Sunday, October 25, 2009

Games Doctors Play: A Play

Scene 1: Medical College Hospital, Ward 1.

Actors: Dr1, Dr2, Dr3

The stage is too brightly lit with numerous over-head lamps, with only one hanging mike at the center visible to the audience. Walls are painted regulation drab yellow - plaster peeled off in patches. Red spit marks bottom right. One old fashioned ceiling fan with cob-webs making creaky noises occasionally.

Drs 1 and 3 are sitting at a table at the end of a long ward. They are both male, in their mid - twenties, unshaven and apparently tired. Dr1 is sulking, Dr3 is writing into a case-record.

Dr1: "I hate him. God, How I hate him!"

Dr3 looks up from the case-record, looks at Dr1, and resumes writing.

Dr1: "I could kill him with my bare hands right now."

Dr3: "I am sure you could."

Dr1: "How could he? I had it all planned for the evening."

Dr3 does not respond. He appears not to have heard.

Enter Dr2 (Right). She is of about the same age as Dr1 and Dr3. She is wearing a white coat, and is greatly excited.

Dr2: "Guess what?"

Dr1: "Him dead?"

Dr2 looks at Dr3, who winks back. She chooses to ignore the remark.

Dr2: "Not yet, but we got another H1N1 admission today. Lady, pregnant, 7 months."

Dr3 stops writing. "One of our own?"

Dr2: "Nope. This one's ref from _________ multi-specialty. Software engineer."

Dr1: "So, What's new? Just another swine flu case."

Dr2: "My! You are today worse than usual, what happened? On second thoughts, dont tell me."

Dr3: "They got a bed for her?"

Dr2 looks at Dr3 with an expression of surprise.

Dr2: "And since when has that started to matter? They throw out, the moment a patient is diagnosed, and we take them in, no questions asked. You ought to know that."

(Exits Left)

Chorus: "You ought to know that. You ought to know that."

Faint wails arising from Right.

Dr1: "I can hear them now, that should be them."

Dr3 rises from his seat, goes to Right, looks out and returns to his seat

Dr3: "You're right. Its the new party. How did you know?"

Dr1: "What do you think how I know? I've been in this ward for a month, 've been on duty here 24 straight hours now, and next to the H1N1 quarantine unit as we are, I can hear them day in and day out."

"I can even tell what's happening just by listening to them. Here, last week, remember the old woman with her beads?"

Dr3 tries hard to remember for a moment. He does not respond.

"I could hear her non-stop reading from the scriptures, day in and day out, and the once or twice I went past that way, I saw that not only was she reciting her prayers, but she was counting her holy beads without pause, as if her daughter's life depended on it."

Dr3: "I remember now. That was one of our own. But she.."

Dr1: "Yeah, the same one that passed away last week. I was the first to know 'cause the old lady had quit praying. I had a good night's sleep that day. She was beginning to get on my nerves."

Chorus: "He had a good night's sleep. He had a good night's sleep"

Dr3: "And now that you've been asked to stay on for another shift, am sure you'll get closely acquainted with the new party as well."

(Exits Right)

Dr1 stays in his seat for a while, gets up, looks out (Right), returns to his seat.

Sound of Loud crying can be heard once again from Right. Enter Dr2 (Right).

Dr1: "Not dead is she?"

Dr2: "No. But the baby.."

Dr1: "That one was a goner alright. They'd be lucky to get the mother."

Dr2: "That they'll be. She got Oxygen Saturation less than 40% in her blood, I am told."

Dr1: "I really wish they wouldn't make so much noise. Its giving me a headache."

Dr2: "Could you for once stop being so cynical?"

Dr1: "Cynical! What's cynical about asking for some peace and quiet? And what's with all these lights anyway? Ask them to replace a broken one in the OP and it takes ages, and here, just look at it, burning away without a care! The obscenity of it!"

Dr2: "Relax. Have you forgotten this is a play and we are on a stage? They need to watch your every move."

(turns and gestures to audience)

Dr1: "Then why just one mike? Wouldn't they want to listen to me as well.. perhaps hang on to every word I say?"

Dr2: "Tell you what.. I don't think they do. I think they would rather look at you than listen to you...(Chuckles) you especially. Who wants to see a doctor whine anyway?"

Dr1: "What's this, a bloody pantomime show? What sort of an audience is this?"

Dr2: "You have been working too many hours"

Dr1: "The old man doesn't think so. Just gave me another shift."

