Happy Birthday…….

It was 2 AM and we were in the male surgical ward. It was our call day when all emergency admissions would be seen and treated by our unit. It was a particularly heavy call day with a steady stream of patients coming in. Patients would be wheeled in from the casualty with cuts, abscesses, burns; the whole spectrum of emergency problems. Prakash and I would clerk the patients, write orders, do minor procedures and shift them to the OR if anesthesia was needed. Both of us had been worked off our feet and nearly at the end of our tether.

A thirty year old laborer was wheeled in. A strong smell of cheap liquor assailed our nostrils ten feet away. He was rolling in agony in his bed. He told us that he had agonizing pain in the upper part of the tummy. He had been paid that day and had promptly hit the speakeasies that littered Dharavi. He was drunk as a lord but miserable as a sick puppy.

I examined him. His abdomen was tight in its upper part. He jumped up in pain when I tried to examine his abdomen. It was very clear that the cheap booze had caused an inflammation of his pancreas. Yes, the diagnosis was very clear: Acute alcoholic pancreatitis. I gave him a shot of pethidine to reduce pain and started an IV line. Now I had to pass a nasogastric tube through his nostril into the stomach to decompress it its vile contents. I informed the patient that I would have to introduce the tube down his nose into his stomach. I reassured him that it wouldn’t hurt and that he would have to swallow it just once and it would slip into his stomach.

The man cringed. “No way, Doctor Baba”, he whined. “I have a very sensitive throat and vomit very easily. Can’t you give an injection to knock me off and then pass the damn thing?” I wheedled and cajoled, but he was adamant. I threw down the tube on to his bed and sat at the nurses’ station trying to collect my patience to try again. Rajesh was busy writing notes.

Prakash walked in. He took the scene at a glance. I saw that he was feeling masterful. “OK, Guru, I will take it from here. I have passed three tubes in the female surgical. It’s a cinch” I told him that the patient was all his and that I owed him one. Rajesh had heard our exchange. He stopped writing and sat up to watch. Both of us watched Prakash as he swaggered to the patient. I could hear Prakash bullying the patient into compliance.

“BLLRRRRRGH”, the patient chucked up his entire stomach contents. A vile smell of cheap booze and old fish filled the ward. Prakash  made a desperate leap backwards. He was too late. The vomit sputtered  all over him. He was bathed in it. I was fascinated at the outcome. Rajesh was bent over, laughing hard to bust his gut.

“OK,Twit, go to your room and wash up. You’re sinking to high heaven. Guru and I will do the needful” Prakash didn’t need to be told again. He left the ward in a run, trailing toxic  fumes behind him. The nurses cleaned up the patient and Rajesh expertly passed the tube. The patient kept grumbling, but you could see that his pain had lessened. There was lull in the patient flow.

“OK, Guru, I will catch some shuteye. Wanna come?”,  Rajesh was at the door. I hesitated. “Go on, I’ll follow you. Got some forms to fill”, I turned back to my work. The ward fell silent. The pancreatitis seemed to be better and had already started snoring. It was a hypnotic sound. I too dozed off, with my head on the table.

The Nurse shook me awake. “New admission, Doc” I groaned and sat up. This was a middle aged man with pain and distension of abdomen. He had not passed stools or gas since the morning. The Casualty officer had done a x ray abdomen. I took a look at it. It was clear that I was dealing with an intestinal obstruction. I passed a nasogastric tube, started an IV line and called up Rajesh who walked in sleepily after 15 minutes. He agreed with my diagnosis. “He requires surgery, Guru. I think I better call Ajay  and ask him to give me a hand. I haven’t done intestinal obstructions before”, Rajesh went to call Ajay Shah, our lecturer, while I called up the OR and asked them to send a trolley to shift the patient.

Ajay walked into the ward. He was in a grumpy mood, being woken up at the unearthly hour. He took a look at the x ray. Rajesh filled him in with the patient’s story. “Let’s take a look at the patient. Have you examined him?”, he asked Rajesh. No, Guru has. I have seen the x ray and it is clear that he requires surgery. Ajay pulled down the patient’s pajamas. The patient had a large hernia. It was very painful to touch.

