Lament of the Indian Resident Doctor

While the media paints a sorry picture of the innocent patient denied elective services during a resident strike, the voice of the protesting medical resident goes unheard.

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Most of us went through a “When I go grow up, I’m going to be a doctor” phase during childhood. Mine began at age 7, and I never outgrew it. It seemed so magical, how my doctor could listen to things that were going wrong, piece together important bits of information to explain why it was happening, and better yet, offer a solution to make everything better. I was amazed that those hands that felt my pulse had once touched every part of a human body, memorizing the locations of all the different organs that make us function on a minute-to-minute basis. Those eyes that looked at the back of my throat had spent hours upon hours reading gigantic texts with miniscule fonts, learning to recognize disease from incidental anomalies. Those ears that listened to my heartbeat had trained themselves to distinguish not just normal from abnormal, but also between a hundred different types of abnormal sounds, while listening through layers of my skin, flesh and bones.

So, it was with great pride that I bought my first stethoscope upon being accepted into one of the foremost medical schools in the country. I was going to learn to do all of that, and so much more. At the end of five-and-a-half years, I would to be armed with the knowledge and skills to diagnose and manage an array of medical problems ailing the people around me. I had worked harder than I could have imagined possible to get into this competitive field, and I was going to endure, with the ultimate aim to earn not just a decent living, but also immense professional satisfaction from service of the sick. My life was made!

It wasn’t long before the Indian medical education and healthcare system began tearing these illusions to shreds. Medical students were a burden to teach, and, for the most part, were expected to fend for themselves. Interns were lowly beings at the bottom of the hospital food chain, whose purpose, far from honing their professional skills, was to perform scut work and assist in transportation of patients, biological samples and lab reports inter-departmentally across the 44-acre hospital campus. It’s not like they were going to be awarded a general practitioner’s license after this year of supposed multidisciplinary professional training. The few interns who managed to take (and ace) another series of even more competitive entrance examinations graduated to the position of residents, who were simply manpower to get through the sheer volume of patients that entered and exited the doors of our hospitals every day. And after 3 more years of underpaid sleep deprivation, they were suddenly licensed to independently practise medicine in a specialized field, unless they chose to take upon the next daunting task of sub-specialization.

Disillusioned, we began branching out. Some, like me, chose to undertake the pursuit of graduate medical education internationally. Others turned towards entirely different careers altogether: business, administration or the arts. Many, however, persevered through all these discouragements for the long haul. Today, it is these very determined souls who are suffering at the hands of the general population and fighting for their rights without any support from the government or judiciary whatsoever.

In the short span of a few weeks, multiple resident doctors have been physically assaulted for a variety of reasons ranging from unavailability of a subspecialist overnight to poor patient outcomes. Resident doctors working unending hours caring for scores of patients have been deemed heartless, lazy or negligent, and beaten, threatened with rape or murder, and in one case, even blinded for trying to prioritize cases and manage several sick patients at once in pitiful working conditions. When they decided to stand up for themselves and demand a safer work environment, the government responded with false assurances of security, the judiciary with threats of termination and the general population with accusations on the collective character of the entire profession. While the media paints a sorry picture of the innocent patient denied elective services during a resident strike, the voice of the protesting medical resident goes unheard. Although I am not at Ground Zero in this situation, I feel obliged to summarize the rationale behind the remonstrations of my colleagues back home, in response to the highly-publicized opinion depicting the modern Indian physician as a corrupt, greedy, lazy youngster with neither the knowledge nor the skills to assume responsibility of the care of another human life.

