Death is a painful experience for anyone. Have you ever wondered what its like to be a doctor, who sees death almost every day!  Its probably the one fight you know you are most likely to lose than win.

Yesterday,  was probably the worst day of my life as a doctor. And I hope I will never have to go through this again.

At around 6.45 in the evening I got a call from a senior doctor, from a nearby hospital asking if I  would take in a patient with snake bite. The ever enthusiastic and exuberant doctor in me, promptly said yes. A little later I discovered that the patient was a 3 year old girl. I was hesitant knowing my limitations.  But the next referral hospital was 55 km away, so I decided to stabilize the patient before sending her away. As I entered my OPD/emergency room, I was greeted by a quiet, beautiful 3 year old girl. She looked scared but she was calm.

I looked at the wound and her eyes, I knew the snake ,was in all probabilities  a neurotoxic one.  She had partial ptosis, but her respiration was normal.

The toxin would kill her if there was a delay in initiating the  treatment. But in a hospital like mine, trying to administer ASV to a child is a dangerous, simply because we are not equipped to handle any complications if it arises.  But then I was ready to take the risk and took all precautions to handle one. In the mean time I made arrangements to shift her to a tertiary care center.

I took all the precautions and gave her the pre meds, observed, and then prayerfully started the ASV  (anti snake venom).  I was prepared mentally and physically to treat an anaphylactic response. Ten minutes into the treatment she started crying. That was unusual for a child who calmly survived all the injections etc.. Something was not right.. In flicker of moment what I dreaded the most happened. Anaphylaxis!!!!!!

Well since I was prepared for the worst, I did my best. I did everything required to resuscitate the child.  Revived the child and by then the ambulance  (108) arrived. I jumped into the ambulance with her and continued my resuscitation. I was ready to inubate and I looked at the EMT (emergency medical technician), hoping for the best. But the rest of my post will tell you why Iam hurt.

I was distraught when the EMT said “Sorry, madam but we do not have a paediatric laryngoscope or endo tracheal tube”. I was horrified. I had to manually bag her for almost 50 km. I had to keep this child alive till I reached the hospital. I was stuck with an amateur EMT and there was practically nothing in the ambulance.

But then she fought, and I was overjoyed when she started moving her hands and opened her eyes. But then toxin had taken its effect and she had gone into respiratory paralysis. She required intubation and ventilator support. But there was nothing I could do but wait till I reached the hospital.

After 45 minutes ,the ambulance entered the hallowed portals of one of the “best” tertiary care centres in the city.

I hate to say this, I’ll never step in to that place again!!

I was welcomed by a young doctor ( I think he is one!!! casualty medical officer) who told me just calm down. I was calm and controlled. But in a single breath I gave the history and told him that this was an emergency. What pissed me off was his attitude. He was like,”why don’t you take the child to the ICU”.

By then 2 middle aged men, who I think were doctors too, came.  Instead of seeing the child there, I was told to take the child to PICU (paediatric intensive care unit). I assumed that the ICU and paediatric casulaty were all the same. Much to my shock I had to wheel the child all the way up to the  3rd floor. As soon as I entered the ICU, I heaved a sigh of relief.  Help at last!!

I repeat again. I do not want to go through this experience again.

The resident paediatrician came immediately.I repeated my story. He looked at the child and said” we don’t have a ventilator, so take the child else where”. I was not ready to cave in. I asked him to intubate the child and then shift. I was startled at the way he went about doing stuff. I was standing in the middle of one the best hospitals in the city, surrounded by an incompetent doctor and nurses. Nobody out there knew the basics of  emergency medicine.

He was paediatrician in the making and he wanted me to intubate the child.  The nurses just stood around and watched the whole drama. Managed to intubate the child and that was it.  He said, “Nothing more. Now take the child and go to another children’s hospital nearby.”

By now I was seeing stars. I was exhausted physically and more so mentally. 1 and half hours of bagging!! But then she was still alive, so I decide to go ahead. So i reached the ambulance door and I calmly told the EMT to prepare the ambulance to receive the child. By that i meant to open the oxygen cylinder, get the ambu bag with the connector etc.

Well as bad luck would have it- “Madam, we do not have a connector!!!”‘ Mind you I have an intubated child, but I cannot manually ventilate her because there was no way I could connect the ET tube to the ambu bag or even oxygen cylinder. I started my CPR again, desperately  tried some of the tricks that I had acquired during my internship training. But 5 minutes later I realised that my efforts were futile. She was gone by then. It took us 20 minutes to find the hospital. By then, it was late!!!!!!

