Inside outside

“You should try ascabiol lotion once you get back home” While going back to Gwalior I was watching Pachauri- my research assistant who was constantly scratching at odd places. He had developed this for 2 days now. I was feeling hungry after the days work but was holding back myself to bring out the munchies from my bag. With no antiseptic solution at hand, I cannot afford him to eat from the same packet. It was 4 hours journey and I had to divert myself from the urge of eating something. Instead I diverted the attention by giving him details of how to apply the lotion, what personal hygiene he should be following and some simple rules of restricting the infection. He was craning his neck to listen to the instructions and repeat them wherever necessary.( I had asked him to sit in the front with the driver).

I was in a relieved mood after completing a 12 day long research assignment. Going from one place to another, talking to people, gathering information, collecting recorded data, bringing out perceptions of people, understanding the undercurrent and dynamics had been a tiring experience for me. I was looking forward to get back home. Just before starting the travel I had called home to inform that I shall be reaching home (inshahallah) soon.

In my current assignment, I was given the task to assess efficiency within the government health system when provided external support. My parents are doctors and have been very sincere civil servants. I was witness to the glory that a doctor possesses in a hospital. I was also impressed by the ethics and dedication that my parents worked with. But what I did not know or could not understand the “red tapism” with which the whole system worked. When I finished MBBS and appeared for PSC, my father came down very strongly against joining the government job. In those days it was synonymous to the stability and security for life. Refusing a government job was equivalent to insanity. So although I was an “insider” to the system due to my parents, I was pronounced “outsider” with my father’s decision. Throughout my assignment, I was trying to make up my mind whether I would have been happy as an “insider” or I am happy as an “outsider”

It was almost dark outside with a little February-chill in the air. The driver was relaxed with the mere thought of hitting home after a long time. Relaxation sometimes makes you careless as well. We had just left the town and were 20 kms away when suddenly the roadside boulder disbalanced the jeep. I could feel myself whirling out of it and landing on a hard ground with a thud. Before I could gather my senses, a huge truck passed by brushing me. Oh my god! I am right in the middle of the highway. No no no…. don’t panic! Get up… right, look around…. Where is the jeep and driver and Pachauri? I started calling their names. After adjusting to the twilight, on my right 8 feet deep in a freshly dug trench, I could make out something like a jeep. But why I can see the wheels? It was upside down with Pachauri trapped in the front seat. I could not locate the driver anywhere. As the occupational standards go, he had fled.

I limped to the middle of the highway and started waving at the vehicles passing by. After sometime (which seemed to be ages) a passenger van stopped and tried to decipher what I was saying in a shocked status pointing at the trench. With some difficulty they could rescue Pachauri who was vomiting and dazed. Once in the van, I requested the driver to take us to the District Hospital.  Pachauri now started complaining of tingling and numbness in feet. Oh my god… he may have a head injury and a spinal concussion. “Be in one position - on your side” I instructed him. Mentally I had started making notes of what actions to be taken once I reach the hospital. He should be admitted and seen by specialists to assess the injury and rule out the dreaded possibility of head-injury and concussion. I need to contact the Chief Medical Officer who can coordinate everything.  A passenger was observing me intensely. He leaned forward and handed me over a handkerchief- take this, you will be needing it. I opened it and saw few hundred rupee notes. He said ‘ don’t thank me, first you have to take care of the  your colleague.’ He also agreed to accompany me to the hospital and then to the accident site to retrieve whatever  could be found.

Once in the hospital I was running around to organize admission, x-ray, emergency call to the Doctor-on-duty and then to the Specialists. Against my personality I had to throw a lot of weight and drop some heavy names to get things organised. However, to my surprise this worked at the higher level but the actual doers in the hospital were still unconcerned. They were facing such emergencies everyday and had grown insensitive towards it. Also they lacked professional attitude. I was given a private room which stinked, but my quilt dipped in diesel masked the smell. During the night I went many times to the general ward to see if my colleague was ok and confirm that his symptoms didn’t worsen. Now I was able to look at my self. I had bruised badly in many parts and clothes were torn. Some how our luggage was retrieved but not the money-purse and camera. My left hand was swollen which looked like a fracture. I had agreed to get a temporary plaster (I had to buy PoP) and decided to get a proper management under my father’s supervision who was a fine Orthopaedician, once I get home.

Although the patient’s condition was stable, I had requested the CMO to refer the case to Gwalior Medical College. It being my alma-mater, I felt more confident to go around and seek medical care. The process of referral started early morning. Finally we could start after 6 hours of  clearing the confusion of who was the driver-on-duty, getting the ambulance tyre repaired, sanctioning the slip for POL, getting a referral slip, case-sheet and discharge ticket  from the casualty,  making the Radiologist write his comments on a bad quality X-ray,  requesting the CMO for an ambulance attendant and of course I replaced the nursing staff .

