Life as a doctor---The Hippocratic Oath

A sharp mind should know to care,
a fiery tongue should neither curse nor swear,
for a caring mind is the one that wins,
and a tongue that swears is a tongue that sins...

"Mr Dattatray Dessai, you can go home today.You are completely fit for discharge" I said handing out the discharge card to the dhoti clad man sitting upright on the hospital bed.
The air smelled of incense sticks and talcum powder.Entering that private 'VIP' hospital room was like entering a parallel universe especially after having inhaled the smell of savlon and betadine dressings in the general ICU outside.

There were no follow up details to be mentioned and neither was there any prescription to be instructed upon.The patient had insisted on getting admitted and much to my disdain, the authorities had decided to humour him.
But there was not much a humble intern could say in such a situation---and so I had watched a perfectly healthy Mr Dattatray Dessai (bag et al) comfortably walk into the private room with a cheeky grin on face and an apparently long holiday in mind.

It was just the beginning of my internship then.After the tumultous 4 and a half years of MBBS torture, I had finally started living my dream (one that every medical student looks forward to, right from the first day of medical school) in the department of internal medicine.

...life as a doctor had just begun.

"I have already informed that i would like to stay here for atleast another couple of weeks" frowned Mr Dessai, like an angry tenant who had been suddenly told to vacate from a comfortable lodging.

A little taken aback by his rude reaction, i said "You are absolutely fine, Mr Dessai.Yours was just a case of mild diarrhoea which could very well be managed at home itself."

I was trying my best to smile but my patience was wearing thin.
On the one hand, there was this Mr Dattatray who had been seeking shelter under a hospital roof, in the comforts of a private ward in the ICU for the last one week for no specific medical condition.While on the other hand, there was a shortage of available ICU beds due to which a lot of patients had to be shifted out into the general ward as soon as they would show the slightest sign of recovery.

"Doctor, we have spoken to your senior in charge about this.You seem to be new here.The matter has been settled." snapped the relative standing near the bed.

He then proceeded to punch some numbers in his cell phone and talk to a man he addressed as 'bhau'.
All this while, Mr Dattatray was comfortably peeling oranges and popping them in his mouth.
The room now smelled tangy and soon it would smell of all the other fruits kept on the side table.
This man was a threat to the fruit kingdom, i thought to myself---there had not been a single time i had entered his room and seen his mouth at rest.

Visions of mafia had started drifting in my head with the utterance of the name 'bhau'.
I whisked it away as a case of over imagination combined with a rather generous dose of bollywood influence and thought it was better to confirm what the senior resident in charge thought about the case, before i said anything more.

"You don't understand, Priyanka.This 'Bhausaheb' is a very powerful man.He has a lot of political connections.Dattatray Dessai has been working with him for over 15 years now and is almost like an older brother to him.I cannot take the risk of declining him any sort of privilege, no matter how unreasonable.One call to the dean and my job can be at risk."

In a low voice, he continued, "Look, everybody at the hospital knows that this man does not require any treatment anymore.In fact he never needed any hospital care to begin with.
When he insisted that we admit him, we tried to talk him into being shifted in the 'observation room' in the general ward.
But the private room is the only room in the whole medicine unit which has a functioning AC and now that he is so comfortable with all the other VIP facilities there, he is refusing to budge."

"But sir, there is a serious case of Falciparum malaria in ward 115.We cant deny that patient intensive care.You know that there are only two interns in that ward and 80 beds there.He needs to be here instead...under constant vigilance."
I could not believe my ears.We were bargaining a life for a stupid air conditioner.How much sillier could it get?


"I know about that Falciparum case and i have discussed it with the consultants as well.Everyone knows the seriousness of his situation.His latest blood reports show a haemoglobin level of 4gm% which could prove fatal." He looked at me for a second, his eyes reflecting a helpless guilt.

"We had planned on shifting him on to Mr Dessai's bed....but..." he stopped with the realisation that i already knew the story.
Looking at the residents crestfallen face, i realised that he was pretty much helpless.
From what it seemed, the Dean was in a vulnerable spot too---the pressures of hierarchy.

