Knocked up and out!

Just writing impromptu today. Didn't think over this thing much. But I thought I must put it down before it vaporizes from my memory space.
So they finally accepted that they are not yet prepared to give sex-education to kids studying in Maharashtra board. Of course, they blame it on the kids, saying they are not 'mature' enough to handle SUCH A SENSITIVE issue! Sensitive my ....!
But no use taking my frustration out on these intellectually challenged parents and teachers, for they themselves haven't got it the right way.
You might wonder why should I be frustrated. I can send my kids to CBSE/ICSE schools or educate them at home about certain facts of life. By stepping back from its tentative plans to introduce formal sex-education in schools, the board simply re-enforced how retro our education system is. But there is a reason I take it personally.
Little kids keep coming to my hospital with various complaints. Little kids from orphanages. They are referred to as Ashram babies. But you don't have to look into their files or even the typical printed rugs they are rapped in to make out they don't have families. You just look at them and you know. They are emotionally deprived. They never show stranger-anxiety, an important milestone in a 'normal' child's development. They'd look at you when they are hungry, for they don't know the concept of a mother. They have been fed by various faces. They suck on their thumbs, for food is always poured into their mouths with metal. They don't talk. They walk late too. They raise their arms begging for a hug when you go to them.
I won't elaborate how much emotionally stirred you can by these things.
But it is a fact that children need tactile stimulation for their growth in early years. That, apart from proper food, hygiene, health-care and emotional stimuli. Deprived of these basic supports, they fall prey to majority of illnesses in their most virulent forms. If they make it to their second birthday, they still remain intellectually and emotionally under-developed.
And where do they come from? Some silly teenager who never had an opportunity to know about her body, falls in 'love' with a crook 10 years elder to her and gets knocked up. She is so silly that its only after her tummy starts showing up and women of the house-hold confront her, she comes to know that she's pregnant! Then the whole family either disowns her or simply asks her to get rid of the life in her without letting the society know. Its too late now. So she brings the unwanted life out into the world and never sees its face again.
If only she knew that making love is making babies and you can prevent the latter by some very simple precautions, if only she knew that unsafe sex may get her pregnant and she can still do something about it, if only she knew that the life she created is her responsibility and no matter what the society says, she loves it too much to abandon it, her child would know the security and love of family.
And who stopped her from knowing it all? The teachers who know everything, but aren't comfortable talking about it. Those goddamn hypocrites are creating orphans every day!
They ought to understand that its the BMC schools that provide education to the lowest economic class of children. Girls seldom continue their education beyond 8th or 10th std. Richer kids have access to various learning material and they know it. They may turn into pervs, but they at least know. Sex education or shall we say 'family-life education' is the need of the hour. We are already over-populated and the unwanted pregnancies symbolize a saying in hindi- garibi mein ata geela! We cannot afford luxury of comfort. These girls must be told where they came from. The knowledge-attitude-practices gap, so called KAP GAP cannot be closed by postponing introduction of sex-education in BMC schools.
For the sake of the innocent lives who never had a say in the decisions of their existence, lets just tell the kids...

The battle

Two resident doctors entered the Pediatric ICU (PICU). They had come especially to help out their lecturer in managing a critical patient. An artificial respirator had been brought from somewhere to the PICU for the 10 year old boy who was suspected to have deep vein thrombosis with pulmonary embolism with (?) acute respiratory distress syndrome. In straighter terms, perhaps a piece of blood clot had entered his lung's blood vessels blocking it, resulting in various manifestations from edema to death of the lung tissue.

In an air-conditioned hall, a meeting was going on between the representatives of MARD and the government. All the important people were present there. The MARD doctors presented their demands again, in totality. They were hoping that this meeting would conclude positively. But they were firm in their minds that if it doesn't, they'll continue their strike on the thirteenth day as well.

The residents knew how to operate the ventilator. Well, they at least knew a little more than the lecturer who knew nothing about the handling of this new machine. They intubated the child who had just entered the stage of stupor from drowsiness. It took a whole fifteen minutes to connect the endo-tracheal tube (that goes in patient's throat) to the ventilator. It took another ten minutes to adjust the flow, rate, etc on the machine. Two interns and the lecturer assisted the regis, as they are called colloquially. Then they left after instructing the interns.

The MARD reprenstatives were a bit less confident this time. They were fearing a split among themselves. The government people had just begun to realize the huge nation-wide support the striking doctors had gained by now. Everybody was blaming the government and not the doctors for the patients' misery. The doctors had their best chances tonight.

