10. STORY OF RESIDENTS AND ASPIRANTS

It was about 2 A.M, early in the morning. As it was a tiring day, I was fast asleep as soon as soon I landed on the bed.
It was hardly past half an hour I had dozed away; my wife woke me up gently shaking my shoulder, -
“Golu, wake up! You have a call from hospital. It looks like an emergency.”
Half opening my eyes as I was in a deep sleep which was much needed looked at the phone which flashed the name –
Dr. Mihir Mehta.
He was an intern in our hospital who was in first year. That was a promising batch who were hardworking.
But needed a slight push and would give their best.
“Dr. Roop, there is an emergency!
A patient who was admitted for fever has had complications and has been put to ventilator”.
My wife, trying to wake me up while I was fast asleep.
I got frightened by the word – VENTILATOR.
Frightened, yes. You must be thinking how a doctor can be frightened.
Yes, Doctors too are bound to get scared at times. We are also humans by the end of the day.
Seeing deaths on a daily basis and dealing with it will make us numb, but the soft heart opens up some times.
And more so it would be trembling situation for these kids entering the field of medicine.
Jiffies of sorrowful days flashed in front of my eyes.
My sister had written to me back in the COVID times about an intern struggling for his life post contracting with the traumatic virus.
(scene shifts to the letter with a flashback)
“Viola Bro, how are you doing?
Things around me, to be true, is crumbling around. Like I did tell you about the nurse and the newly born daughter. Corona has taken over completely on our lives.
Remember you were telling once about how you were admitted into ICU because of an anaphylactic shock?
How Appa and Amma worried for you?
We almost witness this scenario of parents sobbing and worried for saving their child, who is the entire world to them.
COVID times have made relatives to not meet their kith and kin during their last rights.
Every parent has certain dreams for their child, but things take a topsy-turvy change when factors don’t favour it.
More importantly, to send their son or daughter into the field of medicine, is most similar to that of sending a part of their life into war field.
About 100 working hours in a week with not much of personal life and dedicating whole and soul of the child into striving for par excellence would means less family time.
But with eyes with never ending dreams to see their young budding doctor son to seeing the same child lying on the bed with life support would be heart wrenching. Such agony it was.
He was Dr. Nikesh, a boy from a small town near Uttar Pradesh.
He had flied down to Bangalore with eyes filled with dreams awaiting to be fulfilled.
A bright kid filled with grit, fortitude and determination for bettering lives and serving the society.
A bright student who was an opera hat in academics as well as in extracurricular programmes activities.
He was a topper in all four-professional years marking the highest among many previous years.
Once, I vividly remember that he had portrayed me in his sketches which I will cherish till date and to my last breath.
Alongside he was “the Usain Bolt of our hospital”.
There were people who would approach him for advices on various spectrums like heartbreaks to how to study effectively to how to handle patients to many other arenas.
He was the Jack of all trades. A perfect all-rounder.
He was one of the firsts to volunteer and step forward without hesitation and stern decision to serve during the COVID pandemic.
Also, encouraging and reassuring others to join the service so that the manpower increased.
We were in the same unit; he was equally worried for Sister Nanda who was the expecting mother.
Words he spoke while we were dawning off the Personnel Protection Equipment, while gearing up with all excitement to give his fullest still lingers in my head, -
“Didi, I always dreamt of serving to the needy.
This storm which has hit the world making a mess out of all our lives.
Greed and self-centred personality have brought us to this juncture and confluence.
We have been exploiting Mother Earth and nature continuously and unceasingly day in and day out.
Man turning towards artificial intelligence and other modern cultures but forgetting our roots is the worst thing that has ever happened.
Can any plant survive without deep roots?
Won’t it get uprooted and fly away?
This ignorance towards nature has led to the rife of this virus.
Ignorance is not a bliss always.
However, whatever done is done.
We should all start working ahead to better the situation.
To decrease the casualties and fatalities should be our only motto for the day.
We have had long hours of working every other alternate day.
But this is the time we should try giving more than cent percent or even 200 percent to that matter.
We should be thriving to save lives and give it our best shot.
I am the only son to my parents but they have always told me stories of soldiers’ bravery during Kargil war, however this situation is no less than a warzone.
So, let’s all buckle up, gear up and move ahead.”
Those words are still lingering in my ears as I write to you.
He was working continuously round the clock doing his duties honestly and sincerely.
But that honesty and sincerity were not paid off as we would encounter death as close as we could.
When patients are transferred to medium or intensive care units, they completely lose connection with their family and friends.
They stay in isolation, and in many cases, eventually die, without ever having had a chance to share a final world with their beloved ones.
The most painful was to convey the message to the family.
About pain!
About grief!
About death!
About passing away of a patient!
