her sari. Asha perhaps spotted an infant leg that slipped out of the cover. She dropped her bundle and ran to the attendant screaming. She grabbed her by her hair, screaming all the while till the guards nabbed the thief. The Ayah had picked up the child and was hurrying to hand the baby over to her accomplice waiting outside.

The baby’s mother cried and laughed at the same time. She hugged Asha, unmindful of her dirty clothes. An impromptu collection of money was made and handed over to Asha. She giggled when she saw the money but dropped the cash into the charity box kept outside the ward.

Next time I saw Asha, she wore a clean sari. Her bundle was nowhere to be seen. She was surrounded  by happy new mothers who pressed Asha to hold their precious babies. Asha looked ecstatic……

Do not Resuscitate…..

I had transferred to the Nair Hospital to take charge of the Surgical Gastroenterology services.  It was a very busy service with a plethora of gastrointestinal surgical  problems. I had recently returned from Sheffield, where I had gone on a Commonwealth Fellowship. On an impulse, I had decided to sit for the Fellowship examination and to my utter delight, passed at the first attempt. I had also learnt the basics of laparoscopic surgery. Therefore I was busy translating into practice what I had picked up at Sheffield. Naina and I had met the Prof on my return with the usual offering of scotch that the old man loved to have in the evenings.

“You know Guru, A glass of fine liquor extends your life span by several hours. Pleasurable hours too, i might add. A glass of Black Label at sundown is simply the way to live. Let me tell you Guru, never contaminate good whisky with soda or water. The aroma is best enjoyed when it is on the rocks” Prof rolled his eyes in pure pleasure. Naina, who had disappeared into his kitchen, reappeared with a plate of hot onion pakoras. “Onion Pakoras! Naina, you are an absolute jewel. You actually read my mind. This idiot does not deserve you,” Prof attacked the pakoras.

Prof and I fell into discussing laparoscopic surgery, then a new fad among surgeons. I had done the first lap chole and described to the Prof the procedure. “Guru, seems like a good idea. The magnification that the scope provides makes it easier to dissect. Be very careful how you choose your patients. If you damage the bile duct or have a complication, laparoscopic surgery will suddenly become an untouchable. Henry’ law you know. Naina, can I have some more of those delicious pakoras?” Naina frowned. “You know uncle, fried stuff is poison for you. Only the other day Prof Rajan was telling me that your cholesterol is very high. You are already taking medicines for your blood pressure. The other day, you had chest pain” Prof lit a Charminar ignoring Naina’s disapproving looks. “I have always maintained that the only thing that the internists are good at is to tell you things you shouldn’t be eating or things you shouldn’t be doing. Rajan may be a professor of medicine, but he continues to be a master of theory. Please don’t deny an old man, eh?” Prof Wheedled. We stayed for dinner, ordered from the local Udipi restaurant.

I was very busy with work at Nair. I hadn’t met the Prof for some months. He had retired recently and had shifted to a small apartment in Dadar. Naina would somehow find time to visit him regularly. “I think you should find time to visit your Prof. He gets lonely. He loves to argue with you. Why don’t you find some time off?” She asked me one day. “Sure, we’ll visit him this Sunday. We’ll take Svini along too. She will be good company for the old man. He misses his granddaughter,” I replied.

I was busy in the outpatient clinic. I had a new batch of medical students, who seemed not half bad. The nurse came up to me. “Sir, the telephone operator called. You have an external call waiting.” I picked up the phone. It was Prof Vilas. “Guru, come down to the Sion ICCU right away. PJ is admitted with a heart attack.” The phone clicked off. My mind was in a whirl. I informed Naina. Old Pete and a heart attack? He was more likely to cause one than suffer one himself. Of course, he was seventy and hypertensive. He also smoked like a chimney. Otherwise he was quite the healthy irascible old codger. I hoped that it was reflux or gastritis. I drove like the furies to Sion.

Prof looked old and frail on the ICU bed. He was conscious though. I could see that the chest pain was agonizing by the way his lips were compressed. Naina had already reached. She looked desperately worried.

The ICU doors opened and in walked Dr Bhave, old ‘hemorrhoids’. He too had retired but had a busy practice. He nodded to the Prof curtly and looked at the ECGs. Prof Vilas joined him.

