Tuesday, October 27

Why Am I A Doctor?

In this stir-crazy moment when every one of us is confined (or should I say must be confined) inside the boundaries of our homes, I thought, why not to turn some pages of my doctor’s diary and share them with you. No, these aren’t ben-Trovato. Hypermnesia? Yes, you may call it that.

This page is from September 2017.

This was a routine day. I went to my private medical centre as usual. (Oh sorry, just to tell you, in case you are a new reader, that I am a paediatrician and my wife is a gynaecologist and we have our own medical centre at Ghaziabad.)

Besides the routine OPD, there was only one operative case for the day, cholecystectomy (Gall Bladder Removal). Well again, I am a paediatrician alright but for my own set-up, I function as a resident doctor as well. Coordinating with other consultants, managing patients other than Gynaecology and obstetrics comes under my domain of work.

So, after all the instruction were issued to the concerned staff regarding patient shifting and pre-operative protocols, I sat for my OPD consultations. My wife, Rashmi entered into my chamber a few minutes later and said.

“What time is the cholecystectomy planned for?”

Right now, the surgeon and the anaesthetist are coming in another fifteen minutes,” I informed her.

“You will have to postpone that,” she said

Why?”

“Because I’ll have to take up one for Cesarean section now. She has just come, previous LSCS (cesarean section), the scar is thin and FHS is irregular.”

I looked at her to judge the gravity of the situation, to decide whether the lines on her face expelled routine anxiety or impending crisis. They were routine. However, my medical knowledge and experience were enough to tell me that LSCS should take precedence over Cholecystectomy.

Alright, I’ll inform everyone accordingly,” I said.

The entire team was informed and the rescheduling was done accordingly. I sat once again to cater to the patients waiting for OPD consultations. Hardly had I seen two or three patients when the intercom in my room buzzed and I heard my wife’s voice once again.

“Go ahead with the cholecystectomy first,” she said sounding a little bugged.

“Why, what happened?”

“They aren’t ready to give the consent,” she said.

“But why? You said its a previous LSCS case so, I presume they know what it’s all about.”

“Not only its a previous LSCS but it’s precious one as well. She has no live issue, her elder kid died at the age of six months…some fever… don’t know what? Papers not available.”

“Great!… and still they are not ready for the operation?” It was my turn to be irritated.

“They are ready for the operation but not right now, they are waiting for the patient’s mother-in-law to arrive until she comes they won’t sign the papers,” my wife said.

“You have told them about the possible complications of delaying the procedure?”

“Yes.”

“Okay, then what can we do, let’s wait.”

The scheduling, postponing and rescheduling was accomplished, with a little fuss of course, from the Gall Bladder patient who was fasting overnight but it was done. At around two o clock after completing my consultations, I checked in to inquire about the status of the LSCS patients. I was wondering why I didn’t get a call from the OT yet, to attend the cesarean.

“The mother in law hasn’t arrived till now and we all are still waiting…no they won’t allow till she comes.” Rashmi’s irritation level was rising and so was her anxiety index.

What about the patient? Is she all right?… The FHS?” I inquired, as long as the patient is stable we still had time.

“There was no meconium when I punctured the membranes a few minutes back but the FHS is getting quite irregular, I don’t think we should delay it much. As for the attendants, they are still adamant.”

Meconium: First stool of the baby is called meconium and if it is passed in utero, its an indicator of foetal distress. FHS: Foetal Heart Sound

“In that case, I think we should have a little chat with the husband right now and get a few things straight. By the way, how busy is Dr Vivek (our anaesthetist)?

“He had a case in Ambey hospital and will be free by three he had said,” I was informed. The only prerequisite to take up the patient stat was the availability of the anaesthetist. Anyways, another half an hour or so we will wait but it shouldn’t go beyond that, I thought.

Rashmi was right, the man, the patient’s husband, was adamant. He didn’t agree. I looked at him surprised. Here was a man about thirty-five years old, thin, tall and with a pair of authoritative eyes and my reading of those eyes said he was definitely capable of his own opinion and not depend on his mother’s nod to take a call.

“Mr Niranjan, do you understand that any further delay in operation could be troublesome.” I tried goading him, “I don’t understand you, your elder kid died at six months of age, you don’t have a living child, this is a precious moment for you and still you intentionally want to delay it.” I looked at him waiting for an answer.

