DADI IS SMILING AND I AM AWAKE

It is two hours past midnight, and you might wonder why I am not asleep like decent people with two brains and one kidney would be expected to. Did I get that right? Whatever.
Well, it’s a longish kind of story, intricate in its human situations. It needed a Tolstoy or somebody comparable to do justice to it, but please make do with me, okay? I will use my special editing and writing skull skill and make it just bearable.

    THE BACKGROUND

Day before yesterday, I operated on an eighty year-old lady, Dadi, at a posh hospital (called Hippocratic Medical Center) in the grand old city called Unknown. The operation went smoothly, and I, the surgeon, modestly boasted to the two daughters of the lady that it couldn’t have been better done. Period. I am not known for beating about the bush with words. As the girls keep saying, “Give it to me straight and hard, baby!”

Yesterday, the old bird was smiling in delight. She apparently did not expect to survive my surgery. Not one to misunderstand such low expectations as a poor reflection on my reputation, I gave her a dazzling smile, and said she could go home the next morning. Which was today.

    TODAY

This morning, I started off early as usual, for I had a long operating list of seventeen cases, but at another hospital. Happily doing the chop-chop job that characterises the peculiar perversity of being a surgeon, I got a call around noon. It was the old lady’s son-in-law.

“Doc, she is feeling a lot of acid and is puking a fair bit.”
“Hmmn, that is not supposed to happen. Do one thing. Keep her in the Hospital for the day, for I don’t want you to take her home and then have problems. Later in the day, I will come in and look her up. In the meanwhile, let me send another physician to check her up”, I said.
“Okay, doctor.”

I tried calling the internist physician who had been treating the patient as part of my team. He was stuck in an angioplasty, and had loads of work. He couldn’t visit the patient right away, but promised to visit her later in the day.

    SHILA

Shila, the nurse looking after the patient, was a struggling young nurse. With an alcoholic gambler of a husband, she had to earn the bread for her little daughter, and save for her schooling as well. She had got this job of private nurse (where she gets paid for her hours of serving the patient in hospital) with great difficulty. For the few hours since morning that she had been with Dadi, she got paid for a full day. Now she was looking forward to another ‘case’ that would double her day’s income.

Shila did not have much trouble in reassuring the patient and her daughters to take the patient home. She said, “Everything will be alright. I have spoken to your doctor. I have given the anti-emetic as he has advised”.
She called me up and said, “Sir, the patient is feeling much better now. I have given her an injection for vomiting. Her discharge papers are all complete, and if you want to keep her today, she will have to be re-admitted, with extra costs. The relatives don’t want this. So shall I discharge her?”

I was operating while I got this call. I said “If this is what they want, then it is okay.”
Shila got paid twice today.

Back in the hotel (for the family was from another city), the patient continued to get sick, vomiting repeatedly. The family called me, and I assured them I would send my assistant at the earliest. However, with so many cases, he, too, would be able to come in only by late afternoon.

    IN DADI’S HOMETOWN

Around this time at noon, Dadi’s eldest son was shot dead. Dadi’s son was a rich businessman with no vices and an obsession to expand his business. In his hometown, he was the target of extortionists and kidnappers. Recently, Maoist guerillas had warned him to pay them three crores of rupees (around $800,000) or he would be killed. He had refused, and jacked up his security. Today, in spite of that, he was shot at from a hand shake’s distance and dropped, all life spurting out from his chest.

    THE FAMILY OF DADI

Dadi’s family of her daughters, sons and sons-in-law, needless to say, was shell-shocked. Not only was their beloved mother sick, but their own brother and family head had just died a brutal and unexpected death. Very few people live expecting death, very few. Immortality is an invisible stain inherent in human actions and thoughts.

The family privately held a conference, and decided not to inflict the sick old woman with the shock of her son’s death. They decided to leave one daughter-in-law with Dadi, and all of them left for their hometown.

    RE-ADMITTING DADI

My assistant, Parthiv, went to see her, and called me, giving me the picture of the patient. I ordered him to readmit the patient to Hippocratic Medical Center (HMC). Time: 7.00 pm.

