Featured

First blog post

This is the post excerpt.

Advertisements

This is your very first post. Click the Edit link to modify or delete it, or start a new post. If you like, use this post to tell readers why you started this blog and what you plan to do with it.

post

Do doctors cure ……

 

I was a very confident Physician with a bit (an understatement) of an ego. People used to fan my ego further by praising my clinical acumen and treating abilities. They said I was gifted. And I believed them because I wanted to believe them. It felt nice. Those days modest was not my cup of tea.

Till one day ….. in 1994…..( I had only 8 years in specialty then) ……the ego crashed and I was shown the face of reality.

I will cite two cases. One, an 80 year old man who had all the reasons to die but survived and the other, a 14 years boy, who had all the reasons to survive and yet ……expired. I have preserved the case sheets of these two patients and whenever I see these two case sheets ….I realise my worth or rather, my worthlessness.

Case 1

Halwara….

f/o Sep Amarjit Singh, 80 years old was brought to the hospital in 1994 with severe Bronchial Asthma. He was cyanosed (blue discoloration of skin due to lack of Oxygen). I was not keen to put him on the ventilator (those days the ventilators we had in smaller hospitals were worthless). I, in fact considered requesting the anaesthetist to put him on the ventilator that he used in the OT but unfortunately, a surgery was going on. I struggled for almost 2 hours with him before he started improving. The severity for an 80 yr old was such that it could have been fatal without ventilator support. But he survived.

Next day, while he was still struggling (and so was I), he developed a Myocardial Infarction (heart attack) involving the inferior wall of the heart. Though considered less dangerous than other types, in a situation of severe Bronchial Asthma – the combination of lack of blood and lack of Oxygen could be disastrous. I thrombolysed him immediately. A few post thrombolysis complications but…..he survived.

After two days, he had an extension of infarction to the lateral wall as evidenced by fresh symptoms, ECG changes and raised enzymes. Remember, we did not have facility for stents available readily then. I managed him symptomatically. Old age, severe Asthma, second infarct…. deadly combination…. But still, he survived.

For the next 15 odd days he remained symptom free. I thought all was going well. But his (and my) ordeal were not over yet.  He developed Jaundice – Hepatitis B. Considering the incubation period; it was obvious that he had got infected before he was admitted. The Ser Bilirubin showed a relentless rise and it went up to 29 mg% (Normal up to 1.2). The Liver enzymes skyrocketed. And then to make matters worse, he developed complications. His kidney functions deteriorated, he became mentally obtunded, developed ascites (fluid in the abdomen) and edema….ominous signs. I was forced by my Commanding Officer to have a second opinion from the Medical College. I was told that I was fighting a losing battle and that there was no hope. BUT, I struggled, and he struggled. And, he started improving after a few days. He became conscious, ascites and edema disappeared, the kidney functions normalised and Serum Bilirubin improved (we assess level of jaundice by this parameter). The illness and its complications were severe enough to kill…..But, he survived yet again.

By this time the patient had spent two months in the ward and I was taking all the credit with a broad smile without showing any modesty. Though he was improving and his Ser Bilirubin was receding, it was still very high (15mg%)

And then it happened. During the morning rounds I found him in severe agony. His abdomen was rigid like a board. He had fever. And there was gas under both diaphragms. Obviously, he had perforated a viscus. I didn’t know how and why. Now he became a surgical case. I went to the surgeon, Sqn Ldr PC Prasad (who left service and is presently in the US) and the anesthetist, Sqn Ldr  Ravi Chaturvedi (retired as a Maj Gen) and told them to take over the case. I said, “I have struggled with this patient for two months. He had ample reason to die and yet he has survived. Probably he is waiting for your knife”. A recent myocardial, recent recovery from encephalopathy, Ser Bilirubin 15 mg %…..all were indicators of a poor surgical outcome.

