Private practice………my first encounter with reality
It was January 2003 when I left Bareilly to join Meerwati Nursing Home , Dadri ,a small town near Delhi . As a paediatrician it was my first independent assignment . Having completed post graduation in paediatrics from one of the best medical college of Mumbai and the experience of working in a reputed paediatric unit of Baraeilly behind me , there was no dearth of confidence , but the nervousness of dwelling into uncertain domain of private practice was at times visible on my face , the kind of reputation that Dadri had especially regarding the criminal backgrounds of its indwellers , only escalated this nervousness .
The 220 km drive ,with my wife and six month old son, looked never ending . We entered Dadri past afternoon , the area was marked by bumpy , practically non existent , roads flanked by vegetable vendors on either sides ,shady market place was filled with vernacular living souls and a stubborn herd of cattle displayed their indecency by refusing to buzz away from what was considered road in this part of the country .
Have I made a right choice ? Should I take a U turn ?
I stared at Rashmi , my wife , anticipating an approval but there was no audible response only a confused grimace and after a brief moment of expressing disappointment our eyes reached visual agreement as the idea of fleeing a war zone was out rightly rejected . With minimal help from a passer by I was finally able to locate the destination of my would be habitat .
Carrying an exhausted body and burdened mind , I entered the Nursing home . There was chaos everywhere ,people moving in and out of multi gated reception area ,some of them wandering aimlessly , a few with plastered limbs were occupying the wooden couch ,it took me some time and effort to introduce myself and after a quick exchange of greeting I was escorted to the second floor residential accommodation .
After such an hectic day , all I wanted , was a good shower and a refreshing cup of tea but this was not to happen and the intercom rang , there was a patients and I was called to the emergency room . Collecting my self again I headed towards the emergency room .
The scene at the emergency was in compliance with the rest of the centre , chaotic . About five to six elderly females dressed in the local attire and exuding the odour of beedi were hovering over a female child lying on the examination couch . The nursing staff who told me his name was Sunder , dispersed the mob and led me to the ailing child . She was malnourished , toxic looking child , about four years old , breathing heavily as evident from retractions of her chest wall and alae nasi flaring , body burning with high fever and skin showing remnants of erythematous rash , after eliciting short history and completing the examination routine , My suspicion was that the child was suffering from measles complicated by superadded pneumonia .
I sat down to have a dialogue with relatives , the conversation , an eye opener for me , went something like this-
“Isko kya hua hai” ( what’s the problem with the child)
“Tum batao , dogctor kaun hai” ( you tell me , who is the doctor)
“Doctor to main hi hoon par aap bhi kuch bolo , kab se bukhar hai” ( of course I am the doctor but you also say something ,since how long the child is suffering fro fever)
“Khasra hua tha chori ko ,
jhara lagwa diya, sado pur mein ,
wo ab theek hai
doctor bola khasra theek kar diy ,a hai , ab pneumonia baki hai
isiliye to tumhare pass layen hain”
Astonished by the ignorant bluntness of the statement I tried to argue but soon realised it was a futile exercise as my knowledge of medicine seemed too dwarf compared to deep rooted superstition . I steered the conversation back to the child’s condition and the urgent need of intervention .
while I was trying to make my point with relatives there was a loud metallic roar outside as if a speedy vehicle has been suddenly brought to a halt , the rubber of its tyre scratching hard against the cemented pavement producing the noise , I raised my head to see a brand new white Honda City had made its way right across the main gate , the bonnet , in fact , infiltrating the entrance foyer . A young man probably in his late twenties de boarded the automobile as everyone looked in the direction . He was a thin man with artificially coloured hair , eyes flushed with overdose of alcohol , shirt out and unbuttoned , a gold chain hanging around the neck , carrying a cigarette stick between the fingers of his right hand and left hand holding an expensive cell phone , he came charging in the chamber throwing an odour which was a mix of smoke and liquor .
