Light from the central lighting dome attached to the ceiling beamed on the focused operative area as the patient lay suspended under the influence of the anaesthetic drugs. Had she not been oblivious to the outside world she would surely have felt the tension pulsating in every nook and corner of the operating theatre. But would she, the patient, have been able to pick up that subtle jerks of anxiety on the accustomed hands of the surgeon, that fine goblets of sweat ebbing from her stressed forehead or would she have been able to see those fine tribulations of fear camouflaged under her surgeon’s calm voice when she conversed with the anaesthetist?..
..Nay!.. you have got to be her husband, you have got to survive through thick and thin of life together to be able to precisely see the hypsyrythmic changes in her neuronal cortex as she cut through the patient’s abdomen, separated the recti and opened the peritoneum to stare at the distorted gravid uterus and when she was about to make an incision in its lower segment she momentarily glanced at me, no movement of the cornea just a subtle nod for consent, consent for taking the plunge together into the abyss.
I stood still, with my hands folded and gloved to receive the baby, a little distance away in the twilight of OT lights and my mind paced anxiously in the crepuscular zone of humanitarian sensitivity and pragmatic reasoning.
About an hour ago in the middle of the night, we were called to attend this emergency patient. As we walked into the corridor of our medical centre there were at least ten to twelve of them in Burkhas and kurtas in the foyer outside the examination room all in the seeming sense of social obligatory togetherness certainly no sense of anxiety and nervousness in any pair of eyes that I could lay my eyes on. All apprehension and agitation of the hour were reserved for us and were duly served on a platter for us to swallow. And it stuck like a fishbone in our throat choking our wit as soon as we looked at the patient.
Face pale as an angel of ghost and stretched in agonising jitters as if every drop of life has been drained out of it, limbs oedematous, abdomen distorted and taut engaged in the futile exercise of expelling the foetus out and her bed sheet soaked with blood and dirty liquor. I wasn’t sure what threw more anxiety spindling up my spine whether it was the extreme pallor of the patient or the awareness of swelling crowd outside, I guess it must be the latter.
” I think we should refer her to some government hospital. It looks complicated, her haemoglobin is barely four, we will need to urgently operate upon her and to make matters worse her attendants seem to be at a different wavelength altogether, totally out of synchrony with her current situation and our situation as well.” I said to Rashmi, my wife in a tone that was a curious mix of fear, concern and prayer.
” I am not sure… she is full term…in labour and bleeding like an open tap. If we take the risk of shifting her she may succumb.” She said in a concerning voice and moved out to be with her patient.
For a moment my mind oscillated between being humane and being pragmatic. The decision whether to shift the patient or operate upon her was to be taken soon. But my poor innocence failed to realise that the decision was never in my hands. The relatives simply failed to buzz. Out of a crowd of almost fifteen not a single person was a close enough relative to have an authoritarian stand.
Next fifteen minutes were spent in search of someone whom I could talk to and explain the gravity of the situation. I paced up and down the corridor peeping in between into the labor room trying to make a visual judgement of the impending crisis. ‘She will need an emergency cesarean section and at least three units of blood,’ I was told.
In the jumble of ignorant idling crowd, there was no one to sign the consent form. Patient’s husband was yet to arrive and there was not an iota of tension on any of the members present. On the other hand, I roamed with a distressed and heavy head. It looked to me as if there was a deliberate attempt to delay in anticipation of a normal delivery. A deliberate and pretentious attempt not to give any heed to the impending catastrophe.
The consent was obtained after much goading and prodding. The sight of indifference on the faces of those who claimed to the relatives of the patient and the utmost urgency of the situation has left me with no choice but to rush my own resident into the dark of night to the blood bank and fetch two units of blood.
After the visual consensus to take a dip together into the depths of looming uncertainty Rashmi’s hands moved to incise the lower uterine segment and the catastrophe began. As soon as the incision was made the shiny gravid organ tuned into a big red blotted mass with blood gushing from it as if somebody has opened the floodgates.
‘Oh, My God!!’ I made a soundless gasp as Rashmi’s hands slid inside the uterus to reach for baby’s head.
” My hands can’t reach till the head,” she said
” Try extracting him by breech, ” this was the voice of Dr Vivek an accomplished anaesthetist and years of his experience with surgeons had made him an equally competent surgeon as well. ” but whatever you do do it fast, her blood pressure is dipping” he continued in a concerned tone.
” The baby is stuck up, I can’t make out his lie properly,” Rashmi’s tone was rapidly transforming from anxious calmness to panic-stricken.
“Try ‘Patwardhan’ and someone please inquire about the blood and Do it fast.” Dr Vivek commanded.
I am not sure whether the baby was delivered by vertex, breech or by ‘Patwardhan’. for the next few minutes that felt like ages, I saw nothing. All I saw was that the fine goblets of sweat on Rashmi’s forehead had grown bigger and were merging into a stream of neurasthenia, I saw patient’s heartbeat shooting up and her blood pressure sinking and pints of haemaccel and other fluids being pushed into her vein to keep hopes of not losing her, alive. I saw myself throwing out my hand gloves and making frantic calls to blood bank as if sheer power of repetition will transmit blood directly into patient’s collapsing circulatory system. I saw the calm confines of operation theatre being turned into a virtual melee of agitation, I saw expeditious hand movements to secure the bleeding vessels, to make sure that the uterine angles were properly held up. I saw obscure figures of familiar staffs moving rapidly to stabilise the patient.
And, I saw my fretful hands under the orders from a numb cerebral cortex ( or was it only the spinal cord….not sure) trying to resuscitate the baby. The halo of his larynx was filled with ghoulish meconium and I struggled to clear it before the little king decides to take his first breath. But the King seemed to have other plan and preferred to sleep wrapped in a blue nimbus. I don’t know what power of prayer I must have exercised to gain the mercy of the little king for he did finally awake.
My senses returned to near normalcy only after the light reflecting from the foreheads of surgeon and anaesthetist made it clear that the folds of tension have been finally eased off and the agitated stream of sweat has been wiped off for good and I saw the red line of blood flowing smoothly into the patient’s vein.
I said near normalcy because when I walked outside the OT through the corridor and into the emergency room to attend to another patient the only thing that held my shaky legs to the grounds of firmness was the sigh of relief that I had spotted on surgeons faces. The atmosphere outside was no different than what I had left before going into the OT. The same idyllic crowd going about there business as usual, not a shade of panic on the faces of relatives as if they have come to attend a birthday party.
I don’t exactly remember who asked what or what reaction they gave me as I walked past them But I remember discreetly well those nebulous words of uncertain genesis hitting me hard, tearing my bones and nerves and instilling deep into my consciousness.
” सब ठीक तो होना ही था, ये सब ड्रामें केवल operation se पैसा कमाने के तरीके हैं, इतना खून तो हम खिला पिला के बढ़ा देते”
If only, and how I wish so, I was pardoned for one murder in my life…… I would have clasped to death the vocal cords that produced this sound but unfortunately, in the country that we live in, the murderous rights are reserved only for the needy.
As I walked into the emergency room the nurse on duty there informed me “Its a simple case of gastroenteritis but they I have no money to deposit at present”. Nothing unusual there in fact a regular scenario but the urge to punish was so hard that I had to find someone and who better than my own self. I looked blankly into the dehydrated face of the child, into the pleading eyes of her mother and towards the ceiling as if there was no roof above me and no ground below…
” Refer him to some other centre” I found myself murmuring as I walked out of the emergency room.
A life was born but the soul of the doctor within me traversed his last mile