He didn’t answer

“Okay, in that case, I am afraid I’ll have to refer this patient to some other hospital. I can’t allow a deliberate folly, not in my hospital.” I said in a firm and strict tone. Did I mean what I said? Would I actually have referred the patient? No man, It wasn’t possible for me to do that even if I wanted to…shifting the patient at that stage was more difficult a proposition.

“Let’s wait till three-thirty at least, my mother will be here and you can go ahead with the operation then,” he said.

I studied his face for a moment. His expression was blank but only ostensibly so. His blankness had a deceitful shade, there was something I wasn’t able to read. He was anxious alright, but the degree and the colour of his anxiety matched neither ours nor the demand of the situation. Ignorance perhaps, I thought.

I can wait only till three o clock,” I said decisively.

He agreed, though a bit reluctantly. The protocols were set into motion and the operation was planned for three o clock.

Once inside the operation theatre, I checked all my resuscitation equipment, Laryngoscope, in particular, a routine I follow since my residency days much like looking skyward to pray for his mercy before the uterus is incised.

Rest of the OT checklist was ticked as well and the incision was taken. I was waiting to receive the baby. I prayed.

Its meconium, ” I heard Rashmi’s voice when the bag was cut.

What? You said there was no meconium?”

“It was, not anymore,” she said.

I looked at the baby the moment it was handed over to me. It was a big size baby, must be three and a half kg or maybe more but that wasn’t my worry at that moment. What disturbed me was his colour, blue, cyanosed and a mix of dirty yellow due to meconium. What was even more worrisome was that he lay still without any respiratory effort. I checked the cord pulsation, barely sixty to seventy, I had to intubate him and I did it.

What? you want to listen about the entire resuscitation protocol, how I revived the baby and all that? Forget it, you will get bored. It will suffice for you to know that the revival took almost three hours and that the story didn’t end there.

What?… Why three hours? Dammit, it takes time, the resuscitation, shifting the baby to NICU, putting him on respiratory support. Everything takes time so what if I had to skip my lunch, so what if I felt like slapping Niranjan for his ignorance, so what if I wanted to kick myself for not being able to convince him to allow the procedure earlier. It would have saved the baby and myself both from a lot of troubles. It was a real narrow escape for us both. You know how bad it is these days, within minutes I would have been facing the mobocracy.

Anyhow, within a weeks time the baby was much better. I was sitting in my chamber when Niranjan entered,

I want the baby to be discharged,” he said plainly.

“I understand the baby is much better and he is on minimum support but I feel a discharge at this time maybe a little premature. You really shouldn’t be asking me to discharge him.”

He will be fine, nothing will happen to him,” he said without a shred of doubt on his face but his voice did have a hint of irritation as if he wasn’t happy with my efforts.

How can you be so sure that nothing will happen to the baby?” I asked.

You know why I deliberately delayed signing the consent form,” he looked at me straight into my eyes as if he was about to make a revelation

Not until you decide to tell me,” I wanted to know what the revelation was, what was I missing so, I kept the conversation going.

Because It wasn’t a good ‘Muhurat’ before three o clock that day,” he said brusquely.

“Good ‘Muhurat’! all these troubles, the meconium the asphyxia, the respiratory problems…all these were a part of Good Muhurat?…” I couldn’t believe his superstitious bullshit, “…you nearly killed you son that day,” I was hysterical.

“As I said earlier my son would have survived anyhow and as for the troubles he faced, you are the one to be blamed. If only you had waited a bit longer, three-thirty was an even better ‘Muhurat’…there would have been no troubles, Panditji told me,” he said rudely, before leaving the chamber.

I was bumfuzzled and kept looking at the door, there was this intense cry that came out from deep within my heart, an intense bleeding cry…

WHY AM I A DOCTOR AND NOT A PANDIT”

Superstition has a way of creeping into one’s subconscious mind, I knew that but what mystical elixir do these Pandits and Maulvis have in their possession to sabotage lure ignorant minds to outpower every logic, I didn’t know. I don’t know even today.

I am sharing this today amidst Corona pandemic with a melancholic feeling deep within me that however big a sacrifice our fraternity may do to save the mankind their efforts will be disowned by the public and the credit will be snatched away sooner than their wishful liking. An act of God, people will say.

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