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?’