The Assault’s (almost!)

Being a doctor in India, or specifically in the institute I was working in, not only required skill, but also strength. Skill to manage the heavy burden of patients unleashed upon you, whilst you’re still the unsuspecting, naive, freshly graduated intern. And strength, to manage the rowdy, almost obstreperous relatives of the poor patients, who couldn’t afford to go anywhere else.  One of the former Deans of the institute famously stated, “When you signed up for your residency program, you have signed up for everything that comes along with it, including being beaten up by angry mobs.”

There have been a number of near misses during my residency years, not only with me, but also my colleagues. However, a couple of these incidents stood out as a memorable ones.

The First Incident:

Rakhi (name changed to protect identity), was a 45 year old sweeper, who came to the hospital with severe abdominal pain and a continuous fever for a couple of days. Suspecting dengue, the medicine resident on call followed the routine pathway and sent her to the medicine ward for an admission. Her drunk husband, Manoj accompanied her that evening.

Two days after she had been admitted, we received a written call for a surgical reference, stating that her abdominal radiographs indicated gas under the diaphragm. Gas under the diaphragm is a commonly used term amongst surgical specialties to indicate a perforated bowel. However, considering her history it seemed implausible.

Clinical examinations and further tests confirmed their suspicion. She needed immediate surgery. Transfer protocols were initiated and the patient was shifted to the Operating Room (OR). It turned out that she was suffering from Typhoid, which caused her small bowel (ileum) to perforate and let loose the feculent matter into her abdominal cavity. It took us three hours and countless lavages to clear out her abdomen and suture the perforated bowel.

Manoj stayed around for most of these proceedings, volunteering to help in any possible manner. However, his countenance changed when he saw us shifting her to the intensive care unit on ventilatory support. Having seen his mother going through surgery and later being treated in the intensive care unit in the same hospital, a few years ago, his hopes of seeing Rakhi recover diminished.

He confronted us after we shifted her to the ICU, letting loose a tirade of profanities, “You ba*****s, what have you done to my wife? She would’ve recovered well without the need of the machine had she not been operated upon. All you doctors are scumbags.”

We were taken aback with this rant and tried to calm him down, explaining that this was just a temporary phase and that she would be off the ventilator in a day or two. He was assured of a reasonably good recovery.

He would have none of it. His ranting and expletives continued, until finally he broke down, sobbing uncontrollably.

Seconds later, he darted towards the exit. He was going to abandon his wife, leaving her at the mercy of the staff in the hospital.

Every resident is responsible for his patients, whether they have relatives or not. And if her husband would run away, the responsibility of her care would be thrust upon us. It wasn’t a particularly pleasing situation to be in. We were already running on a tight schedule. On a good day, we would get close to four hours of sleep, and we’d had a dearth of such good days. We weren’t willing to shoulder the additional burden of a critically ill patient without relatives.

In a split second, my colleague and I decided to give chase. At that point in time, we thought it’d be worth it. In hindsight, maybe not.

With stethoscopes hung around our shoulders and a white coat to differentiate us from the laymen around, we gave chase, running down the crowded corridors of the hospital and across the bridge, connecting the main structure to its sister concern, across the gates and onto the streets. We somehow managed to keep a visual track of Manoj’s route. Seeing two doctors giving chase, the security guards at the gate of the hospital also volunteered. The chasing party soon expanded from a mere two people (my colleague and I) to a formidable size. Amongst the new members were security guards from the hospital, relatives of patients, who were admitted under our care and were loitering around on the streets and some random bystanders who joined in for the fun of it. Neither of them knowing the reason of their indulgence.

For a relatively older man, Manoj seemed extremely fit. It took us a while to catch up with him. Seeing the chase party following him, Manoj tried to speed up. But we were close enough and I grabbed hold of his shirt by then. He freed himself from my grasp and decided to take matters into his own hands.

Turning around with a menacing look, he quickly shifted to his left. A colossal stone was lying on the street and Manoj lifted it over his head with the seasoned expertise, as if he’d hurl it over us and crush us with it.