He was wheeled in to the OT and after sometime wheeled out without surgery. Dr Prasad said, “Panda, we will manage this case conservatively” and we did. One month of aggressive treatment, and patient recovered. He had all the reason to succumb. BUT, he survived yet again.

This patient, at 80 years had so many reasons to die…….but he survived each battle and finally won the war. After three months, I discharged him from the hospital. I continued to hear from him for 5 years thereafter.

And, I accepted the accolades gleefully.

 

Case 2

Halwara…..

15 days after discharging f/o Sep Amarjit Singh, 14 year old Son of Sep Amarjit Singh (this Sep Amarjit Singh was different from the above mentioned Sep Amarjit Singh) was brought to the hospital with a right lower lobe Pneumonia.

I treated him for seven days. He recovered and check X ray showed remarkable resolution. After 10 days of hospitalisation I decided to discharge him and accordingly put up the papers for signature of the Commanding officer – usual procedure.

It was December. Halwara is bitterly cold in December. Militants were quite active then. It was 0430 hrs in the morning when I got a call that the boy is serious. I wanted to know the parameters. I was told the BP is not recordable and pulse is not felt. I asked about the breathing. There was a pause before I was told that the boy is not breathing. I could feel the cold sweat trickling down from my occiput down along the spine in that severe cold. I could feel the perspiration on my forehead. I could feel my heart racing. I didn’t bother about militants. I didn’t bother about the outside temperature. I just took out my car and rushed to the hospital that was 2 km away. I ran to the ward……just to find the boy unresponsive. There were no signs of life. Tried everything but he did not come out of it and I declared him dead. I waited for the parents. They came at around 0800 hrs. I made a sincere and earnest request for a post mortem. They could see my moist eyes. They agreed. I rushed to MH Jallandhar which is 90 km away from Halwara. A PM was done. Viscera were sent for toxicological examination……nothing was found. It still haunts me. This boy had no reason to die. Why and how did he die?

My ego was shattered. I was told by the unseen and unknown…….”doctors don’t cure. Someone else does”.

An 80 yr old f/o one Sep Amarjit Singh with so many reasons to die, survives. Another, s/o Sep Amarjit Singh, 14 year old, with all reasons to survive, dies…..

So the question – Do doctors cure?

Am I supposed to take credit for curing a patient? Then, I should take the blame for death of a patient too.

I am no more what I used to be.

I know I am just an assistant to someone who cures.

Hope – the only hope for the “niraadhaar” running around for “Aaadhar”. Do not complain, just bear it………

 

Why do we have to suffer patiently and silently for anything and everything? Why are we at the mercy of the administrators, who, instead of considering themselves as public servants, act as the Lords in front of whom we are supposed to bow our heads lest they get offended? Is subservience a defining criterion of being a good citizen?

This is in context to Aadhaar card having been made a mandatory requirement for anything and everything. Fair enough. I will not go in to the merits and demerits of Aadhaar Card. That can be discussed in some other forum. Govt has decided. So, we shall abide by the decision of the Government as good citizens.

There is a sudden surge in the applications for fresh Aadhaar card as well as corrections of existing Aadhaar cards in view its linking with IT, PAN and all bank accounts. I had to visit an Aadhaar booth with my mother who is 87 years old, for registration of mobile number as the same cannot be done on-line. It took her 2 ½ hrs of waiting before the ordeal got over. But, to highlight the ordeal that my mother faced is not the issue.

The issue is the conditions under which people are waiting patiently, in a queue, without making noise, and without complaining. I salute these people for their exemplary display of tolerance and discipline. Or is it subservience? Or is it fear? Fear of delay? Fear of not being able to make the Aadhaar card? Fear of loss of days? Fear, that a mistake will be made deliberately making it mandatory for him to go through the process again at a later date?

I would like to make an attempt to bring out what I saw, but I am not certain whether my words have the power to express the agony.