  1. The ideal doctor exists to serve: no. Most of us do have altruistic beliefs and do really hope to serve the community with our hard-earned expertise, but just like an engineer’s prime interest lies in creating innovative designs, our first love is biological science. It is our privilege to contribute to society in such a direct manner with our proficiency, but if all we wanted to do in life was serve, we would have chosen social work. We do, however, love to serve within our capacities. Are you aware that several young residents currently on strike have organized a blood donation camp amongst themselves to help stock up on this precious commodity for patients in need?
  2. The modern doctor is incompetent: preparing for medical entrance examinations in India required us to study 11 different textbooks of plant and animal Biology, in addition to 2 each of mechanical and electromagnetic Physics, as well as organic and inorganic Chemistry. We took an average of 10 different examinations and competed with greater than 300,000 aspirants across the state for a few more than 6,000 government medical college positions for undergraduate medicine. We then spent the next five-and-a-half years trying to learn everything we possibly could about the human body – both normal and abnormal – as well as how to prevent progression, halt, reverse or even completely eliminate disease processes or causative agents. This cycle was repeated each and every time we decided to pursue further specialization in a field of interest.
  3. The modern doctor is lazy: most of us were 22 or 23 years old while interning at the hospitals attached to our medical colleges. We worked 36-hour shifts, caring for more than 100 outpatients and 50 inpatients on our busiest days. We survived these rigorous hours on bites of unskilfully prepared junk food stuffed into our mouths between drawing blood from one patient and suturing up another patient’s gashes. I once knew a resident doctor who started working in the outpatient department on Monday morning, spent all night with us interns admitting and managing patients in the Emergency Room and then coordinating pre-operative care for elective surgery patients all of Tuesday. As interns, we got to leave for home by Tuesday afternoon, but when we returned on Wednesday morning, the resident still hadn’t had the time to change out of the same clothes, and was preparing to scrub into the OR for a string of elective procedures for the rest of the day. Another one of my supervising residents had to apply for a weeklong vacation 2 months in advance to visit her family for Diwali. Her home was a 20-minute train ride away from the hospital and she hadn’t seen her parents for 4 months. A company with such rigorous vacation policies would find it hard to find employees to fill its positions.
  4. The modern doctor is greedy: in all honesty, if that were true, we would not be doctors. As interns in one of the largest metropolitan cities in India, my colleagues and I earned Rs 5,825 per month (paying the government Rs 175 as “professional tax”). A second-year Pediatric Surgery resident I worked with earned Rs 26,000 a month for being on-call 24/7 (he was the only resident in the program). The average rent in the area of the city our hospital is located in is Rs 36,000. Go figure. True, when he graduates, his earning potential drastically increases – but only if he manages to secure a position at a wealthy, privately owned and operated hospital in a major city. He will probably by in his late 30s at best by this time. So yes, all of us do firmly believe that after sacrificing our entire youth to work towards attempting to allow you to enjoy yours, we do deserve compensation for our efforts. You would not accuse a telecom company of cheating for charging a service fee, so why can you not extend that comprehension to the person who is working to help you hold on to your health?
  5. The modern doctor is negligent: a resident doctor in an Indian government hospital is facing the horrendous doctor-patient ratio of somewhere north of 1:1600. Setting aside the deplorable working conditions and sleep deprivation, they must also deal with patients seeking care at end-stages of lethal conditions and expecting medical miracles without fail. One of my own colleagues from medical school suffered a serious head injury at the hands of several relatives of a pediatric patient who died of dengue after presenting to the hospital in shock. Never mind that he was brought in critical condition, yet initially stabilized, receiving ICU level care on a general ward due to lack of ICU bed spaces. His ultimate clinical deterioration and demise were blamed on medical negligence, and physical assault on 3 young residents by an angry mob was deemed fit punishment. Arrests were made but bail was granted within 2 days, despite attacking a medical officer on duty being a non-bailable offence in India. And still, this case is quoted in newspapers all over the world, focusing on the bereaved family and how they feel no remorse for their actions because their son is dead. Could you legally and morally justify assaulting a politician because his policies did not agree with your own political sentiments?

Look where this blame-the-physician mentality has left us. A budding orthopaedic surgeon has lost his vision in one eye. Do you think anyone would trust him to operate on their loved one? His surgical career is finished. All because he directed a family to seek medical care at another facility equipped with subspecialty services their patient required. Young doctors under training are being threatened with expulsion if they do not return to work, and with bodily harm if they do.

In this hostile atmosphere, what choice do physicians have other than to protest? Would an entrepreneur feel safe if an angry mob of investors could burst through his doors at any minute and pummel him half to death because his venture did not do quite as well they had hoped? Why are physicians held up to a different standard than everybody else? Yes, we deal with human lives, and yes, this is a huge responsibility, but medicine is, after all, just another profession. We are not miracle-workers and we certainly never asked to be viewed as Gods.

Believe us when we say that we do not take our scientific and social responsibilities lightly. Every undiagnosed case keeps us up at night. Every bad outcome takes a toll on our own mental health, no matter whether we could have made any difference with more interventions. We only ask that you consider our side of the story. Recognize that we too are trying to balance personal and professional lives while earning a decent living in exchange for our scientific expertise. We truly do love serving you, but if you could only reflect some of our compassion back to us, we would not need any added security. We are human too, and if we can live by the tenet of “Do no harm,” why shouldn’t you?

Treasure Hunt

A fictional tale of love set in a true incident of terror. In memory of November 26, 2008. To remind us that despite all the bloodshed, horror and mindless violence, love will prevail.

“Smile!”