I was on call that night and i couldn't sleep a wink.As i repeatedly called Ankita, the intern in ward 115, i was informed of how much Gangaram Shirodkar--the F.Malaria patient, needed to be moved to the ICU.
While we cribbed and ranted about the hypocrisy of the entire system, i saw Bhau Saheb's relative sleep peacefully, snoring away to glory in the cool confines of the air conditioned room which was now smelling of what seemed to me, a nauseous mix of fruit salad and sandalwood.

I had to wake up for a few RBSL (Resting Blood Sugar Level) checks at 5.30 am.That meant there was hardly a couple of hours left and all the patients were stable.
The only sign of instability in the ICU was the whirring motion of the ceiling fan in the duty room and the racing thoughts in my head which kept going back to Gangaram, who should have been there instead of Dessai who could have very well gone home.

Since i was not sleeping anyway, i decided to go and help Ankita in the ward by then.Asking the nurse to call me on my cell in case of any emergency, i walked out of the ICU.
Along the long corridor which connected the ICU to ward 115, i saw one relative of Mr Dattatray Dessai, leaning against a wall and talking loudly into his cellphone, like he owned the hospital.
On seeing me, he smirked a little---as a sign of acknowledgement.

When i reached ward 115, Ankita greeted me with a nervous look on her face.She was entering with two pints of blood in hand.

"for the Falciparum patient?" i asked.

"Yes Pri, I don't know what is happening.There are so many patients here.I cant manage all this at once.Rashi has called in sick.I'm the only intern managing all this commotion." I was almost beginning to feel Ankita would collapse any moment.Her teary eyed face spoke volumes of responsibility.
Besides it was unfair of Rashi to have not arranged for another intern to compensate for her absence.But then, we couldn't blame her either---Sickness doesn't come with warning, does it?

I took the pints from her hand and asked her the details.She seemed like she could need all the relief one could possibly give her.I had one hour and 50 minutes to offer, if all went well back at the ICU.
Walking towards bed 22, i noticed a scrawny man of about 30.He looked pale and emaciated.The charts showed a fever which was peaking every two hours that day.Gangaram Shirodkar 32/M, the case papers read.
Below in big bold letters, the diagnosis read 'F.Malaria' with the used falcivax kit taped to the paper, showing a line at the place marked 'F' for falciparum.
As soon as i reached the side of the bed to transfuse the blood, a woman who was sleeping on the floor crawled out from underneath the bed.
Adjusting her tattered but clean cotton Saree, she greeted me and asked when her husband could be discharged.
When I told her that we would be shifting her husband to the ICU for better care, she immediately asked me when that would be possible.
Snippets from the conversation with Mr Dessai and later with the SR came to mind, and I fumbled for an answer.
"soon" I muttered.

She said nothing.She just smiled like someone who had been promised life so many times, that she did not believe in life (leave alone 'promises') anymore.

Behind that smile, i saw pain---pain of seeing her husband suffer in the suboptimal conditions in the ward when he needed intensive care.
Behind that smile, i saw hurt---hurt that we doctors were not doing anything about it and still claiming that the govt organisation was there to help the needy.
Behind that smile, i saw terror---terror of the unknown, of the darkness that lied ahead had the sole earning member of her family to disappear, leaving her and her three children in the jaws of poverty and inhumanity.

That was when i couldn't take it anymore.As i transfused the pint of blood, i felt a hot shame flush my face.

If we doctors ignored our judgement skills and refused to take action on something as simple and clear cut as this, then what use was our medical education, our long hours of burning the midnight oil to study for the exams and vivas that we rejoiced so much on clearing, the Hippocratic Oath we had taken such great pride in reading on graduation day?
What use was a medical degree if it enabled us to save a life and we still refused to save it?
My chain of thoughts was interrupted by the sudden grunting sounds coming from Gangaram.Even in his sleep, his wheezing could not be ignored---a sure sign of respiratory distress.
His rapid breathing, chest retractions, weak appearance screamed of his ailing condition, albeit in silence.

As i saw the woman fold her hands and shed tears in front of me, a surge of anger came over me---anger at the hypocrisy...anger at the injustice...anger at the politics...anger at the indifference.

Leaving a baffled Ankita alone to deal with the patients, i rushed back to the ICU.
Some things could not wait.

"Mr Dessai, can i come in?"
It was 5 am in the morning.A sleepy Mr Dessai mumbled a lazy 'good morning doctor' and shifted his posture from one arm to another.
I went inside and switched on all the lights in the room.By this time, he was fully awake and covering his eyes to accustom himself to the sudden brightness in the otherwise dimly lit room.