The 200 km journey to the Medical College was completed in 8 hours which was more painful and uncertain than the 2 labours that I had. When I handed over the patient to the Doctor-on-duty and then to his family members, I looked at myself to assess the damage I have undergone physically. I also reflected on my mental status. Being a doctor myself, I was able to coordinate quickly and get the best possible care I could. But looking at the attitude of the staff , insensitivity and apathy developed over the years of being in the system, I thanked my father for his strong reservation.

I had been sitting over the fence many times to analyse my feelings and to come to a conclusion once and for all. But still I find myself pondering on the issue of ‘whether I am happy as an outsider or would have been pleased to be an insider of the system’.      

Lalit’s Six Losses

The baby is lost.

This was third time that I was given the same news in last 2 years of my acquaintance with Lalit. He was support staff in the office. He would finish off the routine work long before we all came into the office. If he had a specific work with anyone of us, he would stay back and meet that particular person.

“Lalit please clean the toilet properly tomorrow. It’s stinking & the dustbin is almost full.” While entering my room, I tossed this instruction to him .He said ‘ji madam’ meekly & did a gesture which meant – can I speak to you? I was putting this face to name for the first time. He hesitated to speak in the open. Sheepishly he extended a medical report – “you are a doctor na? This is my wife’s report. She is pregnant but the doctor say there is no baby inside!” His expression conveyed the confusion and disbelief on the expert. I took the reports still looking at him and trying to hear the noise in his thoughts. Since my entrance to the medical school this was the second case of pseudo pregnancy I was coming across. (This is a rare condition where the woman experiences all the symptoms of pregnancy, except formation of a foetus in the womb. This is due to the strong desire of the woman to bear a child.) I read through the prescription. The couple had lost 3 babies; this fourth one was also a lost hope. He could not believe what I was explaining to him. How can this happen? Should he get one more ultrasound done from a different place? What would he tell his wife? I realized how incomplete my education was. Explaining a rare textbook condition in real life – no teacher empowered me to handle this!

Days passed and I remembered Lalit only with the site of a dirty washroom or a cobweb hanging on my head. On a hot summer day one of the drivers informed me “Lalit is on three days leave. His wife is not well. She had an abortion”. Again!! This time he had decided to conceal the news and avoided medical checkup. Instead the couple was a regular visitor to a mazaar every Tuesday. “You scold him for doing such a childish thing. Why should he avoid a medical checkup? See what the result is!” The driver had concern in his voice. Next day he came with his wife Sunita. A short and obese woman with a smile on her face. The smile was more for the husband to sustain hope . Both listened to my advice attentively- try to avoid pregnancy for next 3 months, go for a medical check up immediately after the pregnancy is confirmed, they can continue the weekly visits to the mazar along with it.

“I wish that you take care of Sunita this time.” He was waiting for me outside the office. His request made my heart skip a beat. This was the ultimate submission of the couple, whose hopes were rekindled for the sixth time. Craving for the child had made them courageous to stake their hopes. I asked him to bring his wife along. What was in her eyes- fear, apprehension, anxiety, faith? I explained the possibilities and risks associated. My limitations to provide the needed care were very well known to them. I was expected to agree to the bestowed role of a mentor for the coming days.

The couple kept me well informed of all the developments. Everything was going on in a smooth way except mid trimester hypertension. I did a regular BP monitoring and spent a lot of time talking to Sunita. It eased out her anxiety. She was admitted to the Medical College hospital due to constant high blood pressure. While supporting the move, I felt relieved in last six months. I had an unknown companion who will take care of Sunita and her baby. In the Teaching Hospital with skilled and experienced staff, Sunita’s known bad obstetric history and a preventable situation of borderline hypertension, she was in a safe haven. Atleast I thought so.

It was a lazy Saturday morning and I was trying to concentrate on a training manual for the health workers. The training is designed to enhance their skills to provide care during pregnancy and delivery. It has been a Herculean task to convince experts that through these skilled workers, safe delivery can be guaranteed to a rural woman in a remote area. Evidence shows that only few women will experience complications   and need sophisticated facilities. I remembered Sunita, her reflection in Lalit’s face which was getting fresher with excitement as the due date was nearing.

“They are putting Sunita on drugs to deliver the dead baby.” Lalit’s voice was so distant and calm over the phone. It took me a full minute and 3 questions to understand what he meant. Words ebbed and there was a killing pause. He finally said “that’s okay, sab mata ki marzi hai (it is destiny). I was ashamed of myself and my fraternity. The couple had given me full right to maneuver the course of action. Why did I rely on others? I should have taken a more active stand. But how could I suspect the experts in an apex institute! They never deviated from the technically correct procedure. I realized that they were running on the technically and scientifically correct path. But they hardly stopped at culverts where sensitivity, empathy, accountability exist.

I have neither spoken nor met Lalit & Sunita since then. It had been breach in faith on my part and I feel guilty to face them. Whom should I ask about how they are coping with the loss? What happened to the new baby’s clothes which they had bought? Is she continuing taking the tonics? How shall I console them when we meet? I do not have any answer. I can only say- “I am sorry, I failed.”