anonymous
20th December 2019
A Ringside Seat - 1
A Ringside Seat - 1
Dr.Ravin L. Thatte
The
years through Medical College are romantic years. Not in the girl-meets-boy
sense but more so philosophically. They are years of idealism, hope and
expectations. The world of disease, misery and death surounds you, yet, because
there is no direct responsibility, a thought descends on you almost slyly that
as one grows up to actually confront the situation, ‘it’ shall be somehow
overcome. The years pass fleetingly like flowing water with its gurgles, but
mostly they are bubbles. The water, of course, is tinged with the red and blue
of youth and then, the day one graduates, the dreams are gone - vanished, never
to return. Responsibility stares darkly. It is then that the clinical setting
around you becomes a reality because you are part of it. Patients are now for
real, so are their miseries and the problems of their families. To someone who
has just worn the white coat of responsibility and is weighed down by one's
career, this additional melancholy of the real world seems oppressive. These
are dangerous years. Some young medicos give up too easily and embrace death.
Yes, death! Suicides are common in the medical educational environment. As I
write this, a nurse has just killed herself at the Lokmanya Tilak Hospital.
Some decide to sidetrack and pursue not-so-clinical careers. Others seek the
comparatively easy and not so careeristic pastures of General Practice. Some
lady students realising their biological responsibilities subvert their careers
to those of their men. Some, both men and women, swim along and cross the river
as the current will permit, to pursue goals imposed either by themselves or
their families, for glory or for money or for reasons God alone knows. If
old-fashioned ethics are practised, the road could be rough. I should know,
because I have walked on it. One wonders, even as one approaches the last bend
whether it has all been worthwhile. Perhaps that is not the main issue at all,
because one traverses the path out of one's nature, compulsions or
circumstances. But as one walks through one's career in the medical world, a
unique opportunity is at hand to study human experiences. When a patient walks
up to a doctor, he might be fully clothed, but he is, in fact, naked as they
come. In a doctor's presence, his patient opens up the innermost recesses of
his mind. The anxieties and worries of a patient can be enormously burdensome,
enough to make a doctor lose his sleep. Yet when the doctor effects a cure, it
can be and is an enchanting and spiritually uplifting experience.
The
first coin dropped in my piggy bank in the early 1960s when I was a Registrar.
A man in a state of drunkenness was wheeled into the operation theatre with a
stab wound in his abdomen. The intestines were popping out of the wound and he
was in a state of shock. As the abdomen was opened, it became clear that the knife
had done an ugly job. It had neatly torn half the man's stomach and spilled
nearly half a litre of country liquor and some extremely pungent meaty meal
with half-digested chicken parts all over the peritoneal cavity. The stink was
unbearable and I had to wash my hands again and again before I finally stitched
him up. As I finished, the anesthetist gave the patient only a few more hours
to live. I did not disagree. As I came out of the Operation Theatre block, two
people were waiting literally to pounce on me: the man's wife and a
Sub-Inspector of Police. The woman, very dark, very unkempt but rather
good-looking, was inconsolable and enveloped in fear, sorrow and hopelessness.
Two small girls, evidently daughters, were tugging at her sari, not really
knowing what was going on. I did my best to convey to her that everything
possible was being done. I casually asked her what had happened but at that she
was swiftly on the defensive. All that she muttered was about "an enemy”.
Reluctantly, and rather off-handedly, I turned to the Sub-Inspector. He took me
aside and wanted to know the nature of the victim's wounds. I was taciturn and
sharp and barely gave him the time that he deserved. That is how it is often in
hospitals. The doctor is the boss. The Sub-Inspector was upset and said that I
should give him at least as much time as I gave to the woman. But I gave him a
cold look and walked up to my quarters and fell into a tired, dreamless sleep.
