Tuesday, August 30, 2011

The heart of a Mother

In the MICU of our hospital, which is where I've been posted the last couple of weeks, the hardest part is watching people take bad news. A patient we've had for a week was a particularly bad case to handle. A nineteen year old boy, already a regular drug abuser addicted to Fortwin injections, had overdosed and was brought in with severe respiratory depression. His mother was the only one of his family to stay with him, she was literally alone. The father had left her while her son was still an infant, she had worked as a housemaid to put him through school. Only to have him drop out with no prospects of a job and friends who taught him to single out veins in his forearms with more finesse than my internship's taught me.

His breathing normalized in a matter of days but as soon as he came out of his drug-fuelled stupor, we realized he'd had a very alarming psychotic breakdown, a rather scarily common occurrence when one goes cold turkey. His personality had started a strange sort of rapid cycling. He alternated between aggression, abusiveness, even violent outbursts when he threatened us to let him go home, on the one hand and an eerie calmness, accompanied by spells of sobbing and pleading with us for a discharge, becoming moody and depressed on the other.

It was pointless to explain to him how delicate his condition was, that he needed psychiatric help. His mother, who stayed up for days without sleep, rushing to his side every time he called out for her, begged us to save his life, keep him in the ICU till he recovered completely. That he needed to be transferred to a psychiatric ward seemed unbearable to her.

He wud scream at her, abuse her, beat her even, but she was always the same with him. Talking with him affectionately, bringing him sweets whenever he asked for them, even at 2 AM. Tonight he slapped her hard across the face because he thought she was conspiring with us to keep him in the hospital and we had to call in security to help restrain him. She wept, insisted how he was a really good boy at heart, and once he was placed securely in restraints, went up to him, stroked his hair and kissed his hand.

Our registrar looked visibly disgusted at this show of affection and asked her why she simply did not leave her son, when he so obviously was the cause of her misery. The woman looked at the two of us and simply replied, "How can I? He is my son. You two will also understand when you become mothers, yourselves."

I wondered at that last statement. Will birthing a child really turn me into the sort of person who could possibly love an unreasonable, unrepentant boy simply because he was my son? I really doubt that.

I had not thought of love this way before. Love as some kind of malignant disease, which does not allow you to think or reason clearly. It makes you selfless to such an extent that you lose all understanding of self altogether.

As I was getting ready to leave at midnight, my co-intern turned up and we were talking about how a mother's love is unconditional and Darwin's disciple that he is, it turned out he had a slightly different take. "The idea is to pass on our genes, if we did not love those things, those semi-parasitic, annoying, screeching bundles of flesh unconditionally, we'd be tempted to kill them off and the human race would die out. Unconditional love is just a biological imperative disguised as an illusory ideal."

He may be a little bit further from the truth than he believes, I think. As I was walking to the main gate, I passed the Paediatrics ward where a new mother played with a child with Down's syndrome and I watched the little girl laugh and laugh as her mother tickled her. I went in and ruffled the girl's hair. The mother smiled at me as the kid giggled happily, and said, "I know she'll never be like other children, the way I wanted her to be, but the doctors say she'll be a happy child in her short life. And somehow that doesn't sound so bad. I think it could have been much worse."

I left her, realizing that I will probably never be a very maternal person, even if I managed to become a mother. That's alright. But to love so deeply and so truly is not something one should dismiss as mere biological imperative, even when that love brings nearly as much sorrow as joy.

Wednesday, August 17, 2011

Waiting on the world to Change

"The busy have no time for tears." - Lord Byron

Or for anything else, really. Yesterday, as the rest of my generation set out from their homes with the renewed belief that their actions cud change the world, I set out at 6 AM to spend the next sixteen hours working in the ICU. Every second minute, I received messages from friends telling me to take a day off from work to head to Azad Maidan to stand up for real democracy and in protest against corruption, and there were more messages saying the objective was to get arrested, to go to jail, in Anna Hazare's Jail Bharo Andolan.

I realised the girl I used to be four years ago wud have believed it was my duty as a citizen waiting on change to do exactly what those messages exhorted me to do. To stand shoulder to shoulder with my friends, and chant slogans with them. To believe that I was doing everything an ordinary person possibly cud, by way of peaceful protest, to walk along a path set out for us by the greatest Indian who ever lived.

But this time around, I had work that needed doing that seemed wrong to abandon, even if anyone was naive enough to believe the future of the country depended on it.