This time I met an “educated man”. He heard my story and examined the baby and declared her DOA (dead on arrival). With his help,I broke the news to the family. By then, I was numb ad just held the mother, but she was to shocked to even cry.

There is nothing new here.  She was one of the many. What was different?

Since I am having a mental block, I ll end my post with the story alone.

My predicament

I have always wondered, how some people tackle difficulties in life.  We often blame God, or some divine/ cosmic entity for the bad things that befall us. Well I am no saint. But I have always been resilient, and fought back every wave of uncertainity.  So what is different now??

It has been 4 months since I moved in to a small hospital in a remote but beautiful countryside. The past 4  months has given me more reasons to hate life, than to see the beauty  of it.Left alone in this place to pick up the broken pieces of a dying-reviving mission hospital, I have reached a stage in life where, I am picking my own dying self from the dust. I have lost the ability to smile, to laugh,to fight, to work….. Every morning I force myself out of bed to work. I fight the goblins that taunt me, only to realize that I have miserably failed. I am tired of doing this to myself. The more I try to change, the more I am smothered by my own cries. How long before I succumb???

Last night I told something totally un called for to my bro. His response left me agonizing the whole night and day. I have been weeping the whole day, unable to fight those  horrible demons. I am scared to death. I have no where to go, no one to turn to. Deep down, i want to fight but I am incapacitated.

“Where, then, can we go? There is a place where there is an aggregate of human suffering and questioning. That place is the heart of God- Ravi Zach, Cries Of The Heart”.

I can no longer feel the presence of the God, to whom I once  surrendered my life. So now whom and where? Will i ever find the peace again or will I succumb to the demons of my life never to live again?

Falling ill, was the last thing I wanted to happen this week. I was in the process of ordering my life and here comes the blow. Been in bed the whole day. Haven’t had a proper meal in days. I wish amma was around. Sigh.. Nothing can be done about that now.

Anyways I hope things are better tomorrow. Planning on writing series of articles on “health care in India”. Hopefully the first one will be ready by next week

DISUSE ATROPHY

Most medicos will define disuse atrophy as,  degenerative changes that tissues undergo when they are functioning at suboptimal levels. So what am I talking about? Have you ever wondered why you find yourself struggling to do stuff that  you were once good at? Well if you haven’t then  you are too good but then some lesser mortals like me exist.

This afternoon I was going crazy trying to complete the trauma care module (Psssss… i am a doc). The material was written in simple English and I knew almost everything. But then I just about managed to write the bare minimum required to pass. I was heart broken and I was in tears.  But then better sense prevailed and  I decided to take a break.

So I closed my eyes and pondered over the last 4 months of my life.  Much to my dismay I realized that I have  changed a lot. I could no longer read my medical textbooks or assimilate the information as well as I could. Let alone believe that my skills were still as good as they were or even better.

Being a a graduate from one of the best medical schools in the country, this discovery was an insult to my Alma mater and a big  blow to my narcissistic self.  But what scared me more was “what if I forget all my skills?” Four months in a dilapidated mission hospital located in a pre pubertal village  has done more harm than good.  I cursed the Gods that send me to this place and blamed myself for having chosen this hospital.  In all this emotional turmoil, somewhere along the way, I figured that I was wrong. There was something unique about this whole experience.  I was reminded of the days when I fought against all odds to achieve all that I wanted to achieve. I felt so small before my own conscience and myself. But this time I was smart enough to stop the goblins from ruining my thoughts….

I shifted my focus on the pleasant things of life. And voila, as i always say “there is light at the end of the tunnel”.

We often blame our circumstances and people for the bad and unpleasant things in our lives. Our focus shifts from that which is of paramount importance to the trivial issues of life.  The pain of unpleasant experiences prompt us to believe that life sucks. Our human minds are conditioned to wallow in self pity. And we succumb to it… Alas, before long we find ourselves  in a quicksand. Unable to get out, we sink and sink till we are  no more.

But then some chose to fight..

I have always been a fighter and I kept asking myself why were things different. Why cant I fight them anymore??

With these thoughts in mind  I opened my module. Well nothing changed. I was still slow and did a rather horrible job. But I felt better.

I knew that as horrible as life can be, there was still  a bright side to it.

I am going to fight the goblins that taunt me and come out of the battle victorious . Its never an easy job but at the end of the day when I close my eyes, I can sleep a winner and not a loser. I also know for sure that I will be finer and better than what I already am.

NEW BEGINNING

Ah well, here I am finally… After much thought and meditation (ewww) I decided to start blogging. Most of my posts will be daily musings… Till I find something solid to write on, guys hang on…