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.