Suddenly, the monitor alarm went off. “Code Blue! Code Blue!” the cardiology registrar shouted. The Prof had gone into cardiac arrest.

The next fifteen minutes were a blur of action. The Prof was intubated and ventilated. His heart came back within five minutes. He regained consciousness. He seemed to be pointing at something. Prof Vilas, Bhave and I hurried to his side. He kept pointing to the endotracheal tube. Bhave gave a grunt of understanding. “The tube is too much in. We have intubated the right bronchus,” Bhave adjusted the tube. The Prof gave a thumbs up. “Just close your eyes and relax, you control freak! We are capable of managing arrests” Bhave ticked off the Prof. But his eyes were desperately worried.

An emergency angiogram revealed a three vessel block. I could see why Bhave was so respected. He did a double vessel stent, while dilating the third one. The Prof tolerated the procedure well. But this was merely a rescue angioplasty. He needed a bypass. Prof Vilas did a triple vessel bypass the next day.

I was visiting the Prof one evening in the VIP ward. He had recovered very well from surgery. He was allowed to ambulate within the ward. A stream of visitors crowded the ward. I gave strict instructions to the In Charge Nurse that only few people be allowed to meet him. We didn’t want the Prof to get tired. Sister Eapen, who too had retired, spent almost her entire day by his bedside. His son and daughter in law had not come. His son Vikram spoke to me on phone. “Doctor, how is Dad holding up? I am at the fag end of signing an important contract. I’ll be able to fly out only next fortnight.”

“Guru, I have something to ask you,” Prof was unusually diffident. “If I have another arrest that looks bad, please don’t try to to resuscitate me. Remember what I told you long ago? Let a man die with dignity….” I nodded, too overcome…..

 

The case of roaming hands…

Got a spare Foleys, Guru?”, asked Tatya dolefully. Go ahead and help yourself, I replied. I was in an expansive mood. Only that morning I had operated a hernia, assisted by the Prof. He had patiently taken me through the steps, and at the end, had grunted approvingly. Ajay Shah was on long leave and Herbie, the genial Sardar was our lecturer. Rajesh had stopped calling us twits. We were gelling well as a team.

Tatya had changed alarmingly. He was always a genial fellow with wisecracks and jokes at a drop of a hat. But now he was morose and on the edge. He seemed to be sleepy all the time and looked badly disheveled. He would snap at jokes that he would have laughed at uproariously. His lecturer, a squat powerful looking woman called Vimla Pawar was reported to have it in for Tatya. We wondered what was the cause of bad blood between them.

Tatya would always be seen in the ward. He seemed to be forever filling forms, collecting blood samples and filling up discharge summaries. You went any time to the ward, Tatya would be there, looking grim faced, immersed in his world of forms. Prakash and I watched with concern. Something was bound to give.

The lecturers had the power of life and death over the house surgeons. They could cut off your operating work with the dreaded ‘nil by hand’ at the smallest misdemeanor. They were already post graduates waiting to become consultants themselves and felt that being sarcastic with a junior was their birthright.

One day in the morning, Prakash and I were having a leisurely breakfast when Tatya barged into the dining hall. His face was red with fury. There was an unmistakable odor of stale feces about him. We discreetly covered our noses.

“Stupid turds! don’t go uppity on me I know I smell of shit. Do you know what that amazon did to me?” he growled at us. What, what?…tell us all, we begged him. “Dr Joshi, my boss had told me to to do a hernia yesterday. He told this woman to assist me. We scrubbed up. I was about to make an incision when the circulating nurse tells me that the patient with a duodenal perf had pulled out his nasogastric tube. I had to scrub out and go down to the ward. The bloody woman had finished off the hernia by the time I returned! Later on, the nurse told me that this…this bloody woman knew about the slipped tube all along but instructed the nurse to inform me just as I was about to operate”, Tatya was incoherent with rage. We tut, tutted in sympathy. Why the smell of feces? I asked. That set off Tatya again. “The bloody woman made me do MER today” Manual Evacuation of Rectum is done when a patient usually very old, did not pass stools for several days.  You had to manually clear the clogged rectum piece by smelly piece. It was normally performed by a junior nurse as punishment, but sometimes was ordered to be done by a junior resident as a mark of severe displeasure.