“Missed it altogether, right, Shirahatti?” Ajay snarled at me. Thanks to your carelessness We would have done an unnecessary surgery on this patient . This patient has an irreducible hernia leading to his complaints. Give him a sedative and we’ll reduce the hernia. There is no need for surgery. Rajesh, how do you rely on the findings of a new resident? You should from now on double-check every findings of this idiot. Shirahatti, the first thing you do in abdominal cases is to  examine the genitalia. I will forgive you this once. If you repeat the same thing again, I will keep you nil by hand for two weeks” He reduced the hernia and stalked off. Keeping one ‘nil by hand’ meant that you did not get to operate. It was the most humiliating punishment to a resident. I felt broken. Rajesh patted me on the back and told me to perk up.”Don’t mind the sanctimonious prick. He is going away to start his practice in three month’s time.” I went back to my forms.

Next morning, I felt as though I had been through a wringer. My eyes felt gritty and I had a bad taste in my throat due to acidity. We were on the morning rounds with the Prof. So far, the rounds had gone OK.

“What is this patient?”, Prof asked. “He is a middle aged homeless person brought in by the police after he was hit on the head. He was fully conscious on admission and smelled strongly of alcohol. I asked for an x ray skull, kept him nil orally and started an IV line”, I presented the case. “His consciousness level has deteriorated since admission. I think he is in withdrawal”, I finished.

The Prof shone a torch into his eyes. His manner changed. “Ajay, intubate him fast. I will call Feroz. I think we have an extradural” He snapped. Dr Feroz Khan was the attending Neurosurgeon. Dr Feroz sauntered into the ward. “Spot on,  PJ. Not bad for a Cowboy. It is indeed an extradural. No time to do a carotid angiogram.  We’ll do a craniotomy. Can you spare your resident? Mine has gone off to get married, the fool.” Dr Feroz was a tubby genial guy.

“Since you missed the extradural, it’s only right that you assist Dr Feroz”, Prof told me. I accompanied Dr Feroz to the OR. “Come here, Guru. Take a look at the x ray skull. There is a linear fracture of the temporal bone. Can you see it? It is crossing the middle meningeal vessel right here, tearing it. Never underestimate head injuries. If Your Prof had not recognized the dilated pupil and alerted me, this guy would have died.”

Dr Feroz did a craniotomy and showed me the blood clot on the brain. We suctioned it out and ligated the middle meningeal. Dr Khan let me close. It was much after lunchtime by the time we finished. I hurried back to the hostel,ate the bilge that passed off for lunch and dropped into my bed, fully dressed. I dreamt that my parents were in the room and could actually feel my dad’s hand on my head. I smiled in my sleep.

” Hey Guru! wake up you bugger, It’s time for the evening rounds”, Rajesh was shaking me awake. I swam into wakefulness. “Let me wash my face. Join you in a minute” I went to the bathroom. When I returned Rajesh was was wolfing down some cake. “Lovely cake this”, he said between mouthfuls. “Didn’t tell me that it is your birthday, twit” He broke out into “Happy Birthday to You” in a high falsetto. “By the way, I found this note and the fifty buck note by your pillow” Rajesh handed me the money and the note.

It was in my father’s neat handwriting. ‘Your mother and I had come to wish you on your birthday. Your mother stopped me from waking you. You looked so exhausted. Anyway, Happy Birthday, Son! Use the fifty bucks for dinner tonight”

Yikes! it was my twenty fourth Birthday!

 

Let them die with dignity….

There was an air of expectancy. It was just before 8 AM. The Prof was to make his appearance. Sister Eapen bustled about, tucking in a bed sheet here, arranging a pillow there.

My day had started at 530 AM. I had tumbled out of bed, shaved, showered, thrown on some clothes and hurried to the ward with Prakash. “Did the burn patient go to Guntakal?”, Prakash wanted to know. I filled him with the outlines of what had happened last night. “Wow! your first death? how does it feel to look at the grim reaper?”,  Prakash’s rabbit eyes bulged. I told him that I was shocked that we didn’t attempt to resuscitate. I will ask the Prof about it, I told him. “Holy shit! you have the death wish don’t you? Let me know when you commit suicide. I will be there to administer the last rites” he giggled.

