By Demon Doctor Jul. 01, 2016
Suresh Narayan is your ordinary orthopaedic surgeon in a government hospital. He has not slept for days. And he is ready to operate on you – with a vengeance.
eing an orthopaedic surgeon involves a lot more paperwork than I had bargained for.
Imagine a harassed, underpaid, overworked, sleep-deprived person given responsibility of a life-and-death situation, and you get what most sign up for. But bury them under an avalanche of bureaucracy and you get a clearer picture of the healthcare practice in India.A typical day begins at 7 am with a quick circuit of the wards to check whether patients have survived the night (always a pleasant surprise). Then, on to the outpatient department.
“I have this niggling pain in the back of my knee,” an overweight middle-aged woman complains. “Also I’d like painkillers that will last me two weeks. The last doctor only prescribed it for a couple of days.”
Lack of empathy is a wonderful tool to diagnose bullshit. Bored by this woman’s excuses, I instead concentrate on a fascinating case of neurological deficit in a 25-year-old, otherwise healthy man.
Unfortunately, in medicine, as in politics, the severity of a condition is directly proportional to how strident people are about it.
“Why are you ignoring my mother? She is suffering from the most unimaginable pain,” the middle-aged woman’s son says, venom in his voice. Recognising defeat, I concur that painkillers had been indicated for a month, at least.
Filling out various prescriptions and giving vague directions toward the drugstore takes some time, and I am now behind my schedule. So, I end up hurriedly writing a set of poorly thought-out tests for the 25-year-old man, who has been waiting with no sensation in his left hand all this time.
A lunch of cold samosas and poisonous chutney follows, and I’m all set to hit the emergency department for an all-night shift.
“Your hip is shattered, sir. It will take surgery to fix.” I fight a yawn, while explaining to one man that he needs to call his folks to the hospital. The 65-year-old tells me that he has no one.
So, I rouse a social worker sleeping in the basement and explain my patient’s predicament. He stares at me. Was I a complete newbie to wake him up for this pointless rubbish, he sneers, as only a veteran Class-4 government employee can.
I weakly explain that protocol requires me to contact a social worker in such cases. This time, he doesn’t even condescend to reply.
Thankfully, I get called to the floor right then, as a gunshot victim enters the premises.
The victim was at a wedding in western Uttar Pradesh, where post-nuptial celebrations involve firing live rounds into the air, daring gravity to do its thing. In this case, gravity obliged by punching a bullet through his thigh. The exit wound is a beautiful mess, it seems like his buttock had exploded outward, strewing pink gelatinous flesh everywhere.
While we clean his wound, I tell his family that they would have to donate blood. A blank silence meets this announcement. They then fall over themselves trying to explain – my brother and I haven’t eaten since morning, our women are scared of needles, our uncles, cousins, etc believe that donating blood leads to AIDS…
Screaming is an excellent method of getting things done.
Once I’m done, a scrawny old man offers to donate. It so happens that besides being the least healthy looking member of the posse, he isn’t even related to the victim. I try to shame the family by pointing this out, but none offer to donate in his place.
Surgery is a back-breaking effort. There’s more sweat that pours off a surgeon in the OT than the blood off a patient. That’s why we like our theatres freezing cold. So, of course, when we start on our gunshot victim, the ACs stop working.
Surgery is halted while everyone scrambles to figure out who’s responsible for fixing the air conditioning. Meanwhile, the civil engineers and bureaucrats assiduously pass the buck. Finally, a junior engineer is dragged out of bed to the OT, where he stonily explains that the “problem is from the backside”.
“The backside of what? Can you fix it?” glowers a senior resident doctor.
“Not a chance, sir,” the JE chortles. “CMO saab will write the order for mechanics from Toshiba to fix it, but they can only come in the morning. Also, the order must be countersigned by the officer in charge of tenders, and he is at home.”
Somehow, through a lot of sweat and tears, we manage to successfully operate on our patient.
A tender-hearted intern asks what his chances of survival are. I’m brutally honest with her. “The leg is probably going to get infected,” I say, wiping the sweat off my face (not an ideal sterile procedure).
I go back to the floor to check up on the patients. Splattered with blood and reeking of sweat, I must have been a comforting sight to the people looking for hope in their most desperate hours. A couple of children clutch their mothers when I pass by.
The 65-year-old man with a broken hip is silently crying. To take his mind off things, I try talking to him. Unfortunately, doctors aren’t good at small talk.
“So… How’d you break the hip?”
“It was a goat.”
I stare. Should I call in psychiatry?
“I was taking the goat to the butcher, when it tried pulling away. So I yanked back on its leash, and it turned around and charged at me. Now I’m here.”
It’s now 3 am and the floor is quiet. I stumble on to the filthy bed in the doctor’s room and fall asleep instantly. I am also instantly woken up by a nurse.
“Patient, doctor. He’s making a scene.”
It is now 4.30 am.
A young man is standing on the floor, glaring around him. He sees me and launches into a diatribe about the apathy of government hospitals and the laziness of doctors. He isn’t going to be silent anymore, he says.
“So what’s the problem,” I ask.
“I have this terrible pain in my right ankle. I can barely walk,” he says, striding around manfully and deploring the conditions in our emergency ward.
“Uh-huh. And did you fall, or twist it, or what?”
You choose not to get treated for four months, but decided that 4 am is a good time to show up at the hospital?
“It’s twisted. I need urgent medical attention. You can’t understand the pain.”
“Well, it doesn’t look swollen, which it would if the injury was severe. You also seem to be able to put some weight on it, so I don’t think it’s a fracture.”
He immediately hops on his other foot, grimacing.
“So when did you injure yourself?”
“I can’t remember exactly. I think about four months back”
There’s a long, awkward silence. I figure now would be a good time to start yelling again.
“You do know this is the emergency department, right? You choose not to get treated for four months, but decided that 4 am is a good time to show up at the hospital?”
“I was busy with work. You can’t imagine the pain I had been having, I mean, am having. Look, you guys are supposed to treat this right?”
“Uhhh. Can I just get some painkillers please? For at least two weeks?”
And so the circle closes.