DIRGE AND SONNET

 DIRGE AND SONNET

That was a typical July afternoon. The monsoons had begun to eclipse the sun, wetting the serene landscapes around Asha Kiran hospital. I had just finished my rounds and was awaiting lunch break to tame my burning stomach. A jeep raced through the iron gates of the hospital to the emergency block, bringing along 16 year old Amitha Khora. The avalanche of attendants had to be cleared like snow on the Himalayan Highway, before I was informed that the patient was a known sickle cell disease. Few pints of fluid, antibiotics and oxygen- the therapeutic recipe for the crisis of this ailment, was a regular ritual at this place. I did not see that it would be a problem to see Amitha up and about. But I was wrong.

Amitha was studying tenth standard, a remarkable achievement in the otherwise illiterate family. Suddenly she developed severe chest pain- a quintessential symptom of the aggravation of disease. The old medical records revealed that she was admitted several times, each time receiving blood and pain killers to assuage the distorted blood cells that ruthlessly plugged the vessels supplying various organs, causing intense pain. Her mother, who became extremely fragile after her son’s death confessed that few days ago Amitha had jaundice and was admitted in district hospital. Her heart rate and rate of respiration were high signifying that the blood levels in her body were rapidly declining. She had to be shifted to the ICU. No one knew at that point that Amitha would need the attention, hard work, prayers and priority of the entire hospital for the week to come.

By evening rounds, heavy doses of sedatives and analgesics were circulating in Amitha’s blood stream relieving the chest pain intermittently. Her respiratory rate was still high but her father’s concern was jaundice- the flagrant reflection of an incapacitated liver. I had to order for the liver function tests if not by intuition but by the pressure of her father. The blood tests showed that there was a block in the outflow from the liver. This caused the reflux of bile- the thick green fluid from the liver for digestion purposes causing damage to liver itself- like a balloon that bursts when inflated more than it can handle. Dr. Susithra, the only one to decipher ‘the ultrasound code’ had to be chipped in. She put a probe in the left side of abdomen and in astronomical speed diagnosed Amitha’s problem as cholelithiasis- stones in the gall bladder- the glass like contraption where bile gets stored.

Misfortunes don’t come in singles. They come en masse. The very moment this school girl needed a surgical intervention to pierce open the gall bladder, the surgeon of the hospital was on leave. Dr. Viju John was telephoned and consulted. He said there was no other option but to cut through the abdomen. We had Dr. Ravi at our disposal, a family physician who also trained in surgery. He rose to the situation and took over the baton of hope. He operated on her and it was uneventful. The gall bladder got decompressed and the remnant of bile was draining through the inserted rubber tube. We wished the story ended there. We wished that Amitha had picked up and gone home happily- like it happens to many other children of her age who come to Asha Kiran. But this was the very moment when the story took the ugly turn.

Round the clock antibiotics, painkillers, oxygen, a surgery- all piled up the bill of the patient. Amitha was showing no signs of improvement. So the parents thought there was no point in paying for the services they had received. The seeds of mistrust were planted in the hearts of the attendants that reaped the fruits of anger, dishonesty and escapism. This probably was the toughest thing to handle than the medical problem per se. Dr. Vinod, one of the calmest of men was provoked and was pushed to the brink of belligerence. There were relatives all around but none wanting to shift her to higher centre buy higher antibiotics to kill the severe infection, or to tackle the financial conundrum this issue was triggering. Everyone became restless- the doctors, the nurses, the parents and above all Amitha. Her heart rate almost doubled the normal and her respiratory rate tripled. She had to be intubated- the painful process of pushing in a plastic tube into the windpipe for artificial respiration.

For five continuous days from this moment, the nursing staff became the epitome of perseverance, turning no stone unturned in trying to pull this patient from the jaws of death. They took turns to deliver care to Amitha round the clock. For the first time, there was a dedicated personnel for an ICU patient from their emaciated contingent. All the staff took turns in bagging in air into Amitha’s lungs to prevent respiratory failure. Unlike their urban counterparts who have the luxury of putting patients on ventilator and move on, the team treaded the arduous task of pumping 17,800 times into Amitha’s lungs per day manually- without a break, without a grumble. Dr. Vinod and his team used to go for lunch at 5 in the evenings. They forgot when their duties finished. The work of the staff humbled the relatives’ fury. As days passed, there was an unconfessed admission that the hospital is stretching itself to save their dear ones’ life. In the meantime, Amitha’s lungs got clogged up with secretions. The purpose of patent airway- the basic of intensive care was not being realised. This mechanical predicament needed a surgical solution. The parents surrendered the child, a second time to the harsh incising knife- to cut open the trachea to deliver a bolus of fresh air. The procedure was successful. Her oxygen levels improved. She could breathe on her own. She began to talk and the parents felt that she has survived the fatal episode.

At 6 am the following day, a phone rung in Dr. Vinod’s house telling that Amitha’s airway got blocked. He was in the ICU in five minutes. She had reached a point of no return. Some malignant mucous plug along the tract blocked the air passage. In the meantime Dr. Viju, the surgeon had arrived and auscultated the lungs. He patted Dr. Vinod’s back as if he was bereaved. Dr. Vinod saw the patient go into an eternal abyss in front of his eyes. He took few moments and then asked me to write the death notes.  Dr. Vinod faced a twin trouble- to pronounce death to the parents and to encourage the staff that gave their best to save Amitha. He stood between the gang of Amitha’s relatives and broke the bad news. A commotion followed in the ward and heartbreak among the staff. Old women were rolling on the floor almost fanatically in a deluge of emotion. The body was handed over and the impending retribution that was expected was averted by the cautious and skilful handling by Dr. Vinod’s team.

In the evening, Dr. Vinod had to deal with the psychological wounds of the staff. Almost everyone in the nurses broke down. The doctors’ meeting was no different. The more intensely we attach ourselves to the patient, the more severe the pain when he/she departs. But when we understand that death is not the end, but a mere passage to eternity, our trouble can be relieved. The seeds sown by their relentless service may show fruit sooner or later. Amitha herself had asked for prayer. The community in small groups went to her and prayed almost daily. Bible verses were read to her and she asked for explaining them like a child groping in darkness for her father’s hand. There is a pervading feeling that she had surrendered her life to Jesus during the stay at the hospital. And if one, among the scores of people who had come to visit the patient in her death bed, realise that it is the love of Christ that the staff were trying to show, the whole effort is a success. Then, the dirge that still echoes in the ward will be lulled by songs of joy in eternity.