Thursday, February 7, 2013


Salil was in the last leg of his compulsory rotatory internship, and had about three months to go before he became a Registered Medical Practitioner. He had completed his Medicine and Surgery rotations, and was posted to the Casualty department. He had learned quite a bit of clinical medicine and was fast becoming an adept clinician. The senior doctors trusted his judgment and allowed him to handle patients on his own and dispose them off, or admit them, as he deemed fit. And he was, what the medical fraternity calls, “heavy footed”. A “heavy footed” person is a doctor during whose duty a lot of serious patients usually come to the hospital, call it happenstance or call it divine intervention.
            He was on duty that night, with another internee named Arijit. The postgraduate student who was on duty, Dr. Aman, knew Salil from his medicine rotation.
            “Salil, I need some sleep, yaar. I know you can handle the patients. And you got Arijit to help you. Try not to wake me up unless there is some real emergency, okay?”
“No problem, bro. Sleep tight. I will hold the fort for ya!” Salil replied.

It was a dark, moonless night. The skies were overcast, threatening rain. Arijit and Salil sat under an old banyan tree just outside the casualty and shared a smoke. Salil was starting to feel bored. There had not been many patients till then, and he liked to stay busy while at work. They sat there in silence for some more time, long after the cigarette was burned out. It was almost midnight when Salil slapped his friend on the back and said, “Let’s hit the sack. Might as well get some sleep.” They walked back to the doctor’s duty room after Salil informed the nursing orderly on duty to wake him and not Dr. Aman if some patient came to the emergency.
Salil was in that state of wakefulness which precedes sleep by moments, when there was a knock on the door: “Sir, there is a patient.”
He put on his shirt and went to attend to the patient. It was young boy of about 15 years of age. His father had brought him from some obscure village far away, because he had been vomiting blood since that evening. Salil assessed the patient and found him to be in a state of circulatory collapse. His pupils were dilated, his pulse was barely palpable, and his blood pressure could not be recorded. His heart was beating though, and he was taking shallow breaths. Salil went into over-drive. He started two intravenous lines and started to pump fluid into the boy. Meanwhile the patient had vomited blood two more times. Salil started him on the injectable medications known to help arrest bleeding. Arijit was also woken up and joined him in managing the patient. After the patient received about two litres of fluid, his pulse could be felt and his blood pressure became recordable. Salil now felt somewhat confident that this young life could be saved, but he needed blood transfusion. He went up to the father and said: “See, uncle, the condition of your son is serious. We need to give him blood.”
The man just stared back with a blank face. Salil looked him up and down. He looked like a daily wage worker. “Uncle, your son is in a critical condition. His life can be saved, but we need to give him blood. I am giving him all other medicines. But there needs to be blood in the body to carry oxygen, see? And he has vomited so many times.”
“Okay,” the man replied.
“So, go to the blood bank with this form. They will give you what I want. But in return you have to donate your blood. And call someone from your village tomorrow. We will need more donors, okay?”
“How much money do they charge?”
“They don’t charge any money for the blood. But you will have to pay about 500 rupees for some tests. They you donate your blood and they will send to me what I have asked for here,” Salil said pointing to the requisition form.
“I don’t have any money.”
Salil was in a fix. He scratched his head for a while. “Wait here, I will be back.”
He went into the treatment room and called up the blood bank. “Hello, this is Salil, the intern on duty at casualty.”
“Yes sir?”
“I needed about three units of blood for a patient here.”
“No problem. Send over the requisition form along with the donors.”
“Actually there is only one donor available now. I have talked to him to get some more people in the morning.”
“No issues, sir.”
“Another thing. He doesn’t have any money to pay for the screening tests.”
“I can’t help you there, sir. You have to talk to the Medical Superintendent if the charges are to be waived.”
“Okay, let me see what I can do. Thanks.”
Salil stood there with the receiver in hand, wondering what to do next. He was known to the Medical Superintendent, Dr. Saikia, from his days in the Students’ Union, but then it was way past midnight. Would it be prudent to wake him up at this ungodly hour? What would he say? What if started shouting and being abusive, which he had a reputation for? “Fuck it,” Salil muttered to himself, took out his cellphone and dialed Dr. Saikia’s number.
A sleepy, bleary voice answered after some five rings, “Hello? Who is it? What is it?”
“Sir, this is Salil. I am calling about a patient. Actually…
“Is this the time to call young man? Couldn’t you have waited till the morning?” Dr. Saikia yelled into the phone.
“Actually, Sir, I couldn’t have waited. There is this young boy here who is having massive haemoptysis. He needs urgent blood transfusion, but his father has no money for the screening tests. And he looks very poor. If you would waive the fee Sir…” he let the words hang in the air.
“Fine, fine. Do whatever is required. I will sign the bloody forms in the morning.”
“Thank you, Sir, thank you so much,” Salil beamed into the phone.
Dr. Saikia mumbled something and disconnected the call.
Salil called up the blood bank and told them the news. “But I need written permission, sir,” the technician persisted.
“Okay, I will pay the money if you don’t get the paperwork by tomorrow.”
He then went to the young boy’s father and told him that the tests had been made free by the “baade doctor saab”. “Go there now, uncle. Rush.”
Another hour passed by. The patient was stable but there was no blood for transfusion. He called up the blood bank again only to learn that no one had gone there for donation. He went out to the waiting hall to find the old man still sitting there. Exasperated, he said, “Uncle? Blood?”
“Well, you see, Sir, I broke my hand when I was a young man of 20. would that cause a problem?”
“No, it would not. No hurry,” Salil said and guided him towards the blood bank.

The patient’s condition soon started deteriorating. He had another couple of episodes of haemoptysis and was fast going into a state of shock. At that very moment, the father peeped into the emergency room and asked Salil, “Sir, I have high pressure. What if I die while giving blood?”
“You will not die uncle” Salil reassured him. “Just hurry up now, or your son won’t survive.”
“But what if I die? Who will feed my family?”
“Don’t you understand what I am saying old man? Your son will die if he doesn’t receive blood transfusion”, Salil hollered at him.
“Okay”, the old man said, “one less mouth to feed.” And walked out of the room.
Salil was horrified. “Is this your own child? Or is he a fucking bastard?” he shouted at the old man’s back. But there was no reply. Salil shook his head in angst and sorrow, and got back to try save the kid. He and Arijit fought against all hope for close to two hours, but to no avail. The young boy passed away just as the early morning sun was lighting up the dawn sky. Defeated, they sat down on the couch in the duty room. “We did our best. We did all we could”, Arijit consoled a distraught Salil.
 He did not reply. He just sat there with his face in his hands. He sat there thinking how callous people can be. Was poverty the real reason behind it? A young man dies, a family lives on? Or is apathy an inherent part of human nature? He had no answers.


The Cynic said...

Is this based on a real incident? Something tells me it is.

I liked it because it made me feel it was real. And if it was just a tale, I know it is real somewhere, sometime- many times over.

I sometimes feel I never want to see another patient in my life. It may sound callous and selfish, but every patient I see kills my soul a little. For a sensitive physician, the physical effort needed, the intellectual strain- these are not the true sacrifices that one has to make; I believe its the constant exposure to real, first-hand human suffering that one has to endure day in and day out.

Apologies for rambling on.
Wasn't a very pleasant read, but I could relate to it.

blackgames said...

yep this is a real incident..the intern on duty with me was dr arijit roy