Dr2: "Still do you have to be so bitter? Don't you know half the work-force is on strike?"

Dr1: "May be its better this way. At least I wont have to go to my room at the Quarters"

Dr2: "How's that a good thing to be?"

Dr1: "The room mates are all at the Labour room. Our focus of H1N1 outbreak, you know. Their colleagues had been confirmed to be infected last week. Now they have started showing symptoms as well, and yet they are asked to report for duty."

Dr2: "And yet you share the same room!"

Dr1: "You got a better idea? They did not throw me out when I got dengue fever 3 months ago."

Dr2: "Get yourselves diagnosed as infected or not. They have begun to take nasal swabs at the labour room, I hear"

Dr1: "You hear a lot, dont you? And yet you hear only so much"

Dr2: "Then get it done from the General Hospital. They have an H1N1 cell too."

Dr1: "That they do. And I had planned today to get myself checked there today evening. Guess its not to be"

Enter Dr3 (Right)

Dr3: "Its in the news. The labour room as the focus of infection. They have started shifting the patients out."

Dr2: "As usual. Too little, too late"

Dr1: "My! THAT was Cynical of you"

(Loud wails arising from Right.)

Dr1: "I think I am gonna sleep comfortably tonight after all"

Dr2 goes right, looks out, looks back at Dr1, exits Left.

Dr3: "She's much to learn yet. She still believes."

Dr1 is silent, lost in thought. He goes to right, looks out, and doesn't look back.

Over-head lights are dimmed one by one, until only one over the right window, illuminating Dr1, remains. It stays lit for a small while, and then that too is put out.

Wednesday, October 7, 2009

The day I spoke to Rahul Gandhi

It happened, really, in three parts, and may be that's the way It should be told.


I was on night duty at medicine casualty, on the night of 6th October, 09. It was a particularly hectic shift, having barely been able to sit down for a few minutes until midnight. A first year nursing student at some college in the private sector had jumped off the roof of her hostel, and so in addition to the usual crowd we had hoards of media people going about their job, and in doing so interfering with everyone else going about their's.

At around midnight, there was a momentary lull in the end-less parade of people with heart attacks, snake-bites, 'Bronchial Asthma's and plain high fever of a few days duration. The three of us on duty sank down to our seats for a moment of respite. I was the junior officer. In addition, there was a post-graduate resident and the casualty medical officer (CMO), who was the one in charge.

I listened then to a conversation between the resident and the officer. There was talk of having received instructions from the HOD - Internal Medicine, to the effect that one ventilator machine at the casualty was to be kept free for the night. Mr.Rahul Gandhi was visiting the city on Wednesday, and for the entire duration of his visit the ventilator had to be kept ready and waiting in case of an emergency. To avoid any last minute complications, no patient was to be admitted during the night.

I remember having thought, that the security protocol in case of someone as important to the nation as Mr.Gandhi might actually justify this rather elaborate and costly gesture (in terms of the human and ethical cost involved), and the doctor, who at the end of the day was merely a glorified technician, was only expected to carry out instructions just like the rest of them. I knew the CMO on duty to be a good clinician, and - more importantly - a man of integrity, yet the coolness with which he relayed the instruction down to his immediate sub-ordinate, that was chilling.

Here was what I was most terribly afraid that this system might do to me as well over the years - make me as cynical as the next man, render me incapable of noticing the cost of my actions, and in doing so take my refuge behind the steel curtain of bureaucratic indifference and impersonality. I believe I am halfway there already, having seen time and again how similar steps were taken to mollify the giant egos of even local political wannabes.

The medical casualty has two ventilator machines - which are important in acute life support (please see my post 'The Reluctant Fisherman' for a bit more about acute life support and the ethical dilemmas therein), and usually we have only one of them functioning properly. To keep it vacant for an entire day - for an eventuality that only might occur, and that too when there were scores of such machines in the private hospitals in the city readily available, that was obscene. I know there might be dictates of protocol that necessitate such extreme measures, but I think its about time that more people began asking a few dirty questions around this country.

Anyway, the night passes, thankfully uneventful, but for a few more heart attacks (Myocardial Infarction or MI as we refer to them), a couple more of snake bites, and the usual number of Diabetics with very low sugar in their blood. Nothing happened, that would necessitate use of a ventilator machine, until 8 in the morning, when my 12 hr shift ended.

