Neem Hakeem Confessions : From the Lows to the Highs

FROM THE LOWS TO THE HIGHS.

A long winding road, struck with barriers at few paces leads to two ways. A brick building with a clock on the left and straight on, a modern building and some other gloomy, yellowish sick ones on the right and finally onwards onto the debris of the city that is Lahore.

The air is bustling with life, sickness, battles- loud and silent, cries, a sense of gloom lurking around, an OCD-ed sense of stagnation, and somewhere frail treads hope. Hapless patients out on stretchers pushed by awazaar attendants.

Students on and about, flashing their overalls, possibly clueless or irritated depending on how the day started for them. Ambulances driving by. Vehicles, people, birds in the surrounding typically like anywhere.
But enter wards, your reverie is broken. A thousand ailments, a thousand crisis. You wonder how many excuses God has created to call you back. The aura of a hospital depends on the people inhabiting it.

From strict nurses often annoyed at the patients' tantrums, to the people in charge at the door screaming at the attendants to not consistently barge in other than the visiting time, to doctors who are either too tired or too carefree and moody or too busy, I've seen only a few seniors who have addressed patients as pleasantly and as kindly as I'd have liked to see. Maybe that is an exaggerated assumption, since in their own shoes with a huge load of patients to process every day, perhaps everyone is justified. Because often times the patients are ill informed, non compliant and adamant to a very testing extent. The point in case is, a cheerful environment is the last thing you'll come across.

Perhaps the most agitated are the patients. Coming from far flung areas, with diseases they've no idea or clue about, with possibly the only sense to live life is at the basics- food, shelter, clothing, because they have never been ascertained about these commodities as easily as us, the fortunate lot are.

 They sit by their beds and are observing people- doctors, students, patients, attendants alike as gloom and misery, along with ignorance and perseverance beyond humane capacity , walk around, playing hide and seek, coming in bouts.

 Some patients are lying down, some curled up, with breaths escaping their mouths as if in a hurry to keep pace with the trickling sands of time that are rapidly progressing towards death. Others have a curious look on their faces. Certainly someone new coming in, walking around, any commotion is a fine way to get their attention away from the drains, drips, a frustrated relative or the monotony that seeps in with the passing days. Peace of mind must be the hardest thing to achieve owing to the shouts and screams, bickering attendants and nurses, irritated doctors and pestering students who constantly pursue history taking with the same questions over and over again, sniggering and joking often to each other, unaware of the intensity of their pain.

During my brief time in wards, bunked most minors, I came across some people that left an impression on my mind. Somewhere I could look beyond and just see how life (which is a bunch of tiny troubles involving grades and dull routine and friends and family for me) has its extensions in misery more deeply rooted, more cruelly than I could ever have imagined let alone put up with.

How easy it is to see that yesterday, you were fine and normally walking, enjoying life or scampering and making a living. And in that activity, today, you're in bed. You don't have any of your legs. Entirely. And you can see your abdomen and pelvis, fully exposed. Skinned. Bloody. You can notice the white rim of your Ilium too. Is that a horror story in real life or some nightmare you just can't seem to be waking up from? This was a patient of a traumatic road accident that left him physically handicapped for life. What he may have suffered emotionally would've been a different story altogether. And at times like these, I wonder how much emotional counselling is direly needed in our health system. But neither the doctors are spirited enough (often not always) nor are the patients that receptive and capable. Perhaps Faith is the best healer but even that needs to be rejuvenated now and then.

A middle aged man with greying hair was seated once in a bed in the male ward. He had a certain stink due to this ulcer beside his thighs that was rapidly growing and was full of pus and stench. I tried to reassure him meekly and it was then that he asked me that,"Dr saab mjhe 11 paaray yaad hain. Main saari namazain bhe parhta hoon. Main theek hojaun ga na?" He was hopeful that his good deeds would be rewarded. That he most definitely would heal. And the sheer innocence of that belief and faith was heart rending. I saw a child in that man. He was never married and all alone. And there you wish you could do something more than to merely cure that ailment.

When you visit female wards there is always a hustle bustle around. The women are talkative and extracting histories is easy. I noticed a young girl who was seated by her mother, barely 12 yrs old. I went on to inquire about her mother. She was suffering from a gastric carcinoma. She had three other younger kids and she had already lost hope to recover as she was made to go and take tests every now and then. She was exhausted and I could not help feel any more helpless. Beside her was a burn patient. And all I could see was pink flesh.