Sister G Eapen was a formidable woman. She was short, around five feet tall but looked taller. She was one of the most senior nurses as evidenced by her yellow belt. Ward nurses wore a blue belt while the in charge nurses wore red. Sister Eapen was so attached to her patients that she had refused the promotion to Matron. No flying desks for me, was her reason. Her assistant Rosamma hovered about her. The nurses were in awe of Eapen.

“New residents! Wish I could do without you. All you people do is to mess up the ward and try to seduce my girls. However, I suppose I will have to tolerate you.  No eating, drinking or putting up your feet at the nurses station. If you need something, ask Rosamma. No chatting up nurses. Keep your beady eyes away from my girls”, was Sister Eapen’s greeting to us. “What a battle axe”, whispered Prakash when her back was turned. I noticed that Sister Eapen was very gentle with our patients. Patients were awestruck by her but seemed to like her.

Rajesh had spent the morning showing us how to examine patients and write our findings and orders. “Prof is a fanatic about the SOAP”,  he told us. SOAP? what on earth is that? I asked. “Jargon, dear Guru. Better get wise to it fast. SOAP stands for Subjective, Objective, Assessment and Plan. Makes it easier to read and follow. Prof prefers only WHO abbreviations. He is very particular about documentation. Listen up twits, woe betide you if a patient complains about you to the Prof. You may as well kiss your dreams of being a surgeon”

Prof swept into the ward at the stroke of eight. The caravan started. Leading the procession was Prof and Ajay Shah, the lecturer. Rajesh and the two of us followed just behind. We were followed by a ward attendant carrying a bowl of disinfectant and a pristine white towel draped on his forearm like a butler. The rear of the procession was brought up by Eapen and Rosamma, who pushed what looked like a tea table on wheels piled up with patient files. Rajesh would present the case. Prof would listen, quickly examine the patient and  advise change in treatment if warranted. He would then dip his hands in the disinfectant and dry them with the towel. I had an insane urge to giggle. This act reminded me of Pontius Pilate washing his hands off Jesus. Prof’s manner with the patients was very short, but his examining hands were very gentle. ‘Heart of a Lion, hands of a woman’ indeed.

We were at Ramu’s bed. He had undergone hernia repair the previous day. “Patient is stable.But he has had two spikes of fever this morning” Rajesh started. The Prof whirled around. His eyes transfixed me like a beetle on a sharp needle. “You! Shirahatti, right? what is the cause of fever in this patient?” I would investigate for wound, lung or urinary tract infection, I volunteered. “So you will ask for urine and blood cultures, white cell count and an x ray chest. Spend about one thousand rupees that the patient or the hospital can ill afford. Most post operative fevers in the first 24 hours are due to the trauma of the operation itself. Don’t waste precious resources. Just give an injection for the fever and observe. If the fever continues beyond 24 hours, investigate” Wow! I had learnt something new on the very first day.

And so it went on. As an intern, you are generally ignored by all. This was new. As a house surgeon, I actively participated in the round. We did not put a step wrong. The Prof seemed satisfied with our performance. But the death on the previous night still weighed heavily on my mind.

We had ended up in the female surgical. Rajesh informed the Prof about the death of the woman with burns. The Prof merely grunted. We had completed the ward and the Prof turned to leave. It was now or never.

“Can I have a word with you sir?” I asked the Prof. I was quaking in my shoes. But I had to get it off my chest. Ajay and Rajesh looked aghast at my presumption. “A house surgeon is merely to be seen, not heard. So keep your mouth shut and your other orifices open. The old Pete hates loquacious residents” Rajesh had warned us in the morning. I could feel his angry eyes boring into my back. I did not care.

The Prof’s eyebrows knitted. “Make it short, Shirahatti. I have an important meeting to attend” he told me brusquely. I stammered about yesterday’s patient. “Why did we not try to resuscitate her sir? isn’t this cruel and unprofessional?”, I asked. The Prof’s face changed. There was sympathy in his eyes. “Your first meeting with Death, young man?”

I nodded.