“Why have things come to this pass?” Prakash asked Tatya. For once Tatya looked sheepish. My friendly nature is at fault, he confessed. Tatya was indubitably very friendly. At times he reminded you of a very friendly octopus. His arms would go all around you, patting and kneading your shoulders. Knowing this, the nurses would give Tatya a wide berth.

“You know how friendly I am. I like to slap guys on the shoulder to show my affection. Well, last month, I felt particularly friendly towards Vimla. She had bent down to pick up something when I fetched up behind her. I patted her on the shoulder and called out a cheery greeting. She suddenly straightened up and my hand accidentally slipped down her back and I ended up patting her in her nether regions. She started as though she was stung. Asked me if I had no sisters or mothers and if I did, to go and pat their derrieres. We had some words what with her accusing me of molestation and I telling her that touching her would be the last thing in my mind even if she happened to be the last female on this earth. Ever since, she has been getting at me, using her position as lecturer unfairly” Tatya was indignant. Prakash and I nodded our heads in sympathy but controlled our laughter with great difficulty.

One day Prakash and I were leaning against the parapet of the resident quarter gates, lazily taking in the hustle and bustle on the main road outside. Tatya suddenly appeared, riding his old bicycle, pedaling away as though his life depended on it. He braked to a halt at the quarters, threw the bike against the wall and rushed in. We followed him to find out what had transpired.

Tatya was cycling to work from home in the morning. He passed a group of buxom women in very colorful saris at a bus stop. Being a red blooded male, he let out a appreciative wolf whistle and rode on. After some moments, he heard a commotion behind him and looked back. “My blood froze. I almost dropped a hot load of shit into my pants”, Tatya was reliving the experience. “There were a group of Hijras with their saris hitched up to their knees, chasing me, shouting expletives. Kept shouting that they would castrate me for being obscene. I will dream of their muscular hairy legs pumping after me, for a long long time. I had to pedal like crazy. Almost developed a hernia. Have they gone?” We assured him that had indeed gone away. From that day onward, Tatya would change his route every day, always glancing over his shoulders.

Tempers seemed to have cooled down between Vimla and Tatya. The Tatya of the old had reappeared. He seemed to look less disheveled. We were happy for the poor sod.

One day, I saw Tatya and Vimla coming out of the ward. They seemed to be very friendly. Tatya saw me and said something to Vimla that made her guffaw. They seemed to be in the most excellent terms together.

Prakash and I collared Tatya one day. We wanted to know the reasons for the rapprochement between them. Tatya was evasive, we pressed him. “You remember my Uncle Bal Joshi? He has a very busy surgical practice. His assistant resigned. He was looking out for a newly qualified surgeon to assist him. I kept singing Vimla’s praises to him. Told him that she was very competent and reliable.He finally agreed to take her in as his associate consultant. She will join him from the next month”

“That is very generous of you” said Prakash. Yes, I agreed, “almost christian, considering all the grief that she gave you. I admire the largeness of your heart. I could never have done it”

“Generous, my foot. My uncle undoubtedly has a fantastic practice. As a human being, he is a sanctimonious prick. H e also suffers from the roving hands and fingers syndrome. His hands roam about the anatomy of his nurses and assistants like demented spiders. I have probably inherited this gene from him. His last assistant was also a female and quit when she’d had enough. I am waiting for Vimla to discover the joys of Uncle Joshi’s roaming hands” Tatya’s eyes were closed and he had a huge smile….

Happy Birthday…….

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!

 

Let them die with dignity….

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?”

I nodded.

“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……

On a train to Guntakal…..

“OK twits. Follow me. I’ll teach you the art of making evening rounds”, said Rajesh. We had got our rooms allotted and I’d had a hot shower and changed into dry clothes. The mess food was awful but I was so hungry that I had a second helping of the sloppy rice and the burnt dal. At 6 sharp, Rajesh had barged into our room and asked Prakash and I to accompany him on the daily evening rounds.

