Tuesday, December 1

Developing story [OLD]

The day couldn’t have been better, the Sun was making his come back after the night’s rest and his glistening arrays had started painting the sky with the red and orange streaks shaded at places by the shreds of cottony clouds and the Coruscant Master himself peeking from across the snow-clad mountains bordering the green valley making the visual, picture perfect, as he watched from the window of his valley view room.

It has been quite a vacation away from the perpetuating misery of his remote government hospital of Rajapur where he and his wife Anuradha were working for the past twenty-five years as the only medical officers catering to the needs of the minatory tribal population.

Life has been merciful he thought, as he sipped his morning tea-imbibing the captivating ambiance and throwing an adoring glance toward his two children. Though not as splendid as he would have desired, living in the far off small town- along with its daily challenges, as he analyzed the course of his life at this stage, was certainly good enough to allow him a dearie sigh of satisfaction especially looking at the way they had managed to shape up the upbringing of their children. Gaurav the younger one has cleared his engineering entrance and waiting for his counseling while the elder Pragya was in her final year MBBS.

The visuals of those early days of his career were fading but the assertive forces of the emotional bondage with the feeling of living with his own decision had made the imprint unforgettable and a minimal stroke of nostalgic penetrance could revive it easily as was happening today.

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Twenty-five years ago young Dr Rajesh, having fought with aspirations and desires of his family to see their only son settling in a metropolitan city , having exhibited an attitude of apathy and disregard for the solemn promise and sworn responsibility of providing a blissful future to his newly wed gynecologist wife- who definitely was entitled to such a future by virtue of her own education and upbringing and by the act of marrying a convent educated, duly qualified surgeon of respectable Brahmin family but had excepted the role with pride and duty-bound grace of a devoted Hindu wife, a guilt which Dr Rajesh carried for the large part of his early married life and above all having challenged himself about the purpose of becoming a doctor, had walked into the dilapidated hospital building along with Annu to join as duty medical officers. Whether Annu’s unconditional submission to her husband’s philanthropic wish was reflective of her nonchalance or of unavoidable acceptance, he could never tell for she never complained not even when the primitive hospital infrastructure and an uncaring, indifferent and untrained hospital staff challenged her professional capability to deliver her first patient.

It was almost middle of the night, they had gone off to sleep after spending the entire evening unpacking their stuff and after accepting noodles as their formal first dinner menu, when an impatient hammering noise at the door had jolted them out of their sleep only to find Mangatram the hospital compounder standing at the door. Mangya, the name he was called with, a man in late twenties with short stout figure of a village local,  went on with narration in a frightened haste -his wife was pregnant and was due to deliver at nay moment, the nearest district hospital was seventy miles away and there was no transport at night. After the moments of consolation and reassurance were over Rajesh and Annu went to the hospital to attend to their first official case.

it was dark outside but the sky was clear

The dark shadowy reflection of the duo, against the dim yellow light, on the dirty side walls of the corridor, ran ahead  of them, as if they were running in a dark tunnel deep inside a jungle with no one but their own shadows to reckon with, the moaning shrill of Kunta penetrating the dead silence of the otherwise abandoned looking hospital ward was the only audible syllable apart from the thumping of their own shoes against the floor and some infrequent chirping of crickets. They were led quickly to the labor room by Mangya who, of course, was running at a faster pace. Outside of labor room, an elderly looking night staff whose disheveled hairs, half opened eyes and the reluctant attitude couldn’t conceal her annoyance of having made to wake up from a comfortable night sleep which was perhaps her otherwise usual duty routine. As Annu went inside to check the patient Rajesh couched himself in the only chair available there, his gaze followed the flickering darkness of the old fashioned fan suspended almost three ft down from the ceiling with the help of a rusted rod which itself was undulating widely in a circular motion making the impression grotesque. His thoughts moved swiftly from the anxiety of unfamiliar surrounding to fear of uncertain happening but soon he found himself caught in the web of even greater emotional tangle, the feeling of guilt. The guilt of having dragged his wife to spend her life in this lowly village environ where her intellectual and professional faculty would be challenged at every step not to the academic greatness of the case but rather by the nonavailability of suitable infrastructural tools, both physical and mental, to deal with them. Instead of offering her the glitter of a big private hospital in some of the bigger cities, he had almost forced her to come to a place like this which is demeaning even to talk about. A dull line of reflection from the extreme right periphery of his visual field caught his attention as he moved his head sideways, the light came from a metallic instrument tray lying carelessly on what should have been the examination table, suddenly a shiver of fear ran through Rajesh’s blood, ‘what about sterilization are these instruments sterilized lest Annu might catch an infection’, he wanted to warn Annu but his caring thought were interfered with, by the sound of Annu marching out of the labor room,

“Its meconium and the FHS is dipping down,” she said wiping her hand with the hand towel.

