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.

Advertisements

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?

Thoughts

A piece written after the horrifying consequences of the Delhi gang rape 4 years ago

I have never been proud of being Indian. I have never considered it an achievement— I made no contribution to being born, and I entered the world in a country where the likelihood of my existence was statistically higher than most other places, given the population size and birth rate of our people. My only accomplishment was being conceived, and I had nothing to do with it.

As a child, when I was introduced to the word ‘patriotism,’ I was overawed. What a noble emotion it seemed to be— one that drove people to the extent of pledging to lay down their lives for their motherland! And as school introduced us to Indian history, I fully expected some figurative mental door to open and feelings of nationalism to come gushing from within. Nothing happened. I continued to be impressed by the dedication and determination of the defence forces and everyone else who took it upon themselves to ensure that India progressed beyond the superpowers of the world to the very top of political, economic and social hierarchies … but I never understood it. I never felt that love for the soil of our country that patriotic songs talked about.

Slowly, I began to understand why. When I was younger, I was only struck by the legendary Indian lack of civic sense. The incessant spitting and littering disgusted me. I found it absurd that people could rave about how beautifully clean USA is while simultaneously chucking plastic and ejecting entire mouthfuls of paan-stained spit from their mouths. At first I thought it was plain stupidity, but then I came to realise that it was, in fact, unwillingness to change and an uncontrollable urge to complain.

As I got older, I was introduced, via books and television, to more shameful aspects of our society— corruption, several forms of violence ranging from vandalism to gruesome murders to massacres. And all I could do was wonder how people could find it in themselves do such things.

And then, when I was 9, came the real shocker. My mother had educated me well about the ‘danger areas’ of my body. Nobody was allowed to touch me over my chest or anywhere below my navel. Furthermore, no boy was allowed to show me the parts that made him anatomically different from me and all my other girlfriends. No boy could even talk about these things until ‘a certain age’ that for all practical purposes was several years into the future. And so when I was touched by a man at an age when I was pretty much flat as a board, I knew that something bad had happened. That was when I learnt the word ‘molestation,’ though, being only a child, I didn’t understand the full extent of terrible things it encompassed.

5 years later, just after sex education began making its appearance in our Biology textbooks, I heard of ‘rape.’ And I was appalled. As time passed and I was exposed to more knowledge of reproductive biology and sexual crime, the terror became almost constant. And, like any other Indian girl, I was taught to dress a certain way when out without parental supervision, to come home at a certain hour and never to let a male person inside the empty house unless he was my father.

Soon, it became clear that none of these precautions was enough. Rape happened to women in burqas. Rapists attacked in broad daylight. Worst of all, fathers raped their own daughters. It seemed that the only thing I could do to guarantee that I would never experience the horror was to die.

Forward to the present day: a girl who was raped by no less than 7 men in a moving vehicle and thrown out naked onto the streets of our capital city to die— alone, injured, naked, traumatised, violated— has succumbed to the brutality that had been inflicted on her, after 12 long days of suffering. And I, like every other sane person in this country, feel a terrible, aching loss.

Though it was a horrifying story to even read about, I’m not sure why this particular story has affected all of us so intensely. There have been so many incidents— the first to come to my mind being the girl who was raped by a policeman at Marine Drive in Mumbai. And there are so many more we don’t even know about. Besides, we hear of so many other ghastly tales from other countries that we assure ourselves we are, overall, better off.

Maybe it’s the brutality of the crime. Maybe it’s the detailed news coverage. Or maybe it’s just that we’ve had enough. We have seen more crime than I think it was possible, for me at least, to even imagine. Assault. Molestation. Extortion. Rape. Murder. Terrorism. But the most disgraceful of them all remains indifference.

Whatever we call it— moving on, picking up the pieces, ‘the Mumbai Spirit’ (I find this one the most shameful) — we are merely fooling ourselves. Something happens. We protest. We demand. We wait. Nothing happens. We ‘move on.’

And whether we can admit it or not, we are ALL guilty of this most terrible of crimes. Sure, it is sad that courts still uphold archaic laws while failing to implement the more important ones … that politicians get security enough to keep a small community safe while criminals run rampant amongst the masses … that so many important figures still hold sexist beliefs about women’s status in society while failing to blame the minds of men for creating the discrimination … that communal, casteist and regionalist views are freely perpetuated while citizens are arrested for using their right to freedom of speech to voice their opinions … that civilized citizens are arrested for frivolity while people are killed in the apparent safety of their own homes … that young lovers are harassed for the tiniest form of expression of their love while reports of sexual harassment or assault are lost in translation … that laws dictate victims of crimes to live to remember the atrocities they went through while perpetrators must die without actual punishment …

But are we any better? Do we raise our voices against injustice? Yes. Do we sustain our protests until our demands are met? No. And do we then complain about the government? Yes.

We are liars. We lie about caring. We lie about wanting to make a difference. We lie about working towards progress. If we lived up to our promises, things would be different. Mindsets would change. Thinking would progress. Discrimination would regress. Criminals would fear. People would be safe. Justice would be served.

I sincerely hope I am proved wrong, but I do not believe we are capable of sustaining this uprising. Not just because this incident will soon fade from our memories, but because we fail to realise that the girl whose sacrifice has sparked this anger was not Amaanat, Damini or Nirbhaya but a young girl with her own name, face and identity, studying towards building the life of her dreams that is now just a could-have-been … because we fail to see the thousands of faceless victims that this girl represents, whose cries for help have snuffed out either by the criminals themselves or by the laws of our nation … because we fail to understand that crime happens by us, to us, amongst us and is a constant threat to the safety of our own families.

I have never been proud of being Indian. Today, I understand why.