The ward was light with no ‘floor beds’. We had operated a few patients that morning. The first was a hernia repair. He looked in agony. “Doc, haven’t peed since the morning. It is agonizing. Do something please”, he pleaded. ” So Guru, what is your expert advice?” asked Rajesh. Catheterize him with a Foleys? I volunteered. “You think catheters grow on trees? They cost money and very frequently the ward runs out of Foleys. Reserve the catheter for the real needy ones”, Rajesh sneered.  “OK, Ramu, you are a tough bugger aren’t you? scared of a little pain? Come on, let me help you to stand. You’ll pee like never before”, Rajesh  pulled the protesting patient to his feet. “Nurse”, he called out to the accompanying nurse, Get a urine bottle will you?” “Go on Ramu, drop your trousers and let go into the bottle” Ramu demurred. “In front of everyone? please put a screen around” Rajesh gave him an impatient shake . “Come on man, all of us have the same equipment, only the size varies. Nurse, turn your back ” After much coaxing, Ramu splashed into the container. “Ahh..that feels much better” he said while reclining onto his pillow. ” Post operative pain and discomfort is the main cause of retention of urine. Reassure the patient, mobilize him and he pees up a storm!” were Rajesh’s words of wisdom.

“I hate burn patients. Prof has been trying to get a special burn ward. Old Hemorrhoids always replies that there’s no money. The mortality rate for burn patients in this ward is shameful as most of them  die of infection.” We were in the female surgical. Rajesh had worn a sterile gown and a mask. “Gown and mask up, nerds. We’ll make it fast” We followed him into the isolation area for burns. The smell hit me. There was an overpowering stench of burnt flesh. I gagged. “Breathe through your mouth. Gets a little tolerable” Rajesh advised.

Many of the burned women were deeply sedated. Some who were awake took one look at us and started screaming and crying. “They do this every time they spot the residents. They think we are here to clean their wounds and dress them. The pain must be excruciating even with morphine”, Rajesh  was sombre. “Alright ladies, we’re not here for the dressings. I just want to say hello” he announced. The screams turned into quiet snuffles.

There was a young woman who was unrecognizable. She had 100% burns. “Mother in law did it. Dowry, you see. Beautiful people, the mothers in law. She has no visitors. I am sure that her husband must be waiting for her to croak so that he can go bride hunting again.” Rajesh’s voice was hushed. “Nurse, give her morphine every time she wakes.She is already on the platform waiting for the train to Guntakal” Train to Guntakal? Prakash asked hesitantly. Guntakal is a small wayside railway station. who would want to go there? “On the platform to Guntakal is jargon for a patient on her death bed. You had better get wise to the jargon. 100% burn is a definite gateway to heaven or hell as the case may be. There is no way you can save them. So we make their last days pain free. No heroics” Rajesh explained.  We quickly examined the remaining patients and hurried out. “Guru, you’ll take all calls from the ward tonight.I expect that there will be none tonight as the ward is light. Except if the burns woman croaks. They always have a habit of croaking between midnight and three AM. Call me if she dies. I will show you the paperwork that needs to be completed”

The intercom shrilled. I opened a bleary eye and looked at the watch. It was 2 AM. It was the female surgical. Th e woman with burns was dying. Could I come over to complete the formalities? I dressed, informed Rajesh and hurried to the ward. The woman with 100% burns was almost dead. She was breathing in shallow irregular gasps. Her pulse was not felt. “Nurse! get a laryngoscope, tube and the Ambu. Give a shot of adrenaline” I ordered. The nurse hesitated. “Doctor, she is almost dead. Why the heroics?”

By this time, the patient had stopped breathing. No pulse. She was quite dead. I gave a sharp thump on her chest and started cardiac massage. “What are you doing? Trying to play God?” Rajesh had come in and pushed me away from the patient. “She is better off dead. At least she has escaped from the agony. There’s no way in hell that you can save her. Learn to leave alone.” I was devastated. This was my first look at Death. It was so…anticlimatic. No theatrics, no nurses hurrying, no CPR, no wailing….She just slipped into the Beyond. This was totally against what we we were drilled into in the student and internship days. No patient was supposed to be beyond help. You tried your hardest. Here was my registrar telling me not to resuscitate!

Rajesh showed me how to ‘polish up’ the final orders. We filled up the form for information to the police as the death was due to ‘unnatural cause’ The body was wrapped in a white bed sheet and transported to the mortuary. “Tomorrow morning at 630 sharp. The Prof starts his rounds at 8 sharp. We must finish our rounds b y then” We were on our way back.

I slept poorly. I dreamt of the burns woman. In my dreams she accused me, ‘Why did you give up on me?’