The ICU diary- Bondage

 ‘And always night and day, he was in the tombs, crying out and cutting himself with stones’. Mark 5:5

I was done for the day. I picked my bags and was trudging along the changing room when I received a call from emergency regarding a sick patient. I left my paraphernalia and ran to casualty. The resuscitation room was a buzz of activity and emotion. I was envious of these physicians who dealt with high voltage scenarios round the clock. I had to jostle for space among the crowd to reach the man I was called to see.

He was 30 year old Ravi lying in a ill fitting trolley with blue bed sheet over him. The head end of the bed was elevated to give his lungs some breathing space. The IV drip was flowing like a rivulet into his neck. The monitor attached was screaming for attention hoisting the deranged parameters in yellow and red. Ravi was breathing at frantic pace. He was also rolling in pain. I introduced myself and he was coherent enough to decipher my poor Tamil and reply. I had a cursorial look at the emergency chart.  When he had come his blood pressure was not recordable. Six litres of saline, a dose of high end antibiotics, and infusion of heart powering drug dopamine brought him to this stage. Apparently he was still in distress. He blurted out his history in broken lines even as he struggling to catch his breath.

Ravi was a daily wage labourer. Some days he would get work and be paid and most days he would just stay home. For the last 20 days he developed pain and swelling in his right leg. Initially he neglected it but as the pain became an impediment to his basic chores he visited a doctor. A preliminary scan of the leg showed that blood had clotted in his veins and had caused secondary infection. A dose of over the counter medicines did not work steadily pushing Ravi to this present predicament. Before I was rolling his gurney to ICU, I enquired his wife about his habits. ‘He consumes alcohol’, she said in a dejected voice.

Through the corridors of the hospital, along the wards of radiology and neurosurgery, I took him to surgical ICU. I put him in bed no 2. My senior relieved me from my shift and I went home. Over dinner, Ravi flashed through my mind. I was amazed to see that 6 of the total 13 beds in surgical ICU were occupied by patients of road traffic accidents and all were under the influence of alcohol. Five among them at that time were on ventilators and drugs without which their circulation would fail. Three of them sustained head injury and two of them are on tracheostomy.( tracheostomy is a cutting open the wall of the wind pipe and providing a shorter and alternative pathway for patients to breathe). The biggest tragedy of all was that all of them except one were below the age of 40.

The next day I reached the ICU with a special curiosity to know what happened to Ravi. In the night he was taken for emergency surgery. His leg was too infected to be saved. They had to remove his leg and part of his thigh which orthopedicians call above knee amputation. The attending doctor told me that he may need a higher amputation as there was still a mass of infected tissue threatening his life. Ravi was still intubated on machine with tubes popping out of his mouth, nose, neck and bladder.

Moments later, a whisper wafted into my ears. “ bed no 2 are leaving against medical advice.” I was shocked and then felt that the relatives can be cajoled to stay after a counseling session. The surgeon, the ICU consultant, the nurses were not able to change the mind of a frail old man in lungi and crumpled shirt with a beard ill kempt and voice trembling. He was Ravi’s father. As a last ditch attempt, the chief of ICU Dr SM himself wanted to talk to the old man. Ravi was too young to give up hope on. His vitals were stable. His heart had calmed down and his support requirement has come down from the time of admission. Ravi was improving. Leaving the hospital at that moment would be an unwise idea.

I just wanted to see how the encounter between my chief and the old man would go. I accompanied Dr SM and sat on a sofa facing Ravi’s father and brother in law. The father was firm and clear that he wanted to leave. We asked him why. He had a heart breaking story to tell.

Ravi was married 10 years ago. He has 3 daughters to feed. But like millions of families that are ravaged apart by alcoholism, Ravi’s family also faced its brunt. He was a chronic alcoholic spending all he had on drinks. He would not take care of his family. Children were out of school. Poor wife had to face the mental anguish of an unfruitful husband and the physical assault and battery the inebriated mind would perpetrate. Last ten days were worse. He was just lying on his bed consuming bottles of alcohol with his friends bringing the needful. The old man supported the entire family with his wages.

It was not that Ravi’s father did not know the gravity of the situation. He himself said, ‘I know that he’ll die. I know that he will not cross the hospital premises alive. I just have to show his body to his mother. All my life I spent my money on him. He did not change. He will not change. Now he does not even have a leg. I have his three daughters to tend to. I cannot waste my last resources on him. The story is over sir. Just let us go.’ Saying this he fell over my chief’s legs and began to wail inconsolably. We let him go. When the intern who accompanied Ravi to the vehicle returned, I asked him how Ravi was. He felt no pulse on him during transfer.

It is to stories like these that Christian doctors need to stand up to. It is bondages like these that have to be broken before families and society can be blessed with wholesome life. What is the mandate of bible believing health care professionals in a society mired in the darkness of alcoholism? Are the problems of our patients purely medical or are they social and economical also? What is the distance we can go?

In the pages of the Gospel there is an episode captured where the disciples of Jesus are unsuccessful in driving out evil spirits while Jesus does it. Disciples ask Him how he was able to. Jesus says, “This can happen only through prayer and fasting.” May be we should look at the big picture and discern. May be we should pray for people like Ravi, against TASMAC and the minds that are bent on expending long lives for ephemeral highs.

( The Tamil Nadu State Marketing Corporation (TASMAC) is a company owned by the Govt. of Tamil Nadu, which has a monopoly over wholesale and retail vending of alcoholic beverages in the Indian state of Tamil Nadu.The monopoly trade has led to widespread irregularities like adulteration, corruption, overpricing and black marketing in the retail outlets. It has also led to increased complaints about disturbances created by drunk patrons from residents in areas where the retail outlets are situated. Alcoholism is growing at a rate of 8% p.a. in Tamilnadu. Tamilnadu is also the state with largest sale of alcohol by volume.)