“We will have to go ahead with the cesarean section” she continued in a controlled manner not yet having struck with the realization of unprepared settings.

“Of course, you are not serious’ Rajesh said his voice slightly heavy with the bit of genuine concern.

“We don’t have any other option, nearest help is seventy miles away and there also, the surgeons may not be available”, she glanced at the nursing attendant and said getting into the grove of realism

“This is your first patient  and moreover we are not even sure whether it can be done here, I mean do the facilities for a surgery of that nature even exist here?” words rushing out of his mouth speedily as if the sheer pace of the words would somehow mask the anxiety they contained and perhaps show them a way to avoid the danger they were getting into.

” As for your concern regarding this being my first case, honey I have to begin some day.  True ! Destiny has not given me the liberty of exercising caution and selectiveness in choosing my first case but that’s how it is, plus my concise wouldn’t allow me to refer her anyway especially with the possibility of an anticipated mishap occurring on the way.” Rajesh was awed by the calm sternness with which she articulated her words. His stare drifted towards the smooth curves of her facial lines, the lines so beautiful. The radiance of her brilliant eyes and the astute elegance of her shapely figure gave purpose to the morose hospital setting. Beauty is not a virtue to be appreciated in isolation, it needs to be garnished with purpose and deliverance, the likes of which he was presently witnessing.

“don’t get lost anywhere Mr. thinker, no time for that,” she said, widening her eyes, in a mystic tone ofa lover as if acknowledging the hint of appreciation.

“I am sorry, I got you into this mess, Annu, but, I love the fact that you seem to be much more confident than me”.

Rajesh said continuing his appreciative look.

” You and I have adopted different roles, I am in the role of a doer and you are acting as a protector, a protector whose hand are tied by the rope of guilt and that too of his own creation. Confidence is the hallmark of faith guilt, on the other hand, crushes it. I seem to be confident because I have faith in your abilities to protect me, you need to cultivate the same faith in my ability to perform. I am here because I love you and your decision, Don’t let stupid guilt come in between us” she said coming closer, her voice soft yet firm as before, Rajesh saw the adoring plead in her eyes, which was the purpose he was seeking.

” let’s get going then, ” he said holding on to the tone just a bit longer, to give it the meaning, it deserved.

” What all do we have in terms of equipment and machinery ?’ he asked.

” The OT light is working, the instruments are all there, but have never been used, you will have to check the autoclave unit,” Annu responded immediately not missing the sense of urgency.

“Autoclave is working” in came the voice of nursing attendants as both of them turned to look in her direction.

“If no operation has ever been performed here, how can you be sure that its working” Rajesh asked, the question was asked more in the manner of surprise than of actual questioning.

” We use the autoclave for boiling water for our own purposes like bathing, washing etc.” the nurse replied, avoiding the eye contact, an effort, perhaps, to avoid exposing, the prevailing incumbency.

They both looked at each other and smiled, their smiles crossed at an angle to avoid the full jerk and so as not to disturb the continuity of their action.

“At least it was put to some use, and not choked like the rest of the hospital system”, Rajesh said as he moved on to sterilize the instruments and the draw sheets, while Annu called Mangya to complete the ritual of taking ‘an informed consent’

Annu went on with her narrative, with professional ease, trying to explain in detail the risks and possible complications related to the procedure especially keeping in mind the deficiencies they were facing with, Mangya listened with the attention of an ignorant mind, the only feeling that one could capture on his face was of hopelessness and surrender.