It was an unnecessary instruction. Treasure hunt was by far Samraat’s favourite game. The challenge of locating the clues scattered along the path and the rush to be the first one to figure it all out and grab the prize enthralled him. He especially loved how the best clues weren’t really all that hidden, but instead, placed quite openly, simply masquerading as innocent objects of the general environment. He had always thought it strange for his friends to be unable to see what, to him, was painfully obvious.

He clutched the gift-wrapped box close to his chest and grinned toothily at the blinding flash.

***

“You look terrible.”

“Thank you, Samraat; you always know just what to say.”

“Seriously, Nidhi. You need rest.”

“Just go. I have coffee to keep me alive. And this is the last overnight ObGyn emergency I’m attending; I swear!”

“And the last night on the town you’re missing too. Abhinav is gonna be so mad!”

“So clubbing is supposed to provide me with all this much-needed rest? Get him a beer from my side and he’ll forget all about it. He’s your brother after all!”

“What’s that supposed to mean?”

Nidhi checked her watch, smiling slightly. “It’s 8. I have to go.”

***

“Again?”

“Sorry man. She’s a nerd.”

“Yeah I can see that, but this is getting insane!”

“You can’t tell me you’re not used to it.”

“I am … I dunno how you handle it!”

“What’s to handle?”

Abhinav sighed as he slipped into the driver’s seat. “Sometimes you’re so stupid that I can’t believe we share DNA.”

“What?”

“You’ve lost your talent.”

“What are you talking about?”

“That.” Abhinav shook his head in disappointment, pointing vaguely in Samraat’s direction.

Samraat felt enormously exasperated. Abhinav could be such a girl sometimes: talking in riddles, expecting everyone to understand and then getting outraged when nobody did.

Samraat gave a start as his brother honked loudly to jerk him out of his reverie. “Get in the car before it’s my next birthday!”

***

Ramya laughed. “You are so funny!” Samraat was well aware that he actually wasn’t, but she was still smiling. Which could mean only one thing: he was so in!

He decided to try his luck. “Wanna dance?”

Ramya looked thrilled. “A doctor who can dance? Are you for real?”

He flashed his dimples at her. Things were going to get interesting!

There was a sudden explosion of loud music from the bar they were resting on. Samraat looked down to find his phone ringing. Talk about rotten timing!

“Hi Preeti.” Samraat answered, his tone making it amply clear to his sister that he wasn’t at all happy with the interruption.

“Are you guys okay?” She was screaming hysterically despite the sore throat that had prevented her from coming out that night.

“Of course! Why?”

“Listen; get out of there right now! But be careful!”

“What’s wrong with you?”

“You guys are at Prive, right?”

“No. We chose Velvet Lounge instead.” He heard a sigh of relief. “Preeti, what’s happening?”

“There are terrorists all over South Bombay!”

“WHAT?” Samraat thundered disbelievingly. Ramya looked scared.

“There was firing at Leopold’s, and now there are 2 armed guys shooting around at VT! Please get home!” Preeti was clearly almost in tears. “I know you guys are far away but who knows where the rest of these crackos are? Mum and Dad aren’t in town and I can’t be alone. Please!”

“Yeah, we’re leaving right now. Don’t worry.”

“ABHINAV!” Samraat roared as he flung cash on the counter.

“What’s going on?” Ramya asked him, fearfully.

“Terror attack.” Samraat answered shortly, as he scanned the drunken crowd for their madly-in-love siblings.

“What? Where?”

“Colaba and VT. We’re dropping you girls off and heading home right away.” He shoved his way towards Abhinav and Tanvi, pulling Ramya behind him. It seemed an inappropriate time for him to notice that she had wonderfully soft hands.

***

Abhinav, Preeti and Samraat huddled in front of the television. A news channel had a grainy CCTV video clip of a young terrorist brandishing an AK-47 at VT playing on loop, as the newsreader stated that he had confirmed news that they had finally left the premises, but regrettably, very much alive, and still armed.

An approximate death toll of 27 flashed under a banner of ‘BREAKING NEWS.’ It seemed an optimistic estimate though; VT was always teeming with people.

“Wait … I’m getting a new input!” The newsreader announced as he adjusted his earpiece and listened intently. “There’s been firing at Cama Hospital!”

There was a crash as the glass in Samraat’s hand fell to the floor. Cama Hospital. Nidhi. It took him less than a second to connect the 3 words. How could he have forgotten? How had it not struck him when Preeti had mentioned VT? The 2 buildings are within walking distance of each other. Was he really such a selfish jerk that he didn’t care about his best friend just because he was flirting with some stupid bimbo?

“Nidhi.” Samraat whispered in shock. Abhinav was already watching him apprehensively. Samraat swallowed once, stood up and grabbed the car keys off the table.

