Gokulashtami

Janmashtami9(Names and certain events have been fictionalised in order to protect identities)

A festival celebrating the birth and life of Lord Krishna, one of the most revered Hindu Gods, has also ironically become a festival dominated with stories of anti-social behaviour and injuries. ‘Gokulashtami’ is one of the many festivals marked on the calendar of every white-collared person in our country as a day to avoid venturing out of the house. However, politicisation of the festivals and the unimaginable amount of money spent on the preparations and as prizes, ensures active participation of the masses in the festival. Human pyramids are built, sometimes as tall as a fifteen storied building to reach a pot filed with curdled milk (makhaan) to break it, allowing its contents to spill onto the volunteers. For some a way of showing devotion to the Gods, for the others plain stupidity. Either ways, its a festival no one can ignore.

As luck would have it, I was posted on emergency duty on the day of Gokulashtami for the first two years of my residency. While the first year duty was uneventful and we actually enjoyed it, the second year was quite the opposite.

 

I stood at the doorway assessing patients and blurting out orders to every junior in the Emergency Ward, when Neha, a close friend and an intern posted in the casualty ward walked in with a patient on a trolley. A 35 year old man, part of a human pyramid, fell from a height of 20 feet. Such cases were routine on such a day. But something set this case apart from the rest.

Neha looked flustered when she wheeled the patient into the emergency ward. Too busy to notice, I just carried on with my work, examining the patient she had just referred to us. He was conscious and alert, able to make conversations. This was a good sign. No evidence of any serious head injury. As I moved lower down with the examination, I realised he wasn’t able to use all his four limbs. No injuries to the chest or the abdomen, confirmed with a quick Ultrasound screening, the final conclusion was simple. Mr. Vijay (the patient) had suffered from an injury to the spinal cord in the neck (Cervical Spine)

The brain is a congregation of various neurons which travel downwards to the various parts of the body via the spinal cord. The body in a similar way relays impulses to the brain via the neurons in the spinal cord. The spinal cord is protected by the vertebral column, a case of bony structures around the tubular spinal cord. An injury to the vertebrae causes the bony fragments to damage the neurons in the spinal cord.

Vijay had fractured his sixth cervical vertebra which was impinging on his spinal cord in the neck. As a result of this, he was unable to move all his four limbs, a condition termed quadriparesis (medical jargon). However, he was lucky enough to be breathing by himself. The breathing centres and the nerves supplying the muscles supporting respiration (breathing) were located at a level higher than the level of the fracture. There was nothing much that we as surgeons could do for Vijay. After applying a hard cervical collar to stabilise his fractured vertebra and prevent further damage, we referred Vijay to the Orthopaedics emergency ward. Neha accompanied him. The rest of the night passed by and I didn’t see Neha again.

The next morning, after a heavy 24 hour shift and ample of work, I headed for the canteen to catch my breath and some breakfast with Neha. That was routine. Neha and I often interacted over breakfast on the day after we were on call.

I spotted Neha, sitting in a familiar corner in the canteen, her eyes congested due to lack of sleep and her hair dishevelled implying that she had no time to comb her hair. She still looked every bit as beautiful as she would on a better day. I picked up breakfast for the both of us and took my seat opposite hers. Neha looked upset. On probing her, she revealed what bothered her and why she remained missing through the night in the casualty.

Neha was the daughter of a wealthy industrialist, Mr. Singhania, who had business interests spread across the globe. Her passion in the field of Medicine was amazing. She wasn’t the ordinary Indian student, one who chose to study Medicine to achieve the tag of a ‘Doctor’ or to achieve that elite status in society.

Instead, Neha was the ideal medical student. She loved placing the perfect intravenous line at the first attempt, loved the way she could perform procedures on patients without causing them much pain by using just the right amount of anaesthetic, as also the way patients would thank her for a good job done. While she was working in the obstetrics department, she’d delivered many a babies, but she felt happiest when the infants parents decided to name their ward after her.
She wanted at least a 100 little Neha’s, she’d say. She was the perfect doctor. Compassionate, empathic, helpful and ever ready to learn new things. She wasn’t there to be a part of the rat race, she was there to learn and apply. She had set the benchmark for the other interns to follow.