“You are right in a way. We have all taken an unwritten oath to save patients. But some occasions demand masterly inactivity. Even if you had been able to bring her out of this arrest, she would have arrested again after an hour or two. Due to tissue damage, there is high circulating levels of potassium that are cardiotoxic that would have lead to repeated cardiac stand still. You would have merely prolonged her agony. She is better off dead. I know that no amount of my explanations will convince you today. When you see patients on their death bed, your prime duty is to allow them to die in dignity. God knows you will see plenty of death and suffering. You must learn to be objective. It is not your fault that she had severe burns. The best treatment for burns of this magnitude is to sedate them heavily so that they don’t feel the pain and allow them to slip away.” He left.

I felt a little better, but still unconvinced. “Smart ass” was Ajay Shah’s comment. “Keep an eye on this idiot, Rajesh. Talks too much. May turn out to be trouble” He too turned and left the ward. Prakash and I trooped back to the male surgical. We had to fill up discharge summaries, fill up forms for investigations, do dressings; we had our hands full. I sat at the nurses station, my head resting on my forearms. I was confused, my mind a whirl.

“Doctor, have you had breakfast?” Eapen asked me. I hadn’t, I admitted. “How can you youngsters be so careless? Don’t you know that breakfast is the most important meal of the day? Work can wait for the moment. Step into my office and have some tea”

There was a heap of cucumber sandwiches on Sister Eapen’s  table. I suddenly was ravenous. Both Prakash and I wolfed down the sandwiches and slurped down piping hot tea. Yesterday’s death seemed to be very faraway……

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?’

 

The Journey had begun….

I was waiting in the small hall in front of the Dean’s office. I was shivering uncontrollably. I was completely drenched right down to my underclothes. I had arrived from Pune, my hometown.  I clutched a letter informing me that I was selected as a surgical house surgeon at the Sion Hospital.

I got down from the train at Dadar in the morning only to be met by a veritable deluge. Monsoons had arrived in Mumbai and anyone with any experience of Mumbai will tell you that when it rains in Mumbai, it is serious business. Large areas get flooded, buses and trains go off the road and there is general chaos. But no Mumbaikar worth his salt gets worried of  a ‘small drizzle’. They go about their business wading through knee deep, sometimes chest deep water. I took one look at the deluge outside Dadar station and groaned. My heart sank. There was a sea of water everywhere. In addition, I did not know swimming. I ran to the bus stop opposite the station and waited for the bus. By this time, I was thoroughly drenched. The bus lumbered to a stop, splashing dirty street water on all of us waiting souls. Somehow I managed to reach the hospital.

There were a motley crowd of prospective residents; Medicine, Surgery, ENT, Ophthalmology, Orthopedics…the entire lot. The Secretary would call out the specialties, residents-to-be would go in, get the Dean’s signature onto the forms and go off to the PG section to get their white coats.

“Hi, registered for surgery, are you? I am Prakash. Doing surgery as well” Prakash was a serious looking man with eyes like those of a frightened rabbit. We shook hands. “Tatya, over here” called out Prakash to a tubby guy who was chatting to a huge man. “I’m Arun Joshi. Everyone calls me Tatya” was his introduction. “I too am doing surgery.  You see that mountain there? He is Dilip, the reigning university heavy weight wrestling champion  Don’t ever get on his wrong side. Last week he cuffed one of the fellow interns in the back playfully. That guy peed blood for two days. Hey Dilip! meet the new nerd from Pune. Doing surgery” Dilip lumbered across and shook hands with me. His hands were surprisingly soft till he gripped your hand and made you wince. “What’s keeping ol’ hemorrhoids today? He’s extremely slow. His piles must be acting up,” grumbled Dilip. “Orthopedics,” announced the secretary. Dilip and a couple of others strode in. “Who is old hemorrhoids?” I asked Tatya. “It is our Dean. It is rumored that he has third degree piles, by the way he shifts from one buttock to the other while sitting. Short tempered bugger though. But a decent sort. Likes residents”

Finally, surgery was called. We trooped into the secretary’s office. My teeth chattered with cold. The air conditioning was on full blast. “Look at you! you will catch the death here if you’re not careful. Have some hot tea” This was Mrs Kane, the matronly secretary. I gulped down the piping hot tea gratefully. Tatya gave me a stare, followed by a wink. “I see that you have a way with women. Must teach me your technique” We went into the Dean’s chamber. He peered at us over his reading glasses. “From Pune, eh? Why did you not try at the BJ medical college there? No matter. In any case, this hospital is like the United States of America. We welcome the flotsam and jetsam from all over the country”, he exploded into laughter. I grinned weakly.

