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.

Compilation of professional reminiscences of specialists - edited by M.V.Kamath and Dr.Rekha Karmarkar