The story is that of a small town called Berhampur in the Southern part of Odisha, better known as the Silk City. There is a nondescript building where there is a room that is used for the purpose of Aadhaar card registration and corrections. It is a small, poorly ventilated, dimly lit room, with cobwebs all over and with walls desperately crying for a whitewash. Fortunately it has a fan.

The corridor outside the room, where people line up patiently and wait eagerly for their turn, doesn’t have a fan. The grill has not been painted for ages. The walls and the corridors are dirty (an understatement). There is no place to sit. The children, the elderly and the old keep standing and when they can’t stand any more, sit on the dirty floor. Some, specially the old and the very young, after prolonged waiting, lie down on the dirty floor with flies hovering over them. You would see the mother of the young or the husband of the old trying to use a hand fan for comfort. Then one would see an old or disabled being wheeled in. There is no separate counter / time for the old and disabled.

It is not difficult to imagine the plight and misery of these people, standing for hours or lying on the floor, sweating profusely, without a fan, in a dirty place in hot and humid weather (better now compared to what it was a few days back, but still bad enough). To add to the misery, there is no source of water. The way their face lights up as one registration is over and they step one step ahead is something to be seen to be believed. The gleeful smile on the face of the one who just completed his registration and the sigh of relief says it all…..Aaahhh……the end of an ordeal.

The only silver lining is the young boy who starts his work at 1015 hrs and continues till late in the night, alone, with a tired smile on the face, patiently explaining and answering queries (finished at 2100 hrs on the day I visited). In the almost 09-10 hrs that he sits, he gets up only for the lunch break. I wonder if he even gets a cup of tea in between. (It is a different matter that he charges Rs 20/- over and above the prescribed fee and people are willing to give that much so that he doesn’t close the counter at 1730 hrs – the official time – whereby many will have to go back)

I have brought these to the notice of the District Administrators with various implementable suggestions that would not cost a dime.

I have written with hope.

Hope…….the only hope of the “niraadhaar” running around of “Aadhaar”.

religion ……

Religion is supposed to unite us. But see what religion has done to us. It has been used as a weapon to spread hatred …a weapon to divide… a reason for a separate piece of land…….. a tool for getting votes…..

I normally do not go to temples. In fact, I avoid going to places of worship as far as possible because of the rituals and pretensions. I don’t go to crowded places ….appears I have a phobia ……. I live in Berhampur, a town in Odisha with a population of about 5 lakhs.  It was 27 Jun 2017 when my sister wanted to go to have a darshan of Shree Jagannath. That day I did not make any excuses and took her for darshan. Incidentally, I reached at a time when the evening Aarati was about to start and there were thousands of devotees who were patiently and eagerly awaiting the Aarati and darshan.

And then it started. The aarati of Jagannath started with hundreds of deeyas (a small cup-shaped oil lamp made of baked clay) held in a deeya holder, with chantings of mantras. Thousands of hands held over their heads seeking blessing of Jagannath, the chorus of huluhuli (a peculiar sound produced by rolling the tongue in a particular way by the ladies), the rich shankha naad (sound produced by blowing the conches), the high decibel sound of beating of drums, kept one spell bound. The effect of the mixture of all these sounds is something that can only be experienced.

No one thought for a moment as to who is standing next to him….. a Brahmin,  a Shoodra (a low caste, considered to be untouchable), a Hindu, a Muslim, a Sikh or a Christian. All eyes were glued on to Shree Jagannath for  seeking his blessings. Tears rolling down, people calling out Jai Jagannath in unison………  At that moment, it appeared as if time has stopped. ….all were equal. No one was untouchable. No one belonged to any religion in particular. No one was bothered about anything else. Such was the awesome power that united one and all ………

(Incidentally, Saala Bega, an ardent devotee of Shree Jagannath, was a Muslim. Guru Nanak had a darshan of Jagannath on visiting Puri and his preaching had tremendous impact upon the minds of the people of Orissa).

Hope peace, brotherhood and goodwill prevail.

Jai Jagannath