“Now comes the tough part”, announced Tatya. “We have to meet the Old Pete and get our posting letter from him” Who is ‘Old Pete?” I asked. “Professor Joshi, ‘The Prof’ to us minions. He chews iron nails and residents for breakfast. He can cut you down in a second if you miss something in a patient. A first rate surgeon though. Takes special interest in training residents. Hope we survive”, Tatya smiled wanly. We trooped up to the Department of Surgery to wait outside the Prof’s office. ‘ Dr Praful B Joshi MS FRCS’ read the name board.

We could hear the Prof berating his registrar. “How many times do I need to tell you Rajesh? If a patient develops retention of urine two days after surgery, you have to think of peritonitis. Merely catheterizing the fellow is asking for trouble. We were lucky that We saw the patient today. He will need to be opened up again. Post him for the two ‘o’ clock slot. I will give you a hand” Rajesh’s voice was low and apologetic. We entered Prof’s office, trembling.

Prof Joshi was a middle aged man. He was tall with a lantern jaw and a droopy mustache. There was no sign of any fat on him. His arms and forearms bulged with muscle. He had thinning grey hair. He was dressed in a loose trousers and a bush shirt. His eyes were a deep snappy brown. He looked positively intimidating, towering over us.

“From the Army hey?”, was his greeting. “Ran away from the Army did you?” “No Sir”, I stammered. “I was not selected to the Army Medical Corps because I have a spinal condition” “How the devil are you going to manage surgical residency with a bad back? Don’t expect any favors from me. You’ll have to slog as hard as the others,” He growled at me. “I am from the AFMC. I don’t expect any favors from anyone. If I feel that I can’t manage, you will have my resignation.” I was wet, miserable and furious. No old codger was going to bully me. “Got a temper, I see. Good. We shall see. Prakash and you will work in my unit. Arun will work with Dr Joshi. Go to the residents hostel and get your rooms allotted. You have today to settle down. I will see you tomorrow morning in ward 2 at 730 sharp” He waved us away.

Rajesh was waiting outside. “Either of you worms got a fag?” he asked. I passed him a cigarette and we both lit up. ” Better go to the hostel and dry up. I will show you worms around in the evening. As I am feeling generous, dinner is on me. Welcome to hell’, he hurried off. Prakash  and I looked at each other and grinned. The journey had begun…….

Each Day is a Bonus…..

I noticed that Naina was dressed up to go. I was getting ready to leave for the hospital. “Where to Luv?” I asked. To visit Uncle PJ, was the answer. Uncle PJ? after two decades of matrimony, I thought that I knew all her relatives. “Who is this Uncle PJ?” I demanded. “Your Prof, Silly” was the tart reply. “Old Pete? what is the old codger up to now?” I asked. “He has not been keeping well lately. His cook is atrocious. I am taking some food that he likes” “OK, OK, I will meet you in the afternoon. We’ll return together” Prof lived in a flat all by himself. His only son was in New York. I drove down to his house, not forgetting his favorite cigarettes.

“Welcome, Professori turned Dean” was the Prof’s greeting to me.  He had been to Florence and affected Italian figures of speech at times. “Finally you found time to meet your old teacher eh? If not for Naina, I would have died of loneliness. The  child brightens up my day, not to mention the delicious food that she brings. She is a treasure. Did you get my cigarettes? Pass me my Charminars, will you?” I reached into my pocket and passed on his favorite cigarettes, ignoring Naina’s disapproving looks.

“Uncle, you know that smoking is bad for you. Especially after your last attack of bronchitis. Your physician has specifically forbidden you to smoke” Naina scolded him. “Rajan? he is stupid as all internists are. He was a book worm during his student days and hasn’t improved since. You know Naina, I am seventy six. Each living day is a bonus for me. You don’t want to begrudge an old man simple pleasures in life do you?” Prof pleaded. Naina sniffed.  Prof broke out into a spasm of coughing. Naina and I hurried to his side. He imperiously waved us away.