I left my office, finishing off some consultations, and headed towards the hospital. Both Dadi and I reached around 7.30 pm. One immediate problem. The family had left for home in disarray. They had forgotten to keep any money for Dadi’s further treatment. The 40-ish daughter-in-law looked to be a housewife protected by her family from the vicissitudes of city life. I took the responsibility of the admission. My patient, after all.

    THE INVESTIGATIONS

I needed a set of x-rays, a few blood tests, and most importantly, a CT scan of the patient’s belly to find out what her problem was.

At HMC, the day technicians in charge of the blood and x-ray departments took off by 7 pm. The night duty staff came in only at 9 pm. This two hour gap could not be avoided at HMC because the trade union of the employees was very strong, and had strongly refused to extend their duty hours.

Therefore, I had to wait for two hours for the investigations to begin. I had already started an IV, put in the tubes and catheters that you don’t normally see in the hospital scenes in movies.
Work temporarily over and all alone, I wandered off into the narrow streets of Unknown city. I stopped at a corner tea shop, and had hot spiced tea served in an earthen mug (bhaanr). To keep busy, I bought and lit a smoke. I don’t generally smoke, but now seemed to be a good time. After an uneventful hour of this, I returned and waited for the tests to start.

After another hour or so, the CT scan was going to start now. A full two hours later, the cause has been found. Dadi has a temporary malfunction of her intestines. A couple or more days of treatment would likely see her through.

    ME

What struck me today was that I behaved the way I used to as a young resident doctor: taking risks for a patient, pushing the patient’s trolley, drinking tea and smoking (both without count), proffering a bowl to the retching patient, holding her shoulders and back to help her sit up, regularly asking how she was feeling and reassuring her that everything would be alright. She smiled sleepily at me, contented and relieved that she was not alone.

Today, I am reliving this feeling, this rewind of a life long past, and I can’t say I am not enjoying this. A consultant (at whatever humble level I practise) does not get his hands dirty. Today, I am not shy to say this, I had some of her puke on my hands. I must say that I have done far worse: shaved heads and pubes, pushed wheelchairs, got my dress mucked up with blood and pus, and removed thousands of maggots from the festering sores of drug addicts, beggars and alcoholics.

Thinking of all that, I can almost smell the old, smoky canteen of the medical college, and the anorexia which getting dirty used to generate. Today, I am not hungry. I have not eaten all day, and am going to be awake till morning. But I am not feeling dirty.

27 responses to “DADI IS SMILING AND I AM AWAKE

  1. This is a great post! Thank you for sharing it with us!

  2. I’ve been reading your blog off and on and must say have loved most of your posts. It’s really nice to see that this kind of doctor patient relationship still lives on!

  3. I’m suppressing the urge to use expletives to express my admiration for this post, and ofcourse, for you.

  4. Riveting doc – I love these kind of real life narrations. And yes – this again reminds me of the kinds of pressures doctors have to deal with day in and out. We sometimes forget that.

  5. Rambodoc;

    A moving story that share my reflections on the matter! Thank you! But although we are getting older, there is someting good that comes out of it! We are like bulls, and the older the bull is, the stiffer its horns get!

  6. nice writeup
    reminds me of kishore da s song
    zindagi kaisi yeh paheli haiii…………

  7. This is such a beautiful post, Rambodoc. I think it’s among your best.

  8. I agree: this post deserves a medal. I felt like I was right there, ten feet away, watching everything as it unfolded. I must say that at the end I wanted more, almost as if this were a chapter in a book.

  9. Isn’t there a “blog of the day award” somewhere? Does anyone know how to nominate a post for that award?

  10. This was very touching rdoc. thank you for sharing such a personal experience…
    and the whole thing with a little editing would make for a fantastic short story…you should seriously send it to a publisher.
    Or even better I suggest, you write a book on your experiences as a doc. non-fiction books of these kinds have a great market. send a few pieces to a publisher and they could give you a commission for a book. no I am not joking.
    the doc’s side of the story you know.

  11. Absolutely riveting doc.Brings back to mind memories of my internship days..OP poisoning ,diabetic foot cases..days spent assisting senior PG’s in OT’s ..cleaning up and dressing wounds in Ortho wards…Cup of tea with colleagues in the canteen with masks dangling around neck…

    Should take some time to read “The Scalpel and the Sword: The Story of Doctor Norman Bethune ” again.