"Look Mr Dessai" i continued, "this is a Government hospital and the first duty of a Government hospital is to treat patients who cannot afford treatment elsewhere.I am not saying that you don't deserve to be treated here..but the simple fact is that you do not require any treatment and you should be extremely happy about being so lucky."
He was now sitting upright and staring at me.I felt like a ghost and hoped that he was awake enough to comprehend what i was saying.

"There is a patient in ward 115 who needs critical care.He is a daily wages labourer on a construction site, has a wife and three children to support.
While your relative is constantly with his ear attached to the phone, his children are crying in the hospital corridors because they are starving.
There is an intern in that ward going crazy with the workload and still trying her best to make sure that all her patients there receive at least half the treatment they are actually supposed to be receiving, hoping against hope that her effort will be enough to keep them alive.

and do you know who is responsible for all this?"
He looked at me like a lost child now.

"YOU Dessai...its you." The bitterness had started to surface in my voice.

"You mean to say that I am responsible for all the people suffering in your ward? how many people do you think would fit in this room if I vacate it?" he snorted angrily.

I had to maintain my cool now.I reminded myself of the power this identity had over the authority and I still had 11 months of internship to finish.

"Well, you are a wise man.You should understand that its not of luxury or comfort that we are debating about.
One case of Falciparum Malaria, if admitted in the ICU can receive much better care and optimal monitoring than in the wards which has over 80 beds.In fact its not even about the private room or the air conditioner.
These comforts are of no significance to that mason or his family---all they want is to get out of here...get out of this hospital, so that he can start working again and feed his hungry children.
Unfortunately, for that he needs your help." my voice trailed off again.

Mr Dessai was quiet for a while.

"Watch it, Doctor. Do you know who you are talking to? One call to the dean and you could be interning in some Godforsaken rural place instead." he said, in a haughty tone as he pulled the plate of fruit near him.

It was true, i had gotten myself into a sticky situation.But by now i no longer cared.

In a firm and clear voice i said, "Very well sir.If that is what it takes to stand up for what you believe in, i don't mind that at all.
Because no matter where i am, that one family out there will never forget me for what i tried to do but could not...
and never forgive you for what you could have done but did not."

"These are VIP rooms.You cannot depend on these.As far as i know, they are opened up only when special people are admitted." he muttered.
I noticed his tone had sobered down.I was not going to give up now.It was true that the room was labelled as a VIP room and it was also true that someone who the authorities feared, was considered a VIP.
I had to come up with a satisfactory reply to convince him.

After a moments pause, i asked "Mister dessai, what does VIP mean?"

"Very Important Person" he answered with a quizzical expression wondering where this was leading.
"Exactly!! Now take a wild guess, between a patient with F.Malaria requiring blood transfusions and one admitted for a simple bout of treated diarrhoea, which according to you would be more important to treat?"
I smiled and continued "You mister dessai, might read this sign here as 'Very Important Person' but I as a doctor would always read it as 'Very Important Patient'.
The abbreviation is the same.But when used at a hospital, it changes meaning and that makes all the difference."

The chair creaked as i got up to leave.

"Have a good day" i said and walked to the door keeping my fingers crossed, hoping the man would have a change of heart.
But this time he did not say anything.

As i continued with the BP (Blood Pressure) check, sugar level monitoring and morning rounds, i noticed that the lights in mister dessai's room never went off...they stayed on, just like how i had left them.

Tired from the night's duty, i dragged my feet back to the hostel at around 8.30 in the morning.
It was lucky that our new time table gave us interns a day off after night calls---I silently blessed Vithal, the ward boy who had helped us make the duty time table.
I slept the whole morning and woke up right on time for lunch.

There were 3 missed calls from Ankita and one text message waiting to be opened.

I could not help but smile as i read the text.
It was from the ICU SR and it said, "Dessai agreed to the discharge--told me to thank you..Falciparum patient moved to ICU.Good job!"

...life as a doctor had just begun!

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ A special thanks to KFC and Indiblogger for the KFC gift voucher---a small excuse which stood testimony to a wonderful day out with friends.

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Cheers to faith,
cheers to life!!! :)