“You know, you men are incredibly stupid. Why can’t PJ Uncle move to New York where his son and daughter in law can look after him? His grand daughter simply dotes on him. He says that he feels like a bird with its wings clipped in New York. Keeps complaining that his daughter in law bosses over him” Naina was off and running. I diplomatically kept quiet.

The day started off badly and rapidly became worse. There was a steady stream of complaining patient relatives and politicians with grievances. I had developed a splitting headache by mid day. Mrs Joshi, my secretary barged into my office. Her face was ravaged. “Sir, Prof Joshi is admitted to the trauma ward. The nurse told me that his condition is bad” Tears were running down her cheeks. I ran to the trauma ward.

Every month on the first day, Prof would visit the hospital to collect his pension and donate money to the poor patients’ fund. He would invariably drop into my office for a cup of tea. “You make the best tea in the world Mrs Joshi. It is indeed a treat! How’s our Dean Sir doing?” Mrs Joshi would swell with pride and burst into a spasm of giggles. While crossing the busy road that day, a speeding vehicle had knocked him over. He had lost consciousness instantaneously.  Some passersby had picked him up and brought him to the trauma ward.

The routine of the trauma ward had taken over. He was designated as ‘Unknown male, Bed 1 Trauma ward’. His clothed had been stripped off, the hospital gown replacing it. The senior nurse had examined his pension book and gave an anguished cry: “Oh God! It is the Prof!”

I saw him lying still. His face was swollen due to the injuries to the facial bone fractures. It was the Prof alright. The scar on his chest bore evidence  to the bypass he had undergone two years previously, proclaiming his identity.

“Why have you not intubated him? Have you guys forgotten the standard protocols? Nurse, laryngoscope and tube. Get me the Ambu bag” I gave a hard thump to the Prof’s chest. Intubated him at the first go. Started pumping the bag…All this was instinctive. The Prof had trained me too well… A gentle arm fell on my shoulder. I looked up at Prof Vilas through my tears. For once he looked disheveled.  “Guru, it is useless. He has been dead for several minutes. You can do nothing. There are times when a man’s expertise is impotent against a higher will”

Naina sat ashen faced. I sat next to her in mutual grief……

Mumbai was on fire…..

It was 1993 and Mumbai was on fire. Riots had broken out following the Babri Masjid demolition. Gangs of criminals had the run of the Mumbai roads. Wisps of smoke could be seen almost everywhere. There would relative quiet for a few hours interspersed with a spree of stabbing. The trauma ward of Nair hospital saw endless influx of patients with stabs and burns.

One particularly horrible day I was chatting with the casualty officer who looked all in. Suddenly a police van screeched to a halt. Three police constables leaped out. One of them pulled a trolley to the door of the van. They unloaded a completely charred body on to the trolley. The body was so badly charred that I could not even determine the gender. Though I was inured to the sights in the hospital having seen mangled remains, blast victims, this was just too ghastly a sight.

As the body was wheeled into the mortuary, I asked the policeman “Do you carry the Lee Enfield rifle for show? Why don’t you shoot the b******s who did this?” I was immediately ashamed at my outburst when I looked into the red rimmed fatigued eyes of the cop. He sighed “Saab, there is just one bullet in my gun. That’s all that we are issued. There was a mob of over two hundred who doused this man with petrol and set him on fire in front of our eyes. I felt like turning my own gun against me rather than helplessly watching. Things will change now.  The Army has been deployed with orders to shoot at sight”

In the evening Naina, Svini and I had gone up to the terrace of the building “to eat fresh air”; a quaint Indian expression for breathing fresh air. The sight from the terrace was breathtaking with the sea stretching as far as the eyes could see. The Haji Ali mosque stood in solitary splendor.  The Mumbai Central station was to the left surrounded by slums.

Suddenly fire bloomed near the station. Faint screams and shouts could be heard. The air was filled by screaming sirens of the ambulances and the police vans rushing to the Mumbai Central station. We could hear staccato bursts of gun fire. “Fire Crackers!” exclaimed Svini, all of eight. I did not correct her. My heart sank. My unit was on call. I braced myself for a long night. We went down with a heavy heart. Naina patted my shoulder.