Drearily, I made it back to the quarters, having handed over charge to the day-shift team. One of the perks of being the junior officer is that though you have to be the first person to report for duty, you also get to be the one that stays on his seat through the night - even as nurses and paramedical staff go to bed - and then get to the one to stay on until the next shift has arrived and duty is handed over.


My friend enters my room at the quarters, greatly excited, quite uncharactarestic for his quiet ways. He has a handful of cards in his hand bearing the picture of a smiling Rahul Gandhi. He asks me to grab my college ID card and go with him for the interaction programme with Mr.Gandhi, which was to start in one of the well-known arts colleges of the city in an hour's time. I declined at first, pointing out that I did not possess a valid college ID card just then, as was required by the instructions on the entry pass. However, it had been a while since we had gone out together, and my friends convinced me to try my luck as all the others had their papers in order. I thought of telling them that the Special Protection Group or SPG that was responsible for Mr.Gandhi's security were professionals of the highest order, and it would be futile - and unfair - to expect them to show any leniency, but in the end decided to go along with the fun as far as possible.

We make it to the venue, and surely, there's an obviously SPG person at the gate asking for our passes and college IDs: Clad in smart gray safari suit, tall and strongly built, eyes calm and intelligent. I knew we were gone beyond the point of no return, because to start walking away now would be to immediately rouse his suspicion. Expecting fully well to be turned away, I walk up to him, say 'Hi', show him the invite card, and tell him about the student ID card that has been submitted to the college office for renewal and upgradation to a faculty card. He takes his time to assess me, looking me up and down, and then looks at the IDs of my friends, some of them sporting brand new faculty cards, others fishing dilapidated student IDs out of their wallets, and then, almost to my disbelief, lets me in. I pause a moment to tell him I appreciate the risk he is taking in letting me in, and thank him for it. For a very brief moment, something like a smile fleets across his features, before they again become set in stone, and I realized why the SPG were regarded as the best in the country in what they did. It was not because they were burly robots that would follow rules blindly and to a T, but because they were sensible men who could assess situations and people using their own intellect. That was what made them invaluable and so highly effective.

We troupe in, my friends and I, and find ourselves seats in amongst one of the front rows of an auditorium that would eventually come to be filled with nearly a thousand people. Tired from the night, I start dozing off almost immediately. I was woken up by the sound of a thunderous standing ovation as Mr.Gandhi arrived, without the regular media entourage, which I learned later was deliberately forbidden from hanging in on the interactive session.

After the usual introductions, RG, clad in casual attire, rose up to speak, and went on to explain in some detail why he was making this trip. He talked of the core assets of India being its people, on the demographic advantage of having a higher percentage of youth than the other big nations of the world, and why it was hence important for the youth to take a more active interest in the running of the country. He started taking questions from the gathered students, and in answering their questions spoke of the other India, the India of superstitions and hunger and deprivations, the India that we had to strive to bring in to the mainstream. He gave the general impression of being someone who had learned at depth about the state of the nation - both its problems and possible solutions to the same. More importantly, he came across as someone who was neither blissfully ignorant of the complexities of the problems that we were faced with, but at the same time was not awed by the enormity of the task. He believed change was possible, here and now, if only we might exercise the will and faculties that we possessed. I felt he was someone who cared about this country, and had faith in the system's ability to correct itself from within, a faith that the people of this country seem to be losing dangerously fast. And lastly, it was obvious that this man did not take his authority for a traditional taken-for-granted fiefdom, but had made it a point to earn his entitlement. His faith and goodwill, was infectious.


It was then, that I decided it had to be told. I could see that this man was different from any other politician I had met: in that he possessed a basic sense of decency and respect. I knew then, that he would never ask that a ventilator be denied to anyone whose life might depend on it, and keep it for his possible use. I knew, with some degree of certainity, that he would actually not stand for something like that happening on his name. I could feel that he was capable of doing something, simply because it was the right thing to do. Change was possible, here and now, he had said. I believed him, something I had thought myself incapable of doing in so short a while.

I asked for the microphone, and when my turn came, stood up and told him that I had a question for him, but first, I had a tale to tell.

I told him about the ventilator that was kept vacant only because he was in city. I told him that I drew no conclusions or made no accusations, but I thought he would like to know.

Strangely enough, my microphone failed, and RG asked me to just shout at him, which I did gladly and at the top of my voice.