There was another patient, a girl of nine or ten, who had touched a high tension wire while playing and was severely electrocuted in the left hand and both feet. Sir showed us the exit point of the current beneath her feet while the few fingers that had touched the wire were absolutely charred. It brought me back to DH times when we had had cadavers that were either semi burnt or rapidly decomposing. Only this time, the person was alive, had two of her fingers scheduled for amputation, a semi bared/skinned wrist where a few tendons were visible while the surrounding tissue was pale. Sir was unwrapping the dressing as she whimpered, 'na kren na' out of the fear that we were about to do something. Sir briefed us about the procedure, and then wrapped her hand back again as she politely uttered a 'thank you' in a quivering voice. I wondered what for? We practically just caused her inconvenience. But the sheer diversity and stratification of life hits hard. You wonder if all lives are equal then why is treatment different? Why not similar opportunities and platforms? Because the truth is, all lives are created equal but the moment you come into the realms of earth, a certain rank and label is already placed upon you and it shall stay throughout varying moderately in either direction.

We were being taught the respiratory system examination in medicine ward on a skinny 11 year old. This was a case of suicidal attempt by swallowing rat poison. No one bothered taking a history because what was essential was that we learn the vocal fremitus. I inquired later on from the boy as to why he took them and he was blunt in answering that his father gave him a good beating after he refused to go to work. And in retaliation he took the pills. A child deserves an education rather than the responsibility to earn for the family. He deserves care, not a beating. All I could muster was a hollow advice that he troubled his mother more so than his own struggle. His dad never accompanied him to the hospital and probably never will show any dedication in future. But what mattered was his own reaction to his life's problems and that didn't involve creating more for himself and his extended family.

We were just waiting for our class to commence in the medicine ward the other day when we noticed a very old man who got up from his bed, walked a few steps and sat down. His attendant forcefully grabbed his arm and made him walk a few steps then turned back to grab his belongings and the baba gee sat down again. He grabbed him again and muttered, "aap ne apna waqt bhe zaia kiya aur hamaara bhe. Tang kiya hai bas sirf aap ne aur kuch nai." As they paced forth we inquired why had they not arranged for a wheelchair. In a ward of over a hundred patients at least, only 4 wheelchairs were available and those too were taken. We asked them to wait and asked around if something could be arranged. The wait prolonged yet no wheelchair arrived that's when a friend suggested to ask the ENT department for one. We noticed a brand new wheelchair and asked for it but the attendant refused saying, "Ye Professor saab ne rakhwai hai yahan, bilkul nayi hai, ye istemaal nai hou sakti aap doosri pata kren iska abhe cover tak nai utra." To think that a wheelchair is preferred to be a showpiece than to actually be used for what it was created for is painful. That's the value of human life to a new commodity. Which one's cheaper?

There have been incidents where patients really bring it upon themselves owing to a careless attitude. One patient who was severely diabetic to the extent that she had had two of her fingers amputated and came in with ulcers in the leg and yellow spots in some fingers. Upon being asked if she kept her sugar in check she replied in affirmative whereas her attendant revealed that she was a mother of 4 sons and took great pride in the fact that they handed over their salaries to her. She was a food lover and kept nothing in check.

Similarly, a woman lied about not puffing a hukka whereas her sister begged to differ. Some patients turned in only when their problems got worse or were not cured by the local quacks.


And then there were some who battled bearing immense pain. A woman undergoing TB therapy that went wrong and caused her liver failure. One of the most surprising occurence in surgery ward is that the patients never hesitate to undo their own dressing to reveal their scars. Patients who have their ileostomy (An ileostomy is an opening in your belly wall that is made during surgery. An ileostomy is used to move waste out of the body when the colon or rectum is not working properly) done or undergoing treatment for ulcers, readily undress their wounds when asked to show. And perhaps what else is courage than to bare your own wounds? The woman with TB was discharged with intact opening that would last for almost a year. I remember her glances at the wound and screams as they taped and untaped the dressings to change her stool bag.

As much as the amount of struggles and hardships are residing in air, hope, courage and faith are not far behind in putting up their own fight.

I was talking to a man who had his arm amputated due to faulty treatment of a wrist fracture previously. I was quite put off by the fact that a little carelessness of a doctor caused a patient massive damage for life. As I began to repeat my nervous, assuring one liners at the end of every history taking, the man simply pointed his finger upwards and reassured me in fact, that He is there to look and take care of all of this.  That is what's needed. Faith. And belief in His plans.

I'll wrap up my rambling by mentioning an adorable, old woman suffering from a benign breast cancer. Old people have a charm about them resembling a toddler. The same innocence, the similar childish-ness. With thick round frames and rosy white cheeks, her toothless grin warmed everyone up in those chilly January times in the ward. She told me that one PG asked her to pray that he finds a good wife whereas another HO had bought her medications.

A little kindness goes a long way. And some gestures never leave the memory. I will always remember how she would embrace me, utter my name and give bundles of prayers to everyone. And I guess the best thing I'm finding about Medicine so far is this priceless interaction that goes beyond our limited circle of friends and family and encompasses the most random people around that leave a certain permanence in our lives.
It's magical.