The security guard of the building informed me the ambulance from the hospital had arrived to transport me and some nurses to the hospital. The ambulance driver’s face was grim. “Situation is bad Prof” he told me. “My ambulance almost got attacked by a mob. I manged to swerve and drove like a madman. I hope the crowd is gone by now”.

“Daddy, why do have to go? There are bad men out there” Svini wailed. Naina comforted her “Daddy is a brave man. He has to go and treat people who are hurt. He will be back soon” Her troubled eyes met mine.

The ambulance took off swerving from side to side.  It was of probably an Army surplus vehicle of the second world war vintage. The roads were deserted. We went round the ‘Saat Rasta’ circle and headed towards the hospital. Suddenly the ambulance screeched to a halt. Stones thudded on to its body. The windscreen shattered. The driver was blabbering with fear. The nurses with me in the ambulance were whimpering . I felt a cold chill.

I had seen minor riots and unrest in Mumbai. Ambulances and Fire tenders were never ever attacked. This time it was different. There had been rumors circulating that ambulances were being used to ferry arms. There was a crowd of around a dozen ruffianly looking persons surrounding the ambulance. They were asking us to get down.

I could see a posse of policemen at a distance running towards us. One of them put what looked like a gun to his shoulder. I was petrified. Suddenly something landed under the ambulance. It was filled by an acrid ammoniacal mist that made our eyes tear uncontrollably. I suddenly realized that the policeman had fired a tear gas shell at the mob, which was running helter skelter. “Drive” I screamed at the driver. He didn’t need to be told again. We careened into the sanctuary of the hospital.

The trauma ward was in a chaos. There were patients everywhere. Rajiv, my lecturer met me at the entrance, his eyes dancing with excitement. Someone from across the road had fired into the huge plate glass windows of the ward. There were two neat round holes in the glass. The platoon of Gurkha rifles had immediately ordered everyone to  drop to the ground. Some soldiers had crossed the street to the building from where firing seemed to have come. Within minutes a small group of rough looking people came out with their hands in the air.

I went around the ward. The injuries were not serious. There was a body covered by a blood stained sheet. I pulled back the sheet and stared in horror. This was a middle aged woman who had half of her face shot off by a high caliber bullet.

“This is  Kamlaben. Do you remember her, Prof?” said Rajiv. I had met her a couple of times when she had accompanied some patients to the Surgical outpatients.

“She was leading a group of rioters. Had a sword in her hand. Didn’t stop even after three warnings. Had to to this. Pity. The Army hates it when called for civilian riot control duties. I have to counsel my men before and after the duty, telling them that they are shooting at anti nationals and not their fellow countrymen” This was the young dashing  Captain of the Gorkhas

“Doc, the Gorkhas are here. We will sort out the rioters pronto. Don’t you worry” The Captain smiled. His eyes were unsmiling.

 

I will destroy you and your whole family….

The ‘carpentry shop’ was up and running at full tilt. The Orthopedic emergency OR sessions were affectionately called the carpentry shop as fractures were nailed or plated and bolted just as a carpenter would do to his planks of wood.  These patients had been seen in the outpatients in the morning or referred up from the Casualty. Assorted fractures were treated by closed reduction and cast, wounds were sutured and tendons and nerves repaired. It would start at around 5 PM and go on till past midnight. The conductor of the shop was the orthopedic senior registrar, a man mountain. Dilip was the University blue in wrestling. Most of us house surgeons looked puny beside him.

A small Nepali woman was wheeled in from the casualty. I examined her. She had fallen in the bathroom. There was no doubt about it. She had a supracondyler fracture of the humerus. X rays confirmed the diagnosis. “Guru, examine her radial pulse” was the shouted advice from Dilip. I felt for the pulse. It was absent. This is a well known complication of these fractures when the fractured fragment injures the brachial artery. “No radial” I yelled back over the din in the plaster room. “Shit, we have to reduce the fracture right away. Else she will have gangrene” Dilip told me. “When has she eaten? We need immediate anesthesia” The patient confirmed that she had not had anything by mouth from the morning. I noticed a curious thing: all the OR attendants seem to be very reverential to her and treated the woman with the utmost respect. As a matter of fact several actually touched her feet asking for blessings.