‘Kya kah raha hai dogtor?“(what’s happening doctor)
Before I could respond , the old lady I was talking to earlier, replied
“Namunia hai , Bharti karna parega ,
( its pneumonia , needs an admission)
Dagtor kah raha halat theek na hai“(Doctor is saying she is critical)
He pulled the chair and sat in front of me in an authoritative , rather demolishing manner , bending forward onto the table , his right elbow resting on it and fingers pointing in my eyes , he said
“Dekh Dogtor , tere bas ki ho to bol nahi to hospital bhatere hain”
(look doctor if you have the ability to treat , tell me otherwise there are n number of hospitals)
Sudden gush of anger swept my blood ” of course I can manage, I can manage patients more critical than his daughter , even if it meant putting the them on life support measure I can do it. what does he know ?”
I wasn’t expecting any courtesy from him but this offensive behaviour was new to me . Not accustomed to such rudeness I wanted to shout back , to tell him that his daughter’ condition was a result of his own ignorance and apathy and he was the one responsible for condition , not me . However none of these feelings surfaced as the practical implication of such an out burst intermixed with the element of fear which has crept in me by now, advised me otherwise .
Outwardly I could only muster enough courage to say that I can treat your child and possibly cure her but of course there is no guarantee .
“No.. Guarantee..ee ,he roared ,
phir tu kahe bat ka dogtor hai , hain bhai
( if you can not guarantee then what kind of doctor you are)
“Tere se achcha to wo tha ,
jisne kahi , char din mei gaurantee se khasra theek kar devega ,
so kar di ,
ab namoonia bacha so tum karo “
( he , the quack, was much better than you who said he will cure measles with guarantee in four days and he did it , now pneumonia is left and its your turn to cure it )
Bewildered and not sure whether to laugh at his ignorance or cry at my own pitiable situation I glanced towards Sunder, the nursing staff, for help , he gestured me to follow him to the adjoining room , I complied . In the quiet of the neighbouring room I asked him in a hushed voice
” who is this guy ? What does he do ? Is he some kind of a goon? ”
” yes”, replied Sunder
” His name is Ranveer , he is a useless fellow not doing any thing but now , empowered with two crorers compensation , that he has received , against the land from Greater Noida Authority , loot , arson and decoity has become his proud profession .
” Two Crores.. I gasped ”
” Yeh , every body has got money , even I have received 50 lakhs “.
“Fiftee lakhs” , I sighed
Here I am who doesn’t even have 50000 in my pocket after 12 years of slogging .
Suppressing my astonishment I asked ” what to do ? Should I refer her ?”.
“He won’t take her away ” Sunder replied .
“why , he is rich and can afford big hospital ” I continued .
” you can try” sunder said with a smile .
I came back to emergency room , tried to make a hasty re examination of the child which was actually an effort to pretend than the actual deed , and resumed my dialogue with relatives of the child .
I told him that his daughter was critically ill and since money is no problem for him it will be in his interest to shift the child to Kailash hospital straight away without wasting a moment , even before I could complete my statement , the foyer outside echoed with a thundering cry . An old women collapsed on the floor beating her chest with both her hands .
“Arey dogtor ne jawab de diya ,
(the doctor has refused)
chori serious batave hai ,
(Girl is critical , he is saying)
Kailash ki kah raha hai”
(advising to shift her to Kailash hospital)
Her cry had a cascading effect and soon the melodrama engulfed the entire hall .
An old villager who was probably the grand father of the child came forward and asked ,
” Kailash le jana parega? , tere bas ki na hai “
(is it necessary to shift to Kailash , is it beyond you)
“Rakesh to kahve tha , bambai se dogtor ayaa hain ,”
( Dr Rakesh ,the owner had told him that the new doctor is from Bombay)
not able to find any word to answer I just nodded .
“Kitna kharcha aa javega kailash mein”( what will be the approximate expenses in Kailash)
“kareeb pachaas hazar “(approximately fifty thousand) , I said .
The old man glanced at the goon for his reaction and the goon , responding to the situation , articulated the most unbelievable sentence ever spoken , a statement devoid of any human sensitivity , logic and belief .
A statement beyond imagination and human comprehension .
A statement whose words are still echoing in my senses .
He said ,
“ dogtor pagal ho gaya hai kya , phachaas Hazar , yu chori ke liye kharcha karavega , isse saste mein to doosri aa javegi , aur karne ka maza avega , so alag .”
(Doctor ,have you gone mad , fifty thousand for a girl ! Giving birth to another child will be cheaper and the pleasure having sex , complementary )