DILEMMAS AND DIRECTIONS

DILEMMAS AND DIRECTIONS

October brought with it, the quick transition in weather as the chill blanket of fog, pushed the monsoon winds to oblivion. Likewise, the in-patient department of Ashakiran hospital was putting up its contrasting facets like an artist flouting various costumes. At a moment it was a sanitised version of hell; in the next it became the sentinel of hope. At an instance it offered solace; it broke the hearts of men in the next. In those moments of rapid incarnations, the ward offered valuable lessons as I sit down and ponder over a Sunday that took me through a full circle of dejection and contentment.

The phone rang persistently voicing the urgency of the call that Saturday night. The nurse on the other side spoke in her typical dialect, “Saar, naya patient asla!!” (Sir, a new patient has come). Clearing my eyes of the scales of somnolence, I looked at the watch. It was 2:00 am. Facing a cold that was sending a shiver down my spine, I set out of my room. The wind was making a mockery of the two sweaters I wore to resist the army of winter. As I entered the nursing station, I saw a man fighting with himself, pleading his lungs to allow some air in. The attendants looked at me expectantly as they usually welcome a witch doctor.  40 year old man, presented with breathlessness which happens to him every winter. Every person is allergic to some thing or the other. The man, on the bed struggling to breath was allergic to cold air. The body’s immune system as a response throttled his airways pushing him into a phase of strangulation. The treatment would be to give a nebulisation- pumping in medicated air through a machine that would open up the constricted airways insulted by the icy wind. Three episodes of bronchodilators and the reversible hypoxia would end. Excruciating symptoms and instant relief really make the doctor a healer of sorts. But this time it was not meant to be so.

The involuntary response, as I heard the musical sounds from the patient’s chest was to ask for a nebulisation. The ward nurse in a quintessential response of innocence and helplessness said that the machine was not working. To be exact, the nebuliser was not functioning with the meagre voltage that was hardly illuminating the lights in the campus. I asked the watchman to switch on the generator that shall provide the required voltage for the apparatus to function. The next possible intervention would be to give some oxygen to restrict the furtherance of damage. I was informed that there is no oxygen in the ward. The patient in the meantime was beginning to go into a respiratory paralysis- the phase of muscles giving up after severe exhaustion. The usual audacity gave way to panic. I was for the first time beginning to feel that I would lose a patient for a condition as innocuous as Asthma. I called up the pharmacy. The sleepy attendant said that oxygen was not their jurisdiction and advised me to contact OT staff. I ran from pillar to post. It took 47 minutes for the first whiff of oxygen to enter the patient’s adamant lungs.

Within moments the lungs opened up. The patient was relieved of the distress. I sat down consoling my own breathing that was provoked by agitation. A series of thoughts ensued that challenged my convictions, I wished to build my life on. Why is there so much of a lassitude? What if the patient had tumbled into the jaws of death before my very eyes? Is this because we can condone compromised healthcare for the poor people who have nowhere to go? Is this the equality that Christ talked about? Is all missionary activity only luring people by carrot of medicine to the gospel? It was discouraging and I slept long afterwards suppressing the feelings of anger and self-pity.

Sun kept its appointment and shined brightly that Sunday. It was like a breeze of warmth after a blizzard. As I reached the ward, the patient suffering from Asthma saluted me and awakened the nightmares of the previous night. I pretended non-chalance and finished my rounds. I was about to go to the church when a young lady brought her 8 year old son in her arms. It looked as if the angel of death had just kissed him. He had no radial pulse a sign of life. His extremities were clammy, signifying the poor circulation. I checked his heart. It was beating. I pinched him. There was no grimace of pain. I unsuccessfully shouted in his ears for a response. It was a tough for this child to trek the valley of death into the meadows of life.

We started an IV line. One litre of fluid was rushed into his body. Blood was taken for investigations. Oxygen, this time at a stone’s throw was instantly connected. The body was fuming with fever. A tepid sponging was done. In few hours, blood pressure limped back to normal and temperature was being suppressed to insignificance. There was no response from Koilash who was playing cricket the previous day with his friends when a spirit allegedly took hold of him. The blood smear showed malignant Plasmodium that caused this fatal episode. Two doses of antimalarials were given. The boy was still not opening his eyes. I wondered if I missed something. Was it meningitis coexisting with cerebral malaria? I performed the gruesome procedure of lumbar puncture. The CSF showed no signs of infection. I kept my fingers crossed and my consultant Dr. Viju John taught me the virtue of patience- of waiting for the drugs to show effect. Experience is a virtue that best works in adversity. Dr. Viju’s judgment was right. After three days of admission and the last dose of injection, Koilash opened his eyes and looked. Soon he talked, walked and smiled. He lived again. The day he was leaving, he waved me good bye. I felt he should come back again. An inner voice wished he should not come back in a state he had come this time.

The more, I practice medicine, the more enigmatic it becomes. It humbles us at times; it gives contentment in another. Sometimes it rips us apart; some other time it pumps in joy of saving a life. And life is precious which we can neither give nor take. Only the One who breathed in life can snatch it out. What we as well-meaning doctors do is, use the gift of medicine to reach out to people for sharing the good news of what God did for us, against the umpteen odds. There are infrastructural constraints, language incompatibilities and cultural rifts. There are many instances of lack of trust and faith. We have to work uphill and against the wind to share the gift of eternal life, not just to extend it after the three score and ten years. After all we are called to look at the eternal things and not at the ephemeral.