The
victim subsequently died; a year later I received a summons to appear before
the Sessions Court. As I entered the court premises, I was taken aback by what
I saw. Among those attending the case was the victim's wife, but now she seemed
a different woman altogether. She was wearing lipstick and some garish and
cheap jewelry. She sat there chewing paan. Her hair was made up into a bun and
she had an expensive sari draping her. The children were missing. She recognized
me instantly and for a moment, I thought she gave a hint of a smile. After I
finished giving my testimony and was walking out of the court, time seemed to
stand still because just outside the entrance stood the same Sub-Inspector who
was handling the case. In a moment of curiosity I asked him about the woman and
her new avatar. He gave me a broad grin and said: "You hardly know these
people! The woman has become the mistress of one of the accused conspirators
who is out on bail!” With these words, he put on his cap and waked away. It was
his turn to ignore me. Five years later, another experience was to jolt me. I
had volunteered as a civilian aid following the 1965 Indo-Pak War. I was
located about 100 miles northwest of Jammu in a camp meant for persons
displaced by the war. Signs of an armed conflict were missing, except for an
occasional rumble of tanks through the night and the sound of jets flying
overhead at rather low altitudes at all odd hours. The terrain was hilly and I
was housed in a tent. It was December and bitterly cold at nights. There was no
running water, no electricity and no regular food. My tent was surrounded at a
lower level by a huge settlement of about a thousand people also living in
tents. Time crawled slowly; at nights, in the bitter cold, a thin layer of
icicles made an ice-box of my tent. The Tashkent Accord was not yet signed.
Another epoch making event was to happen in a short time. The American
astronauts were already up in space, but had not yet stepped on the moon. It
was on one such bitterly cold night, when I was fast asleep that I was woken up
by frenzied shouts and the flapping of my tent. I got up most reluctantly,
still wrapped in my blankets and opened the flaps only to see a group of ten to
fifteen men holding lanterns in their hands. I was told that a man was seen
lying in a small nullah, probably dead and would I certify his death? It was a
kind of emergency, so I came out of the tent, trembling with cold, my
stethoscope in hand, mentally cursing the people who had woken me up so
unceremoniously. I was led down a hill for about a kilometre when another group
of men came into view. As I neared the group, I could hear loud wails from a
few women who had gathered round a dead body which looked rather like that of
an overgrown boy. His head was smashed on one side and one arm was lying at an
awful angle, all mangled. The body was cold and fairly rigid. Death must have
occurred some five hours earlier. Certifying death was no problem, but a post
mortem appeared essential. I had the body covered and sent two men on foot to
the nearest civilian post to get more sophisticated, technical and legal help,
so that the body could be taken to a taluk hospital. Having done that, I
returned to my tent and spent a restless and miserable night, trying to get
some sleep. The face of the boy kept coming back in my dreams at regular
intervals.
There
was something about the face that had struck me which I could not quite figure
out. In the dim candle light, that face showed no signs of adulthood. It was a
child's face plastered on an adult body. As my servant boy walked in the next
morning to clean the tent, I started making enquiries. He seemed reluctant to
answer my questions at first but then came forth with a nugget. The deceased was
mad, not quite sound in mind. It was only when the ayah came later to help me
with women patients that I stumbled on the truth. The deceased had been not
only mentally retarded but was also deaf and dumb. That explained the look of
innocence on the face. As she explained the story to me, the ayah shed a tear
or two as women will do, and then we settled down to dispensing iron and
vitamin B-complex tablets.
Three
days later, the post mortem report arrived. There was a large intra-cranial
haematoma with laceration of brain. A week later followed a deputation, with
papers to fill and a message that almost made me jump. It said:
"Notwithstanding a rule that all deaths in this camp are to be compensated with
a sum of Rs 250 to the family of the bereaved for funeral arrangements, the
money is being withheld because the authorities have been informed that the
death may not have been accidental but was caused to earn the funeral charges”
(The cost of a life of a useless member of a large, impoverished family!). "You
may therefore countersign this letter as read and make discreet inquiries from
your patients in this regard”. I got up and walked away, not to return to my
tent till late in the evening. A week later, I was transferred to a base
civilian camp. Nearly a quarter century later, as I write this, I still
remember the boyish face on that adult body and the play of light and shadows
as the lanterns threw light on the mangled arm.