As a kid Neha would frequent her fathers office to play in the play area. It was during these visits that she developed a close personal bond with the security guard at her fathers office. He was assigned to guard the kids by her father. Years passed by and Neha’s visits to her fathers office became less frequent. It had been almost a year since Neha had visited her fathers office (internship is quite hectic), but she hadn’t forgotten the security guard.

As Vijay was wheeled into the Casualty as a victim of the Festival of Gokulashtami, Neha recognised him immediately. He was the same security guard who worked at her fathers office. She got him to me directly for an evaluation and accompanied him after I referred him to the Ortho emergency room. Thats where Neha had been all night.

Vijay needed observation in the Intensive Care Unit (ICU). Unfortunately, the Orthopaedics department had no ICU under them. Mr. Singhania, being the powerful man that he was, pulled a few strings within the government and ensured a bed was reserved for Vijay in the surgical ICU. Something that would have enraged most of us working there, under normal circumstances. I was on the other side of the fence now and realised how it felt to be there.

Vijay was admitted to the SICU and managed conservatively by the Orthopaedicians. He was observed meticulously by the ICU registrars and the Orthopaedic residents. However, it was a universally accepted fact. There was hardly any hope for recovery. Vijay’s brother and wife did all they could to comfort him. They arranged their work schedules around each other so that Vijay would always have someone attending to him. For Sushila, Vijay’s wife, life wasn’t easy at all. Managing an ailing moribund husband and taking care of two school going girls at the same time would prove to be quite a challenge for the best amongst us. Sushila organised all their lives so efficiently that she would have done an MBA graduate proud.

After a brief period of observation, Vijay was discharged. Inspite of being advised to admit him to a nursing home or a spinal injury recovery facility, his relatives chose to take him home, buoyed by the fact that Neha would visit them regularly and take care of his minor medical problems.

A month after Vijay was discharged, Neha called me on the day of my emergency duty in the morning.

“Vijay has a wound over his lower back from which a terrible stench is emanating,” she said.

Vijay had developed a bed sore, a consequence of lying down on his back for a prolonged period of time, coupled with a lack of sensations over his body. The pressure of his body weight had caused his skin to break down and get infected. I asked her to shift him to the hospital urgently so that his bed sore could be tackled.

Vijay required a procedure which lasted half an hour, one done under no anaesthesia considering all his bodily sensations had anyways been compromised. The bed sore was cleaned and debrided (unhealthy tissue was excised). The relatives were educated about the wound dressing and other measures to prevent formation of any more bed sores and he was sent back home. He refused admission to the hospital and insisted on not being taken to the hospital at all, unless he was promised he would be taken back home.

Unable to move around and eat much, Vijay had lost a lot of weight. His family and Mr. Singhania’s company hadn’t lost hope just yet. They tried all the alternative therapies to improve Vijays condition. None worked. How could they? Vijay had lost every working nerve in his body below the level of his sixth cervical vertebra.  But he hadn’t lost his smile and will power. Vijay wanted to survive and we were trying to help him do just that.

 

“Vijay passed away suddenly this morning. My dad and I are going for the funeral in the evening today,” an audibly upset Neha informed me over the phone, 6 months after he had suffered the injury.

Every doctor constantly battles against the patients disease. At times the patients emerge triumphant, but sometimes the disease wins the battle. No doctor wants to be reminded of their fallacy by attending a patients funeral. It serves as a reminder of certain uncontrollable variables in every disease and we doctors (esp. Surgeons) hate not being in control.

Vijay was more than just a patient to both Neha and myself. I felt morally obligated to attend his funeral and so I did. Neha’s father and his office employees all of whom were familiar faces by now were surprised to see me at the funeral. So were Vijays brother and wife, who cried, at first venting out their grief but then, in joy, on seeing me there. Maybe it was worth going to the funeral after all.

Vijay’s case was a stark reminder to the society in general and the organisers of the festival in particular, of a middle aged man losing the function of his body to a misplaced and over-zealous celebration of a festival that is meant to bring happiness to families and not injure & eventually kill the sole bread-winner of the family. Hope his case can inspire a change!

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