Hope, Rajesh thought, is a strange feeling, while its total lack made Mangya surrender to his destiny an abundance of the same kept Rajesh going. against the oddities of the situation, he had hope of accurate recollection…recollections of procedures which he had only seen and not performed on his own, how could he ever imagine that a day might come when he will have to work like an OT Technician-prepare the theater, clean and autoclave instruments and worry about the oxygen assembly all by himself. Even in the multiplicity of roles, he was pursuing to fit in, there was one role that he was still oblivious to, a role he was ultimately compelled to take.

The thought struck him soon, and to both of them, simultaneously as the patient mounted the operating table, blood dripping from under her surgical gown, dictating the urgency, ”  who is going to give anesthesia ?” the question came as sudden augmentation of tension that left them both panic-stricken.

” Dr. Uday is on the payroll but he comes only during the day time and that too, for elective cases only,” said Sandhya, the staff, her tone carrying a hint of mockery as if implying that the whole effort was nothing but a futile indulgence of novices without any pragmatic consideration.

” I can give spinal….I mean…. I have done three months posting in the department….I think I can manage…I hope…” Rajesh offered to bail out of the situation. ” Is that allowed legally or even ethically?” asked Annu her voice had a quality which was a strange mix of bewilderment and hope, she wanted to say no but expected to hear yes.The answer, however, came not in words but only in the glance- the glance which said, that the  question itself was out of place and irrelevant, that the matter was beyond any questioning, a glance which held in its swiftness the acknowledgement which Annu returned in the same format of visual acceptance which she continued to hold, when the spinal needle entered the intervertebral space, when the drug was injected and when Rajesh quickly moved to assist the operation. not a single word was spoken as Annu’s hands moved with professional efficiency to quickly open the abdomen through the paramedian approach, to dissect the layers and expose the uterus. to incise the lower uterine segment and to extract the baby out from her uterine position. the room held an air of silence as all three living souls waited with baited breath to hear the cry of the fourth one, which came, sooner than expected allowing them a sigh of relief.

“Sister clear the oral passage quickly, the liquor was stained with meconium ” for a moment Annu.s attention was directed towards the newborn in sublime recognition of a potential complication-meconium pneumonitis but this little drift away from the operating site had made her, temporarily, oblivious to the sinking silence that Rajesh was going through.”what’s the matter?”and without waiting for the answer, she yelled, at the very next moment “oh! hell, she is pouring”

“Relax, and pass me a fresh sponge,” Rajesh said in a calm and composed voice, trying to control any spillage of anxiety. The operating field was obscured with the flood of blood, every nook and corner of the gravid uterus was oozing profusely. “we have to secure the angles fast,” Rajesh deliberately kept on talking, repeating the steps of the procedure as per the protocol as if making a conscious effort to engage Annu and prevent her being engulfed by the sea of tension and to avoid the “surgeon’s block” which they both knew could happen with anyone in a situation like this.

After the uterine angles were secured tightly by the suturing thread and the structural demarcation of the organs and the layers improved it became clear that the bleeding was chiefly from the uterine cavity itself. “it’s postpartum hemorrhage ” Annu’s voice sounded  clearer and more in control of herself as she went on, “uterus is relaxed, not contracting properly due the effect of prolonged labor”.

“Can someone check the blood pressure and can we do her hemoglobin at this time?” Rajesh said without a pause and without any hint of actual hope but the answer did come as surprise when the nurse informed that the laboratory technician lives on campus and is camping outside the operation theater to give company to his friend Mangya. 

“Then summon him inside urgently ” yelled Rajesh “and ask him to do blood group and hemoglobin and what’s the BP?” he continued gently swaying his head backward in a slow rotatory motion, a habit acquired since college days as an unconscious effort to shirk off the anxiety spasms. Blood pressure is falling probably nearing 80 he was informed, by the hesitant voice of the nurse, and he knew, by her unconfident manners, that value could be lower only she didn’t posses the competency to accept the actual. there was a shudder of weakness in his knees as the feeling of impending doom crept in ‘ the patient is sinking ‘ he thought, the shudder ascended upwards giving his hands a slight jerk as he tried to focus on the red glow emanating from the center of the operating field where the uterus lay extracted like a large dough of meat pulsating and oozing, though the incision at its lower segment was sutured neatly, For a moment his temporal muscles flexed in suppressed anger, anger directed not at the nonavailability of the supporting staff nor at their apathetic attitude but on his own temporary insecurity which has started eroding his otherwise confident composure… it’s a fierce battle and he must go on   

“She is still bleeding” Annu’s anxious voice jerked him out of his trans ” uterus is not contracting properly and her blood pressure if falling as well we need to do something, and that too, quickly, but what?” Annu continued without looking upward, a small concretion of glistening white pearls had started flowing down from her forehead downward forming a thin line of sweat drifting smoothly into the curves and crevices of her neck.