“Who is she?” I asked one of the attendants. “She is called Durga Mata Doc” said one of them. “She has meditated in the Himalayas for several years and has acquired several supernatural powers. If she blesses anyone, they prosper. If she curses you, misfortune is their lot. No one wants to displease her”

I took the x rays and went to speak to her. She had the most beautiful smile. When I told her that she would require urgent intervention for her fracture, her face clouded. “Beta” she told me “This period of time is inauspicious. Wait till morning do treat my fracture” I tried explaining to her that we could not possibly wait till the morning as gangrene would have set in by then. She was adamant. It was a No Go. She would not budge. I notified Dilip.

As mentioned already, Dilip was a wrestler and a short tempered one at that. He strode up to the patient. “You had better give consent, woman. Or else we will be forced to tie you down to the operation table and reduce your fracture” I tried to interrupt Dilip. But it was too late.

The woman’s face changed. Her lips peeled back in a snarl. Her face changed to become ugly and terrifying. Her voice sunk several decibels till it became guttural. “You dare to speak to Durga Mata in that tone, you worm?” she growled. “I will destroy you and your whole family. Be very afraid of my anger” The OR attendants were quaking with fear. Though in those days I was an agnostic, cold fingers of fear ran down my spine.

Then Baban, the senior OR assistant intervened. He asked Dilip to move away. He spoke to the woman in a placatory tone. After fifteen minutes of persuasion, her face changed back to its petite calm form. “Dilip Baba, She is willing for he procedure. She wants an apology from you” informed Baban. We convinced Dilip to say sorry so that we could get on with the job. “Dilip Baba, She feels that doing the reduction will result in a disaster. Please be very careful will you?” was Baban’s advice to Dilip who sniffed in disbelief.

She was wheeled into the OR. Sara was the Anesthesiologist. I sighed in relief. She was experienced and had handled difficult cases before. Pre-Oxygenate the patient…Connect to Pulse Oxymeter…Inject Pentothal…Give Scoline….Ventilate with the mask….Get ready to intubate….Standard anesthesia steps. And the lights went out!

It was very very rare for power outages in Mumbai. The last one had occurred several years back. The OR was plunged into pitch darkness. The anesthesia machine that worked on electricity fell silent. There was a stunned silence….

“I can’t see the vocal cords. The laryngoscope light is not working! Oh God! I can’t get the tube in” screamed Sara in panic. “I have to reverse her from the muscle relaxant” This would have been a disaster. The panic was contagious. For once even Dilip was lost for words. Someone had produced a torch. We could see in the faint light that the patient was getting cyanosed.

Suddenly the Professor of Anesthesia bulled his way into the OR. Prof Mehta was rumored to be genius. Stories about his managing patients virtually on their death bed and dragging them back to life were legion. He was also an avid Contract Bridge enthusiast. It was believed that during his free time, he would play bridge against himself!

“You with the torch” bellowed Prof Mehta. “Bring it here and shine it into the patients throat. Sara, move aside. Let me intubate.” Within seconds the tube was in. The patient stabilized.

“Close your gaping mouth, Dilip and get cracking. Can you reduce the fracture?” asked the Prof. Dilip and I sprung into action. Give traction to the forearm….Fingers on the radial pulse….Gently manipulate the fracture…Feel the click when reduction occurs….Gently bend the elbow while monitoring the pulse all the time…..Apply a posterior slab…Make sure that it is not too snug so as to allow for swelling….Whew! it went off beautifully. Dilip and I drew a deep relieved breath… Suddenly we were blinded. The lights had come on thanks to the power generator set that had been installed only that morning!

“Sir, how come you are around so late?” I asked Prof Mehta. “I didn’t realize that it was late. I was engrossed in a difficult bridge hand. Just as I was leaving, I had a strong sense of unease that some disaster was waiting to happen. So I walked around all the OR blocks. Your OR was the last” He explained. He patted Sara, who was ashen. “Anesthesia is like flying a plane. Induction and Reversal of anesthesia are most crucial just like the take off  and landing of a plane. You have to be extremely focused and careful. Once the tube is in, we are on autopilot. I think this has been an excellent experience to all of you” Sara nodded weakly.

The next day, the patient was holding court with the ward attendants who were fawning over her. Her beatific look was back……..