July 1, 2008.
Time: 9.05 am
Place: Pediatric Ward,
Background score: A baby crying at the end of the ward. Sister-in-charge shouting at the mother “Apna ghar bhi itna ganda rakhte ho kya? Yeh saaf karo!” Houseman running around and screaming “Aye intern, iska form bhara kya? Kab bharega?”
Perfect chaos. Perfect morning at the Pediatrics ward where we were posted.
Two of us had reached the ward early. It wasn’t that we were too sincere but it was just the typical GS attitude-let’s take the best cases before anybody else from the batch. So we went on to savor the fresh cases (sorry for the sarcasm) from the previous day’s emergency.
There was a boy named Nayan Shah…walking around in the ward, with a tan and like a pregnant lady. We told him to sleep on the bed and asked him why he had come to KEM. “I have to take blood every month” he said. Perfect, we thought. Its must be thal and he’s got H-S-megaly. Let’s take this ‘thal-case’. The thing about children is that they will not allow you to examine them unless you divert their attention. I gave two chocolates to Nayan so that he would let us examine his abdomen without fuss. While palpating his massive spleen, to indulge in some idle talk so as to divert his attention, I asked him, “Why don’t you eat these chocolates now?” He said, “I have kept these for my two younger brothers. They are coming here after their school.”
And that was lesson number one for the day from the thal-case…No, from Nayan. While Nayan, for whom chocolates are a luxury, wanted to save the two chocolates for his younger siblings, we still take pride in having khoof clinics. There are hundreds of cases everyday in the wards, and we students still have tiffs about who would take the best case. Or two ‘friends’ who won’t talk to each other for a week because ‘she put the Foley’s when it was my turn to do so’. Or another two who start a cold war when the one auscultates a case of PDA before the other.
The truth is that the environment that we doctors thrive in is constantly testing us while teaching us the way to live life. The situations that arise test the character that we are made of. The patients keep reminding us to forget our petty frustrations and see the larger picture of life. The suffering we see around helps us appreciate the little moments of happiness and togetherness we have with our family and friends. Like a friend, who after seeing her first case of normal labour went home with a present for her mother and thanked her for giving birth to her.
We moved on to the next cot…Sagar’s cot, but walked ahead after a minute. He was a eight-month boy who had been in the ward for almost a month now. Everyday we would see his mother either holding him in her lap trying to make him go to sleep, changing his diaper and feeding milk to him from a wati. Nothing new…all mothers do that! But in this case, sometimes we would see his mother just keeping on holding his hand as it went into phases of jitteriness or feed him one spoon after another of medicine syrups or just wait while a group of ten doctors came to the bed and discussed something and moved on. Then she would move on to her next task-of taking care of her child.
Sagar was a case of cerebral atrophy, and as we saw him in the ward, he seemed to have no emotions at all. He would just lie on his bed staring…no where. He would hardly cry and would never smile. Even then his mother would religiously keep on doing something for him. There wasn’t any conviction on her face, the way it is described in inspirational writings. There was no helplessness in her manner. There were no tears that we saw. I don’t know whether she knew that the prognosis was bleak, but her efforts were unmovable. She knew that she had to take care of her child and the results then were not in her hands.
Many of us throughout our life have fretted thinking about ‘why did he get two marks more than me?’ or ‘how did he get the first rank in class? Why am I always second…I had worked so hard for this exam.’ And then some of us get frustrated…‘What is the point of studying, I am not going to get good marks’. But really, the results are not in our hands. The only thing that we can do is put in constant efforts like Sagar’s mother. While she probably knew that her son may not improve, we still have the hope that our efforts will prove to be fruitful.
