Endless bickering with staff, doctors and the 'System'. For a moment when I get these people I treat for sometime in a flashback, I wonder what I have been doing. I am not saying I do more, but I give all the percentage of my capacity to my job. I am passionate about a proper and systematic workup, and months of doing Emergency duty have now taught me some rude truths about Indian System of Medicine. But I am not going to speak about that now. I want to talk about the 'Me' that has sunk down somewhere behind the 'Madam' and 'Docsaab' business.
When I work for whatever length of time, and I return, I don't know but I am drained. Not physically but mentally. The hagglings behind a family who decide to do nothing about a sick child, the Blood Bank attendant refusing to give blood to 'Non emergency patients'...the typical example of who sent that day were 2 patients with Refractory Heart Failure secondary to severe Anemia, a patient who had to be dialyzed the next day...and a patient of Hydrocephalus to be operated the next day. I was picking cudgels against a 50 year old man at the other end of the line talking in a tone my friends would never know existed in me. Thats normally the aggressive animal i turn into when I treat patients. I am fast, swift, but angry. And sometimes its required to keep attendants on their toes. Whatever.
After threatening these people of things like sending a written complaint forwarded by my Professor ( I use his name unabashedly in places like this where I feel a moral code of conduct is violated...I don't know if he would approve...but that day all 4 of them got their BTs..I was feeling almost physically abusive towards the doctor who denied Blood transfusions to these patients saying Blood Bank had issued precise instructions not to do 'Routine' Blood Transfusions after 2 pm. I asked that man to define what 'Routine Blood Transfusions meant' and was it similar to the 'Routine urine and Blood examinations that were done in Central Laboratory'. He kept blabbering. I told him the precise indications of all 4 patients for whom I had requisitioned a B.T. And then I asked him to point out which one he thought was routine. He started about telling how the new Dr in Charge of the Blood bank was the one to decide this and now that she had gone out to the emergency and could not receive a call so that the onus of everything fell on him. Next I asked him with all the anger that was bursting through my lungs.
'What is your name uncle ji? I will personally come to visit you and Dr N in thirty minutes with a letter from my Professor.'
'Madamji, send the requisitions again. I will see what I can do about them'
In 2 hours, all my patients had BTs and were as usual bickering with the sisters about the drop count.'
Life is that pathetic here. And it takes someone to pick up the cudgel to show these people to be aware if not at least be sensitive to the needs of such a population that comes under our care. And I tell you...its not easy. You go too far with this anger bubbling in your veins and you are more likely than not to have someone coming at you. You have to stay careful of these people.
Change in this group of people is not possible from bringing it about within them. Because its nearly impossible to be that sharp and beat so many people taking an aim at you. Change can more rationally be bought by being above them, ad being withing them. Something like the 'chadmavesh' the incognito principle of all kings in the past. But I am not sure if principles remain the same once you reach up there. The higher you go, the tighter the snare gets.
I love that pounding thing in my head when I manage to bring these ridiculous fools to their knees. But what saddens me is that I am speaking to a 50 year old man who is tied by a similar snare, though from a difficult angle. I would have no personal enmity with him. But I would always remember his voice. And he would always remember my name. I hate myself then, for what we become to bring about some change.
I am drained by these conflicts. When I walk home I am usually happy about some patient or the other. I don't know if the picture I am projecting is that of a dictator. My Professor is just the opposite. And he doesn't know how I am cleaning the system under him. I don't know if he will approve. I am quite clear that only those people who cannot do without an admission on an emergency day will be admitted. A cent-percent diagnosis in at least 80 percent is my target. More importantly, a 70 percent full treatment. No fuss treatment, rigid adherence to therapy. Almost disciplined. ( What a pity none of my juniors have a good handwriting...I cant tolerate dirty treatment charts...)
What does that make me? What has that made me? And what have I lost in the process of getting this..The answers to this are beyond me. I just promise this to myself. That I will be honest to the core. And fearless. And that no situation should arise when my greed for something will overpower my resolve to act on these lines.
I am striving to make my unit as organized as possible. Some people tend to believe I am against admissions and work up. To a big extent I appreciate intuitive clinical acumen over the test oriented, investigation backed, analytical one. I am also against the idea of mooting for the diagnosis so that by the time we are patting each other's backs over a diagnosis we made, the patent's family have spent every cent of their earning on the tests we order and have none left for treatment. to this extent, I would ask for a B12 challenge with followup rather than an investigation sent for vitB12 and Folic acid to some lab...In any case..we are treating nutritional anemia...My Professor does this wherever he can and its something I will take to my graves.
Dont make the treatment sicker than the disease. And I am ready to go to any extent to safeguard these people when it comes to a situation when people either by commission or omission of an act, do these things that hurts people more than it heals them. Be it as a knack for 'following the trend' or be it to stand up against 'This is the irrefutable diagnosis'. And if I am right ( and that will require acquiring knowledge), I will speak in a similar note of highheadedness to anyone placed anywhere in the system. And be ready to face the consequences.
Similar was a day when I returned home in a happy mood after thinking I had broken the ice with someone. I wont go into details how hectic those 3 hours turned out to be. But basically, my adrenaline was pumping. Checked room, checked computer screen. A mail was staring. With some links on it for writing a thesis plan. " Unless you want to wallow in self pity or slather yourself with the latter, check these links." Later I learnt it was meant to be in humor. But I was not in a mood for it. Maybe the evening had been scheming all along. It brought back some memories. And then everything fell apart. But in the process the vision got clearer...
I am a little surefooted today. I make reasonably good diagnosis. And today I say this that leaving other things apart, if I manage to become even half the doctor I think I should be, I will be happy not to get anything else in my life I have wanted. These people who drain me, this profession that put me on a backfoot every time a chance came where I should have accorded priority to my life, I better get good at this.
Today an incredibly sweet woman hugged me before leaving the Emergency. I was reeling from fatigue from having slept 5 hours in the last 72 hours. My personal life is like the fragments of a shell that has burst, oozing fresh wounds everywhere. Some where then, I did not automatically forward these blessings to the address I normally send them to whenever someone blesses me in a way that I appreciate. I kept that thing to myself. And tried to feel what it feels to be a little selfish about blessings.
And you know, I felt sadder than before.
Maybe I got to think about this 'Wallow' part....
Smiles....
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