    Thanks doc for the post

  12. @ Rambodoc: I second Nita’s idea/ suggestion. Do consider an entire book. I have found Atul Gawande’s writings very interesting for the same reason of authenticity, which come from the coal face of medical sciences and services. Good reflective post!

    @ Prax: Isn’t it Manna Dey?

  13. Now, it actually gives us insights in to a doc’s life. Never saw it with this intricate detail. And more so never thought that docs too would have to dealing with muck and puke. Strange but it never crossed my mind.
    Thank you all you docs for being there. And you Rambodoc for making me thank them. ;)
    Now get some sleep. It would be a well deserved one.

  14. Amazing post!

    Thank you Doctor.

  15. Doc, thanks for sharing a multifaceted life, from the various points of view. Couldn’t help but think of a song currently listening to, esp. the re-living of the experience.
    Haunting listen here: (Coldplay, The Scientist)

    Lyrics:
    Come up to meet you, tell you I’m sorry
    You don’t know how lovely you are.
    I had to find you, tell you I need you,
    Tell you I set you apart.

    Tell me your secrets and ask me your questions,
    Oh lets go back to the start.
    Running in circles, Comin’ up Tails
    Heads on a science apart.

    Nobody said it was easy,
    It’s such a shame for us to part.
    Nobody said it was easy,
    No one ever said it would be this hard.

    Oh take me back to the start.

    *I was just guessin’ at numbers and figures,
    Pulling your puzzles apart.
    Questions of science, science and progress
    Do not speak as loud as my heart.*

    And tell me you love me, come back and haunt me
    Oh and I rush to the start.
    Runnin’ in circles, Chasin’ up Tails
    Comin’ back as we are

    Nobody said it was easy,
    Oh it’s such a shame for us to part.
    Nobody said it was easy,
    No one ever said it would be so hard.

    I’m goin’ back to the start.

  16. Gosh! I didn’t expect a post filed in the bleary hours of dawn would evoke such approval from my critically sensitive readership.
    To all of you, thank you for your comments. I value them more than I may show.
    To those of you have commented here for the first time, please feel welcome to continue participating here.
    Jackie, that song is one of my favorites.
    I am bushed today (6.30 pm now). Had another long day. I think I am gonna crash pretty soon. Please don’t mind my not replying to each of you individually as I normally do. My patient is doing well so far….

  17. Oh wow. No wonder they made shows like ER. You handle things so calmly, like it’s just another day at the hospital. And the best part is, you don’t judge anyone. Like Nita said, you have to write a book one of these days.

    Hey, thanks, Marc!

  18. jaage hain deer tak
    hamen kuch deer sone do
    thodi se raat aur hai
    subah to hone do
    …………………

  19. beautiful. touching. fascinating. brilliant.

    just some of the words that come to my mind. you just restored my faith in the nobility of the medical profession.

  20. Excellent post rambodoc. I agree with Paul this is your best post. It seems to have come straight from the heart.

  21. You did an awesome job, doc! Immense gratitude that your patients must have for you is a source of serenity for you and them as well!!

  22. Damn, THIS is why I regret not being a doctor.

  23. Prerna, Xntric, Anand, AD and Lakshmi,
    Thanks for the kind words.

  24. For completion sake, is dadi alright now? Has she been given the bad news about her son?

    Lakshmi,
    She is much better now. No, she has not yet been told….

  25. Excellent post Rambodoc! Being an engineer, I always wondered how the life of a doctor is..and I think I got an answer now. Thanks for the post..

    BTW, is the dadi’s son the businessman shot dead in Jamshedpur?

    Thanks, Harsha!
    This case may, for the sake of propriety, be properly considered as a hypothetical case unrelated to any actual event.
    I hope you understand that confidentiality issues prevent me from revealing anything further beyond this disclaimer.

  26. Thank you, Rambodoc, for such a moving story. Truth is, indeed, sometimes stranger than fiction. I wonder if lawyers have similar experiences to share.

    Thanks, Vivek, for taking the time to go through my old posts!

  27. Nice post surgeonji, now if you could please scan a copy of your feet and put them in your next post!

    Dude,
    You say this to everyone, don’t you? :-)

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s