METAMORPHOSIS- The journey from an intern to a practitioner

METAMORPHOSIS

The howls of the wolves and the rattle of the crickets interrupted the scary silence of Lamtaput. It was just 9 pm but the thick blanket of darkness was not challenged by any flickers of flames unlike urban India. I had just had the last morsel of my supper when a phone rang with an aura of urgency about it. A woman in labor had just arrived and I being on call that day had to see her first. With a torch in one hand and a stethoscope in another, I trudged along the path to the hospital. The labor room was filled with the customary hustle-bustle as I walked in. The patient crying in pain, a dozen chaperons attending to her, a dozen more outside the room separated by a wooden door and the nurses busy with recording vitals- all caused an unrest in my heart. I pretended confidence and gave a ‘I-saw-this-a-thousand –times-before’ look to the husband of the patient assuring him that I would take care.

Just out of medical school, that too from one of the best in our state, I was ill equipped and inexperienced to deliver basic medical care. Even before I knew what the term ‘basic’ meant, I decided to become an intensivist. So, I entered the compulsory rotatory internship with a prejudice that obstetrics was not my cup of tea. The only syllabus that bothered me was the MCQs that would appear in PG entrance. Likewise, I ignored surgery. It is too brutal a branch to pursue, I opined. As I finished my year as an intern, most days passed with reveries of becoming an intensivist, rather than learning the basic care I had to offer as a medical graduate. If there was a sense of irrelevance within, there was a milieu of discouragement around. ‘What do you want to be?’, was the first question most of the working PGs would ask. And if their branch was not the answer, the usual reply would be-‘finish the work fast and go to the library boss!’ As the calendar changed, I finished my graduation with a conviction that a good doctor is a super-specialist and a super-specialist need not know basic medicine encompassing all branches. In fact I went far enough to think, that a great doctor is one who would not waste time in the nitty-gritty of different subjects but would focus on his interest alone. That was the philosophy of the day. Interns who would spend their time with patients, workups and injections were looked down with disdain and those intellectuals who would set the reading room on fire were embraced with admiration.

One fatal attitude that infected me as an intern, was compartmentalization of the work. My job was to send bloods, give injections, bring reports, write prescriptions, and assist surgeries. For a year all my time and energy was spent on these aspects of patient care. Very rarely did it dawn upon me that it was a patient I was tending to, a fellow human suffering. The usual cliché would be-‘This is my work. I’ll finish and push off. I don’t bother if the patient finally gets well’. That’s why there were usual ructions with the staff and ward boys about what was and what was not the work of an intern. ‘Don’t do anything that you are not expected to do or else, thanks to the parasitic nature of the working setup, you’ll be assigned  unnecessary jobs from tomorrow,’ was the usual refrain. An empathic word, a tender touch, a gentle pat and a tear of bereavement were not the mandates of our programme and naturally I did not bother inculcating them. Life took a strange turn after college. And I landed up in a rural hospital. 

The lady was a primi (having her first pregnancy), and had never come for any checkups before. In our college, if a lady had not had any checkups, the PGs would pounce on her like animals raising a tirade of verbal inflictions on the already tired pregnant before she was taken up for delivery. I did not want to do that because ignorance must be handled not with retribution but with awareness. I informed her that regular antenatal checkups were beneficial to mother and child. At the rural hospital, I had to do everything within my reach to see that the patient gets well. I would examine him, think of a probable diagnosis, order investigations, follow them up, do some basic imaging in needed, counsel the relatives- allaying their fears and facing criticisms, write discharges, recommend compliance, refer to higher centers and be in contact with them post referral, to mention few of my job activities. I could not say I did not know. I could not say this is not my work. When a person walks up to me saying he has a problem, he becomes MY patient. I cannot say don’t bother me you pregnant woman! I am aspiring to be an intensivist.

The per-vaginal examination revealed that the baby was almost out and she needed a couple of strong uterine contractions for the delivery of the child. My thoughts flew back to the night duty at Victoria Government Hospital. I had to conduct two deliveries in one hour as the attending PG was notoriously famous to delegate her work to interns while she gave herself up to the pleasure of sound sleep. I cursed her from the bottom of my heart. I thought she would be a very bad obstetrician and so on. I was left with no other option but to attend to those women in labor. In this avalanche of hate words towards my PG, I learnt the art of delivering babies. I was deep engulfed in the pitfalls of my senior’s duties without realizing that they gave me opportunities to learn, if I took them. Meanwhile the lady on the delivery couch pushed one last time and the baby’s head popped out of the mother’s perineum. The shrill cry of the child filled the room. The nurse noted the time to be 9:28 pm. The baby was accompanied by a gush of amniotic fluid, the nutrition liquid for the baby in the womb. I clamped the umbilical cord, severed it with clean scissors, separated the placenta, made sure that it was complete and discarded it in relevant containers. The nurse had given injections to contract the uterus and asked if she could suture the episiotomy (the incision around the birth canal during delivery for the passage to be easy) wound. I agreed and looked at the baby. A male child weighing 3 kg was staring at the warm light swaddled in clean clothes. I wrote down the notes and walked out of the room.

The ‘new father’ looked anxious. I told him that all was well and he had a baby boy. His demeanor instantly changed from fear to ecstasy. He thanked me and I waved at him. I remembered my lazy OG post graduate not with a sense of bitterness but strangely gratitude. And for a moment, becoming an intensivist felt too small a dream. It dawned on me that a good doctor is one who can alleviate the suffering of as many people as possible. He is one selfless being to whom specializations fall second to the objectives of relieving his fellow beings of disease. Degrees can be means of helping but must never become the goal of anyone who practices medicine. Three years have passed since this story came to pass and I still wait to become an intensivist. Life has taught many lessons including what I thought were not my jobs as an intern. From an intern to a practitioner I have come a long way. Often I am inclined to think whether what I learnt as an intern- the attitudes, the worldviews, were right. Or are they?