After an hour or so, the tube got disconnected somehow and the machine stopped. The lecturer didn't know how to operate it. He started giving intermittent positive pressure respiration with the AMBU (ambulatory manual breathing unit) bag. The child's heart rate was dropping. He instructed the nurse to push atropine and adrenaline down the patient's IV line. The heart began racing again. The IPPR continued. The doctor asked the father of the boy to press the bag rhythmically.

Outside the meeting hall, reporters were waiting eagerly to get the news of the strike being called off. Even they had an idea that it can't go for long now. Someone suddenly said that the government has agreed to the demands. All news channels started flashing the news that the strike was over. A little while later, the spokes-person of MARD said that nothing has been given in writing yet. The strike is not off yet. The meeting is going on. They waited again.

The intern took the bag from the father and pumped for ten minutes. Then the co-intern took over. Then the father again. The interns discussed with sarcasm the hopelessness of the situation- "Now we are just waiting for the heart to stop, right?" The intern tried to connect the pulse-oxymeter to the boys finger. It displayed the message- PATIENT DISCONNECTED. No peripheral pulse could be found. The hand was cold. But the heart was racing. The adrenaline-heart. This continued for another hour. The boy would move his hand once in a while. The lecturer asked the father to call the other relative (mother) to do the pumping in turns. The father wasn't so eager.

The government officials listened to the doctors patiently. They explained their situation too. They negotiated with the doctors on some points. The doctors hoped that they will be taken seriously finally.

The intern was pumping air into the intubated chest. The father went around the bed and lifted and dropped the limbs of the boy one by one. They were lifeless and limp. He said, "Yeh to gaya ab lagta hai." The intern was aghast! "Iski dhadkan abhi chal rahi hai. Aap aisa kaise keh sakte hain?" He nodded apologetically. Then he sat down on the floor and started swaying in sleep. The boy took a gasp between the pumped breaths and vomited blood in the second tube coming out of his nostril. The heart was still racing at 120 per minute. The pumping continued turn-wise for another hour. His mother had come inside too. Finally, the child moved his hands one last time, with a much less jerk than before. The parents called over the lecturer. He examined the boy and declared him dead. No tear was shed.

The news channels flashed the news that the strike is finally over and this time its confirmed officially. The government has agreed to all demands. Finally the doctors have a little more money and a little more respect. Physicians rejoiced nation-wide.

In the PICU, the intern's head dropped helplessly on the table.


The boy was the twelfth surviving child of the Muslim couple who were hardly half a century old. His eldest sister was thirty. His illness had lasted for just a week. I saw the parents sitting on the road inside the hospital next morning, staring into zero, waiting for their deceased son's body.

Dead life...

Warning: Some parts of the following jabbering may appear really gross to some sensitive individuals, especially the non-medicos. Read at your own risk!

Ten days have been managed with a tinge of success. After being in the rather theoretical four and half years of medical under-graduate college, I was suddenly exposed to the full-fledged clinical side, thanks to the RMO strike. People have actually started calling me doctor. I am actually telling them what drugs to take. I am making a difference to their lives. Hopefully, a good one!
And they are making a difference in mine.
When I first saw a cadaver in first year while learning human anatomy, I was blank emotionally. I dissected dead people as easily as I dissected rats in twelfth standard or as easily as I cut vegetables in those days of my glorious daughterhood. I saw the sharpness of the blade separating layers of cells, meeting dead-ends, reverently avoiding cords and tubes. It was simple. Dealing with death is simple.
Now I deal with life. But its not the serene life in the giggle of a child, its life struggling for gasps with choked throats. And when I see it lose the battle, all the pride I hold in the super-advanced knowledge of mankind about our body comes crashing down.
Sometimes, life looks like walking death. She was tall. She was black. Charred. I didn't see her go inside but just when I put my feet on the other side of the door, I saw her walking in small and slow steps towards me. Slow but hurried. The place stank of kerosene. I love its smell. But it stank. Her face was black too, except her eyes which were half shut and her mouth which was strange, I don't remember exactly but I think it was pink. Out-turned and pink. We walked past each other. Two men were supporting her. I looked down at the floor. There were powdery-black foot prints. Ashes of her kurta were flying gently above the floor. 80% burns, I heard someone say. She was shifted to a private hospital immediately. I rushed to the sphygmomanometer to assess another patient complaining of giddiness. Work went on.
Sometimes, a defeated life visits. It doesn't look like death. She was a young slight Muslima once again. Her husband who was crying like a child had brought her along with his brother after she had an episode of hematemesis. (Bloody vomiting). My colleague took her blood-pressure on the stretcher itself while I looked for an artery pulsating with some hint of life. Both of us couldn't find what we were looking for. Her hand was cold and she was still like stone. I proceeded to record her ECG to confirm no cardiac activity. My lecturer said something about uncertainty of life and death and I said yes, only half-listening, for I could imagine the life staring from the half-shut eyes a few minutes ago, and I was stunned even if for just a moment. My lecturer shoved me on the shoulder, half jokingly, "What yes?". I obviously wasn't listening to her and just managed to be polite by saying, "Yes mam, we are so uncertain." Work went on.
But last night those lives re-visited me. Like most somatic pains are worse at night, so are the emotional ones. Shuffling on my bed for over an hour, I kept thinking about them. And I hoped that the burnt woman was burnt deep enough to have her nerve endings destroyed so that she couldn't feel pain. I remembered her mother rushing to her, weeping, seeming more upset because they were an actually happy family and this was the biggest tragedy ever. I remembered I didn't allow a child to go in and see his aunt in this condition and I remembered the Casualty Officer giving me an oh-you-are-so-naive kind of smile at that gesture. I remembered the blood-stained teeth and nostrils of the BD (brought dead) patient. I thought that obviously the rest of her mouth must have been wiped. I couldn't sleep for another hour.
I realized it was stress. Then I realized how stressful it would be for the resident doctors who do this job for three years! Right now it is difficult for me to disconnect my emotions from the things I see every day. My feelings wait till my mind is free from acute demand of alertness. But they don't stop from occurring.
I strongly feel that there is a need to let the resident doctors Have some time during the day, or at least twice in a week, for relaxation and recreation. They must even be evaluated and counseled regularly by psychiatrists. And if they still don't understand, I request Mr. Johnny Joseph, the BMC guy, to just be in the casualty for half a day. The system is acting suicidal by not letting these guys in white coats work in human conditions!