I was right in that RG shared my sentiment. But he was shocked, and I hadn't counted on that.

"Its disgusting", was his reply. He promised to get on top of it right away.

I went on to ask my question, about the need to more strongly promote social engineering, rather than leaving it up to the people themselves, with the result that different communities were experiencing vastly different standard of living and rates of improvement of living indices. I asked about our inability, or rather, unwillingness to counter the sort of propoganda that led to the two-nation theory and the partition. I was hoping he might suggest a uniform civil code and more aggressively encouraging all sections to form a value consensus with the mainstream. The question was nebulous enough to have begun with, and without the help of the microphone it was hopelessly lost on RG, who could only catch my beginning phrase about Democracy in India having been the imposition of an intellectual minority. He talked of their having been elements of democracy in our culture long before the republic was formed - something I totally agree with him on. Argumentative Indian is a must read on this subject.

Immediately after he had answered the question, Rahul came back to the story of the ventilator, and wanted to know the name of the hospital and the doctor who had issued the order. Not wanting to shout names just there, I offered to tell it to him after the meeting was over. A dignified person came to me and introduced himself as working for RG, and took down the details. He took me aside and asked me to wait there for a meeting with RG. Soon afterwards, Rahul came down and came to where I was standing, and repeated what I already knew - that he didn't have anything to do with it, and would have never allowed it to happen in the first place. He asked his secy to raise the matter with the SPG at the earliest. I was beginning to feel ashamed for having made this man apologize twice for what was clearly not his doing, and I felt to compelled to say something.

I told him, words I'd always remember. "I hadn't planned on saying any of this here when I had come in. But after seeing you, and listening to you, I felt you deserved to know what they were doing in your name."

"You are a good man, Rahul Gandhi."

And I dare say I had the nerve to pat him on his back. Twice.

I think he was moved as well. He paused two seconds, said thanks, patted me on the back as well, and got inside the SUV that took him away.

Change is here, Rahul Gandhi. Way to go.

Sunday, October 4, 2009

The Stench of the City, part III

I dont think anyone would want to read through in detail about what happened at the sewage plant, but I might as well finish it off for completion sake.

My team consisted of 2 health inspectors, 2 junior health inspectors, 2 public health nurses, 4 junior public health nurses, driver, and a police escort.

We could smell the place more than a km before we actually got there, especially as we happened to cross the path of downward wind.

The plant was located, not at a desolate stretch of wasteland, but on a somewhat thinly populated village.

The plant was not set up with the permit of the village panchayat, as such it could be called an illegal establishment. The panchayat had, for the past decade, been mired in a fight against the much stronger city corporation which was the sole beneficiary of the project.

While construction for the plant was under way, the gullible villagers were told that the corporation was preparing a garden and a flowering plant nursery. It was a reasonable explanation because 10 years ago the location of the plant had been a hill, which was a popular hang-out for local people. That hill was razed over the next decade to cover garbage in the sanitary land-fill. The hill was called, 'the sunrise-view'. By not giving them advance notice, probably because the govt knew it would never be able to establish a plant with the concurrence of the local population in this high density state, the govt had denied the local people the option to shift to other areas, and now their properties were un-sale-able due to proximity to the plant. Residents of nearby areas have not been re-settled to date.

So here the corporation was conspiring against a village panchayat, and because the plant was absolutely essential for the running of the capital city, the legal machinery and even political parties had decided to look the other way. The media, but for the occasional report, made no big hue and cry, as is its wont in such matters.

I especially remember one household that I visited, a large, old house built in traditional kerala style, and could for one moment picture this place as it was, only a few years ago. A house that once had a joint family living in it. The big cattle shed with numerous animals. The fertile lands full of fruit-laden plantains and coconut trees. Now all those capable of doing so had moved away to the city or other villages. Those left behind, left without their earning hands, were barely eking out a living. They were unable to rear livestock anymore, because the local stream where they used to bathe the animals had turned vitreous. Man and animal was bound to get sick if they touched the water. These were our people, and we were disbanding them.

At one point the local people, tired of fact-finding missions, blockaded the corporation van, and I could see that the police escort was no ceremony.

And I knew with a sinking feeling in my heart, that this mission was a joke already, even without my going in as the expert. It was no anomaly, just that the joke, without any mirth, had become that bit more funny. What do you expect when the corporation is sponsoring the fact-finding mission that would investigate complaints against itself?

Just then, I could really feel the stench of the city.