In hindsight, I wish I’d never chased Manoj down. I wish I’d stayed on, in that wretched intensive care unit and let him escape. But then, hindsight always gives you a very obvious biased view of your quandaries.

A comical scene ensued. The chaser had now reversed roles and was chasing our company with a giant stone lifted over his head. The ten brave men who gave chase so valiantly, dispersed into the mob of surrounding people to escape Manoj’s wrath. That was the last we saw of Manoj, who dropped the stone, as we scattered around and fled with unimaginable pace.

Rekha was now our responsibility and we took care of her reasonably well. She recovered well, barring few minor complications and was discharged into a social welfare setup soon after. Manoj had disappeared and was nowhere to be found.

The Second Incident:

Just a few weeks after the ‘Great Chase’ and being the butt of every joke cracked in the hospital, came another incident. One which was more serious and had dire consequences.

The mornings in the emergency ward were usually very hectic. Partly, because most of the unit doctors would be managing the out patient services and partly because the patients, who came in late for the out patient services, would end up in the emergency ward, seeking a quick fix to their problems. These requests were rampant on almost all days. A strict diktat had been issued to service every patient that turned up for treatment in the emergency wards, causing formation of unmanageable crowds and a lack of dedicated time to the actual emergencies.

The only protection that a doctor had from being assaulted in such circumstances was a security guard (or two, if the doctor on duty was lucky). What would a lone security guard do against a crowd of a hundred people queued up outside the emergency wards?

A company of four men and a woman came to the emergency ward, on one such morning, while I was on duty. Being from the area and speaking the local language, they were surprised to find an on duty doctor who fumbled with the local language. The nurses volunteered that I belonged to a different community. The discord started there.

I had no control whatsoever on the local language, but spoke reasonably well in the national language. After examining the patient and prescribing some injectable medications, I went back to the desk to fill out the requisition forms for the investigations. I simply suspected a urinary tract infection along with a renal stone and advised an ultrasound and a urinalysis (a test to check for bacteria in the urine sample). I doled out all the instruction in the national language, only to be told to repeat them in the regional language (they understood both languages reasonably well).

Not knowing the language was irksome enough for the group. When I told them to get the urinalysis done from a private laboratory (the laboratory in the hospital was for some reason not performing the test at that time), it got them really wound up.

Communalism stems form age old practices and a legacy that has passed down through generations. Being a part of that city and state, I had never experienced a communal attack (verbal or otherwise) thus far. It changed that day.

Some expletives and raised voices asking me to go back to my parent state, were followed by the group throwing the glass bottle (that I had handed over to collect the urine sample), at me. Reflexly, I ducked and the security guard (the single man) shielded me from any further assault. The group was forced to leave the emergency ward, but that wasn’t the last of it.

The local community and the politicians got wind of the incident and lodged several complaints against me, alleging negligent treatment. How could a doctor working at this prestigious government hospital not know how to speak in the local language? How could an ‘outsider’ get admitted to such a reputed medical school, meant only for the locals? How could he order an investigation from a private laboratory outside the premises of the institution?

Questions poured out from almost every direction. Thankfully, I was shielded from most of these questions by the senior surgeons working in the same unit. Every question was answered tactfully and every answer written down and re-scrutinised.

We are all Indians. We are all expected to know the national language, Hindi. The constitution recognizes 18 regional languages, but the actual number far exceeds that. How can one possibly learn every regional language to cater to every community in different parts of the country!

Our constitution also proposes to provide every citizen with basic rights. Isn’t right to education without a bias towards caste, community and religion a part of these fundamental rights.

As for the investigations being ordered from a private laboratory. I wasn’t a part of the administration or the pathology department. If a particular investigation wasn’t being performed and was vital to patient diagnoses, should I have avoided it? Would that be negligent practice?

Eventually, when the answers were presented to the authorities, their case lapsed and normal service resumed.

The final diagnosis of the patient was: Urinary tract infection with a solitary ureteral stone, size 4 mm. I stood vindicated.