PS : I was very pleased to see my seniors sending calls to the Psychiatrist even for patients showing some sign of depression, irrespective of the fact that he was a thief under custody. And the psychiatry lecturer on call attended these patients religiously, taking enough time to sit and listen and counsel them. Long live the noble professionalism!

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The doctors should've waited till the election season before going on strike.

Carry on Doctor!

Resident doctors are on strike.
I can't make up my mind.
On one hand, logic says that they shouldn't come back until their rightful demands are met with by the government/BMC. The mind knows that they work 12 hours a day and at least once a week, they work non-stop for 24 hours. Their job compells them to be on their feet all the time, literally. Yet they cannot afford to lose a second's alertness. They are supposed to keep thinking all the time about all the patients, remembering the past, enacting the present and planning the future. Neither the mind nor the feet can take a break. Moreover, their actions bear consequences that deal with the most precious thing in the world, life. Hence, the pressure of responsibility and competence cannot be done without. In addition to that, they have to talk and keep the relatives of the patient patient too. And after a week of dealing with them, I have a fair idea how stressed out those relatives can be who even watch over me when I collect 5ml of blood from the patient's vein and they make it a point to tell each time that they don't have enough blood and I end up explaining them that the body has 5litres of it! They panic. They have to be tackled with the mind. If you try their patience, you know what happens. And those doctors are PG students, meaning they have to study for exams. Swallow every word of tonns of fat books!
And what do they do it for? 8ooo bucks a month? Engineers of their age earn thrice that measly amount. The quarters that they live in don't comply with the living standards they have to mug up during some part of their lives. I mean, there are rats and roaches all over! And the flood water somehow always alerts these health-workers first. I ate in the RMO canteen one day and got the runs. Talk about hygiene and prevention...
Then my second personality says (c'mon, we're all crazy schizophrenics!), they do it not for the peanut-sized returns but for the gargantuan experience and knowledge they gain (potentially) by seeing so many patients. They do it because at the end of three years (potentially) they will be the best doctors they can be. If their so called jobs, weren't paying jobs but a simple studentship where they would work only as much as they wanted, even then I think they'd take up these posts and slog the way they do it under authority. Or would they?
When I can't make my mind settle down with a side, I just ask my self a question. What would I do if I was in this situation? I don't have to think twice. I'd not stop working. I choose my work and I do it because I want to work. Not for any kind of worldly recognition. Also I won't stop working because people won't stop falling sick. Even if I have to sit in the casualty to just guide someone to a private hospital in the worst pain of his/HER life, I'd do it. Because I'm human and I respect myself for being one. My respect doesn't depend on how many people I have to share my room with despite having all the skills my profession demands and all the significance my profession holds in the society.
But the government should agree with their demands. Thats the best way to bring this strike to an end. The patients and the interns are suffering after all...
The issue of applicabilty of the morality of an individual to the society and vice-versa remains unsolved in my mind but considering the fact that I have to remain in the casualty for ten hours in the night, I must now go and conserve some energy.