How does one order one's priorities, a disappointed friend's sms asked. He rather dramatically asked me if temporarily relieving the suffering of ten people ranked higher than catalysing societal change for a billion.

I said yes, for a doctor it does, and that it was all deja vu for me. I had done this thing before, going to Azad Maidan, climbing into a police van, being detained in a warehouse for four hours. All for an issue I had rather strongly believed in - back when the protests were organised by students against the Supreme Court ruling for 27% reservation in all educational institutions over and above the existing reservations. I protested, felt good about myself, believed I was doing the right thing, doing what Gandhi wud do. Four years later, nothing's changed on that front.

This time it's a different kind of fight staged by the same kind of people. A rather curious mix of young people who're optimistic about the future and older people who've managed to shake off their apathy atleast for the time being. I hope for their sake and mine, the outcome this time around is a favourable one. Simply because this time there is more at stake.

I hope that something truly good comes out of this struggle in the end. And that when it does, I am not as busy as I was yesterday, so I can celebrate with the friends I had to say no to. And go out dancing with them after ages. Because, like a wise man said, 'a revolution without dancing is a revolution not worth having.'

Thursday, August 11, 2011

The day you fly without me

I look out my window tonight as your plane etches a line in the sky
Outside, this mad city recedes from me
with its million teeming hearts in a million sleepy chests

I sit still in the night, you move towards dawn
I remain a fixed point on the map as you consume its longitudes

Our pact to read our farewells
at two in the morning
with you in the air, and me on the earth
weighs unbearably on my mind

While your unopened letter
lies on my desk,

Saturday, August 6, 2011

There is a Light that never goes out

In our hospital, the fact of life and death going hand in hand is somewhat ironically underlined by the placement of the Labour Ward from the OBGY department along a corridor right opposite the Male Medicine Ward for Seriously Ill Patients where I am posted right now.

While this leaves much room to philosophize, ground reality presents a rather different set of observations to be made.

Four nights ago, on the night of my second consecutive emergency inside of a week, at around 3:30 A.M. approximately, while our houseman and I were trying our level best to maintain some semblance of conscious brain function while struggling to stay awake, two of the 'seriously ill' patients in our ward simultaneously took a turn for the worse.

That I wud have to watch my houseman, in his sluggish although frightened mental state, perform a quick but random triage in his head, did not occur to me while he rushed to the side of the patient on bed number 1, ordering for the intubation tray and the emergency cart. He began what he knew was about to be a failed attempt to resuscitate the dying man, when he gave me a sudden deer-caught-in-the-headlights look and as if just then remembering we had yet another dying man to deal with ordered me to bed number 27, and as I began to do what I hoped wud bring about a miracle, he yelled at me to call for help. From the MICU or the EMS, anywhere.

And unless somebody came, he seemed to imply, we wud likely lose both patients simultaneously. Asking the student nurse to hold my mobile to my ear while I was doing chest compressions, I managed to get two very sleepy medicine residents on the other end of the line, both of whom declined to come, citing reasons slightly churlish but wholly practical.

And as soon as I heard the call disconnect, all my slowed-down mind could grasp was, this was it. This was the first patient I wud watch as he died with my hands compressing his silent chest. I wud have stopped when I knew he was not coming back but the look on my houseman's face meant I wud have to keep going. I did it for ten whole minutes before he stopped and it meant it was okay for me to stop as well.

I must have looked really sad or distraught becoz he talked with both sets of relatives himself, I was relieved he'd spared me from having to deliver the news of the death. I walked slowly back to the side-room and lay down on the bed before he entered around an hour later and kindly asked if I was okay.

He said to me, in what he hoped was a comforting voice, "You'll get used to it. It happens all the time, every day. People die and you deal with it. It's strange, isn't it? Their bodies, out there, have everything the same as before, nothing's changed in them. Yet, the force that animates us all, is gone. Just like that."

"How come no one came to help?" I asked him. He sighed and said, "It's late at night, they've got their own work to do. Don't blame anyone. It was my job, anyway." He turned away from me and fell asleep for what little remained of the night.

Outside, in the lightening sky, I heard birds chirping, signalling dawn and a new day. In the corridor outside, a woman was sobbing, loudly at first, and after some time, she stopped, only whimpering now and again. In the next wing, newborns cried as they took their first breath of life.

As I rose to start the morning blood collections, I realized I had learned a new and important lesson. That it takes more than adequate knowledge and good intentions to save a life. It takes luck and random chance. And acceptance of the fact that saving one man does not mean you'll save another the next day.

But life goes on. Atleast, until death intervenes.