Place: Back to Pediatric ward
Time: 9.45 AM
The unit we were posted in began the post-emergency rounds and we joined in. The whole group of twelve-odd people moved from one cot to another. The registrar was presenting the case, the Professor confirming whether a certain investigation was done and yearning the juniors to come up with more differential diagnosis on each case. We glided along with them, straining our ears to hear each word and trying to jot down all the ‘important’ bits of information. Till suddenly, while at one bed, a mother started shouting at the whole group of knowledgeable, white-coat doctors, “Why don’t you tell me what is wrong with my child? Nobody around here tells me what I have to do? You just come here and stand for five minutes, discussing God-knows-what and move on. Who will tell me what’s wrong with my child? When will she get better?”
While we students hover around the ‘teachers’ urging them to take a clinic, we often forget to learn to talk to patient. We ask them questions about their symptoms, their family history, past medical & surgical history, ask them since how long this particular sign has been present…That’s it. But do we ever talk to the human being whose ‘case’ we are taking? Do we ever go to the ward the next day after the case has been presented to ask the patient how he is doing now?
A professor once narrated to us the incident of a surgery practical examination where there was a case of right iliac fossa lump. One of the students taking the case made efforts to be nice to the patient and developed a good rapport with him during the exam. When he was almost done with the examination, the patient pointed out to his left groin saying, “Sir, please check this. The examiner had shouted at the previous candidate who was almost crying and told him to examine this.” The patient had an incidental finding of a left sided inguinal hernia which was missed by the previous candidate who failed, but our hero here had managed to present it in his findings and was saved.
Talking to patients about their ailment plays rich dividends. When the patient asks you “Doctor, when will I become better?” we students come to know that this is the patient’s concern and we must actively search for this answer when we are reading about their disease in the text books. But emotionally too, it helps. Like a patient of Rh-issoimmunization told me the next day when I went to see her again, “Hi, I was waiting for you. I had some questions that I wanted to ask you. Could you please explain to me…” And that felt good. Somehow I had alleviated some of her worries, though by a very small amount. I hadn’t done anything about her ailment since that’s really not in my hands but she wasn’t as worried as she was before.
The rounds were almost over. The senior teachers were on their way to their offices and the registrars back to the ward work. Just as everyone was about to disperse a little boy came with a yellow rose in his hand. The registrar whispered that he had been admitted some time back in the ward. He came over to the Professor and gave the rose to him and said “Happy Doctors’ day” and ran off to his father waiting outside the ward. The Professor later told us in the OPD “I may be fifty. But everyone likes to be appreciated once in a while, even if it is by a small boy.”
Time: 4.30 PM
Place: Medicine Ward
That evening a friend posted in medicine dragged me along with her to take a CNS case for presentation the next day. After searching through the register, we found names of four patients of hemiplegia. Perfect (again)…now we can pick and choose what case we want. So did a survey of the entire ward. There was one old patient with aphasia and no relatives around so that case was out. The other one was sleeping. We still had option 3 and 4. Both of these patients were lying on adjacent beds. One of them was a man who looked to be in the early forties with thick black hair and black moustache & beard with two females sitting beside him, probably his relatives. He had a very rugged look on his face. His face was away from the side his two relatives were sitting. We tried to ask him his name. But he just turned away and said nothing at all. We went to next bed. The other man seemed ‘less dangerous’.
We started taking the case of the old friendly man. He was telling us about the stroke had struck him when suddenly the young man with hemiplegia on the bed next to us started crying. Now, it is quite a site to see a young man who could well pass off as a bully crying before you. He couldn’t speak. But he just kept on crying. He tried to say something to one of the relatives who was trying to placate him. We stood there transfixed, not knowing what to do. Did we do something? Did we say something that we shouldn’t have? What do we do now?
We asked the relative what the man was trying to say. She said “he is crying because you doctors are not coming and treating him. You went to the other patient, why don’t you do something about him?” I enquired further. The patient used to drink alcohol and smoke regularly and then this young man getting a stroke didn’t seem surprising at all.
There are times when the toughest of us…may have to cry. Situations make the most fortunate of us to lose something. So it is very important to treasure each moment of life in the present, every bit of happiness and health that we have today.
Time: 5.30 PM
Place: Borivali local train
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