“Let’s Do It,” Rajesh said, this time staring directly into the eyes of Annu infusing the sense of determination, which he himself was seeking a moment ago. “Let’s do what?, Hysterectomy! Are you serious?” Annu’s exclamatory tone carried the bewilderment of her glance that swept the breath of the room making brief pauses at its occupants the nurse and technician who was drawing blood sample finally resting on Rajesh’s stern stare as if making a visible effort to believe the unbelievable- her first caesarean section ending with hysterectomy. She shuddered momentarily, made a forward rotation of her right shoulder synchronizing it with a sideways tilt of her head, to wipe off the stream of sweat about to drip from the angle of her right jaw the consumed modicum of time acted as a cushion to absorb the shock.

“There is no other course of action at our disposal right now to salvage this patient and our neck as well,” Rajesh said in a low but confident manner his head nodding in synchrony making a deliberate attempt to reassure Annu. “we can explain anything to anyone if the patient survives, death, on the other hand, will be completely unexplainable”. “what’s her blood group he asked looking at technician. ” It’s A +ve “, in came the reply 

” It’s A +ve “, in came the reply from him who was through with the procedure by then 

” Excellent, that’s my group as well, so it’s settled we will go ahead with the hysterectomy and to take care of the falling BP we will infuse rapid fluids coupled with the blood transfusion with the blood which I will donate as soon as I am through with the operation” Rajesh announced as he looked at Annu, waiting for a nod of approval, a sign of response but there was none, Annu’s elegant persona has transformed into a mechanical robotic silhouette, carrying on with her job like a pupil who has just received a beating from her master, the master, in this case, happened to the unseen destiny. Her vision seems to be fixed on the bloody circles spurting out of the glowing sheets of the layers she was dissecting, circles grew bigger and darker merging with, the blackness of the thread which secured the bleeders, with the blinding shadow of the OT light, with the images of the people occupying the room and those standing outside when she walked out after completing the surgery. She didn’t notice anything neither the cry of gratitude in Mangya’s eyes when he touched her feet nor the sigh of relief on the nurse’s face depicting the narrow escape from a major tragedy, what mattered to her was, the sense of satisfaction, which she had a glimpse of,  in the eyes of Rajesh as he lowered himself to the examination couch ready to donate blood.

What mattered perhaps, was the feeling of relaxation she felt in her aching muscles…and what definitely mattered was the fact that, a life was born…successfully.

During the days that ensued the choked engine of Rajapur general hospital was put to start like an old Lambretta scooter after multiple kicks and tilt kissing the ground for extracting the last drop of oil, like an old kerosene stove;s burner cleared with the thin aluminum pin.

The news of a doctor couple having arrived spread like wild fire, a local newspaper;s headline read ‘ Doctor donates his own blood to save a pregnant female’s life’. The humility of Rajesh and Anuradha became the talk of the town, news of their competency reached far and wide and the queue outside their OPD clinic started swelling up

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Warmth of the crepuscular ray descending from the mystic clouds of the mountain town interrupted Rajesh’s nostalgic sojourn, the warmth that he carried held up in his glance as he turned to look into the adoring eyes of Annu which seemed to admire his relaxed posture as mother would admire his son sleeping after a long day of work. ” Why are you looking like this?” he said giving his eyes a subtle mystic roll.” Nothing, I was admiring your relaxation, I am happy that we took this vacation there have been very few instances when I have seen you relish your inactivity, tell me what were you thinking.” Annu said in a tone that itself conveyed the mood of relaxation as is telling him that this holiday morning she is ready for the introspection which Rajesh was seeking.

“I was thinking about Kunta And Kiran, our first case, and the journey thereafter”

“Why today”

 

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