“Where do you think you’re going?” Preeti demanded to know.

“Nidhi.” He replied stupidly.

“What?”

“You’re staying here.” Abhinav informed him, reaching for the keys.

“Nidhi!” Samraat insisted urgently.

“Sam, there’s … nothing you can do.”

“But—”

“Maybe she left early.” Abhinav said, rather too optimistically. Even he knew Nidhi too well for that.

“No, she—”

“Even if she didn’t, she’ll be fine.” Abhinav was clearly increasingly beginning to lose faith in his own words.

“You don’t know that! I have to go there!”

“The area is sealed, Sam.”

“But I should be there! With her!” Samraat could only repeat the single thought in his mind.

“Do you want to get shot?” Preeti look terrified just at the thought.

“I don’t care, I just—”

Abhinav sympathetically pulled him into a comforting hug. In a flash, the hug seemed familiar— the emotion was just like it had been the only time Samraat had lost a game of treasure hunt at a birthday party— and Abhinav’s girly riddle from earlier that evening suddenly made perfect sense. He was right. Samraat had lost his talent of seeing what everyone else couldn’t … in fact, now he couldn’t even see what everyone else could. He was losing his treasure hunt. Worst case scenario: he’d already lost it.

He blinked a few times to clear his suddenly-blurred-vision, only to feel 2 warm streaks making their way down his cheeks.

***

Loud guitaring jerked Samraat awake. He couldn’t believe he’d fallen asleep in the middle of such a nightmarish situation. He jack-knifed up and grabbed his phone, desperately praying for it to be Nidhi responding to the service text she should have received alerting her about the 100-odd missed calls he had left her. An unknown number flashed on the screen.

“Hello?” He bellowed into it.

“Hey, Samraat!” A happy female voice chirped, as if the horror his best friend was going through was just in his imagination.

“Who’s this?” He snapped angrily.

“Ramya!”

Samraat made a disgusted click with his tongue and hung up. Gone were all the illusions of her cuteness. Who wanted a spineless suck-up for a girlfriend? And what real use were soft hands, exactly, if they were attached to someone that brain dead?

“What’s happening?” He asked his siblings as he redialled Nidhi’s number for the nth time.

“There’s been one death at Cama.” Abhinav said solemnly.

Samraat froze. There was a short pause, during which he heard the same recorded message he’d heard countless number of times within the past 2 hours: ‘The number you are trying to reach is out of coverage area.’

“It’s not Nidhi.” Preeti grinned.

A wave of relief swept over him. He laughed before he could stop himself.

Abhinav gave him a thump on the back, grinning widely.

Samraat jumped to his feet and turned to Preeti. “Now can I go?”

“Are you really that stupid? You’re staying here until this is all over.” Elder sisters can be so bossy!

“But—”

“Look, she’s a hard-working intern in a hospital that just got attacked by terrorists. She’ll be busy.” Abhinav had never been so sensible.

***

It had been 3 days and Nidhi was still there. Samraat should have known she’d stay back and help to the point of exhaustion, even though she’d just gone through the same nightmare as them. He watched her from outside the Labour Ward. Her hair was a mess. Her eyes were red and swollen from lack of sleep. Her apron was spattered with blood. And she still looked beautiful.

For a moment, he contemplated barging into the room and dragging her away from the delivery he couldn’t believe she had energy left to be assisting. Then he thought of how overworked she must be, and decided she didn’t need more drama from him. He’d waited 3 agonising days … what were a few more minutes?

1 placenta later, he saw Nidhi pull off her gloves and head to the basin to wash up. Another 2 minutes and she was out, looking ready to collapse.

Before her tired brain could register his presence, he had enveloped her in his arms— blood and all. In no time, she was sobbing into his shirt, mumbling things about showers of bullets, evil bastards and a dead ward-boy. He kept his face buried in her hair as he stroked it lightly, muttering, “Its okay … its okay …”, until her breathing evened a little.

Then:

“I … am a huge idiot.” He pulled himself free and gently cupped her tear-stained face in his hands.

“Colossal.” She corrected him, her mouth twitching. She clearly already knew exactly what he wanted to say.

Impossibly, standing in the very building that had witnessed gunfire 2 nights ago, they laughed. And shamelessly, in front of an entire corridor of expectant fathers, he kissed her.

“So … I love you.” Samraat whispered goofily.

Nidhi almost glowed. “I know!”

As he pulled her into an embrace again, he caught sight of their reflection in the bullet-hold-ridden elevator doors. This was it. His most important treasure hunt was over. And he’d won. Barely, but still. He’d won! There they were … the way it was always supposed to be … true perfection … Samraat and Nidhi: the king and his treasure.