That phase of death can be painful as it can be.
To the patient as well as to the family.
Dying alone without having to see closed ones by the side.
As Corona virus attacks lungs primarily, and other organs start detiorating, the respiratory system takes a downfall.
It hampers the influx of oxygen and makes it difficult to breathe, landing them inside an Intensive Care Unit.
Patients complain of lungs filled with bees along with a sense of impending doom.
The accessories around ICU could definitely level down the morale.
They gasp for every breath with a ventilator on.
It gets harder and harder as the time passes by. It averages from 14 per minute to even 30 to 40.
Such a panic state!
Sigh! Sigh! Sigh!
It would feel like breathing through a tiny straw.
Harder to inhale and exhale more than 20 to 40 seconds.
But these covid attacked patients have to bear it for weeks together.
Some patients I encountered complained a feeling of band over their lungs and was on fire.
Some others had thick secretions being one of the reasons for breathlessness we see commonly in serious conditions.
That is what COVID does!
Few others wish for death on an ICU bed as it is excruciating and painful.
One of them went on to an extent saying, -
“I would not wish this situation for my worst enemy”
Covid plays with body, mind and soul. Its symptoms are not bounded only by breathlessness, headache, cough, fever, it makes us feel miserable and helpless.
A true havoc!
An ICU setup has always been daunting for me.
The BiPaps and ventilators.
It is most gruesome and invasive experience for COVID patients to be stuck to these machines.
Risks of delirium, a state of confusion an increase because of increased steroids, and other medications.
Right Didi?
The weird sounding machines, wires and all gadgets are a nightmare to any first-time visitor to the hospital.
This can lead to added fear, agitation and anger.
Head to toe clad PPE gear with just a strip visible for eye contact made patients even more anxious and worried.
There was no in person face to face conversations they had apart from us.
This lowered the energy to a certain degree. Isn’t it Didi?
I had anxiety as to how I would combat this innate fear.
But, once I stepped in, it was magic.
I loved every bit of that feeling.
That sense of gratification of service was unbounded.
And today to be able to contribute my bit in this pandemic, is just surreal.
We’ll all be on the other end soon.
Ok. Bye, Di!”
These were the conversations we used to have just before he started postings in ICU assisting us after his shift in general ward.
He attended a critical patient in the Intensive Care Unit on his third day with parameters inching low, sPO2 was about 60 with oxygen support with fever rising intermittently.
The patient had comorbities with hypertension and cardiac issues.
Alas, we could not save him!
This had a huge impact on Nikesh.
It was one of the deaths he witnessed so close during COVID.
I agree that seeing patients on a death bed is a less extraordinary scene.
But for young doctors like Nikesh, it is rather disturbing initially.
He spoke to me over a phone call today, -
“Didi, I feel so guilty for not saving that patient.
He was hyperventilating and anxious since the onset of the disease. I was trying to intubate him and consoled him during the procedure that he would be back with his family soon.
But…. But…. (in a weeping tone),
…. lost him within an hour.”
Trying my best to comfort him was the only thing I could do from my end.
He continued -
“The deceased was the bread winner of the family leaving behind his wife and two children in their teens. That is troubling me the most”
It is definitely so hard for these little ones stepping into medicine and getting traumatized.
I vividly remember how I pestered you that I would discontinue with medicine after my first posting in Surgery department.
“Bhai, my hands are shivering while holding syringe. The sight of blood is scary. Suturing is so arduous”
That literally took on your nerves at first.
Yelling at me, - “When you aspire to become a doctor, you should be as confident as you can. Be a brave kid. I know you’ll ace it.”
It was quarantine period for them within 3 days, they were sent for periodic RT-PCR.
Sadly, Dr. Nikesh developed fever with breathing issues on a gradual manner after 2nd day of his isolation.
I instructed him to keep a check on his vitals.
Suddenly, on the 4th day after he contracted the virus, his SpO2 dropped to 70 and he complained of breathlessness.
He was soon shifted to Intensive Care Unit with life support.
But it was disturbing and worrisome to see him battling for life.
We called up his parents with much doubts and glooming condition video called his parents and conveyed the bad news to them.
He was a fighter, a born fighter!
We all prayed for his well-being and speedy recovery at the earliest.
Every time we wore PPE and visited him, he would give the same wide smile behind the ventilator which he had always had and wrote to us to continue in our duty.
He also wrote “ALL IS WELL” with his signatory wink smiley.
That was the courage he had along with strength provided us with positivity.
A person who used to help us manage critical patients is on almost end of the life rope.
I wished he recover the earliest and get back to the team.
I had flashes of him when I visited him this morning.
One another heart-warming conversation was how his relatives also called and checked upon him.
He once told during the course of discussion during his quarantine period, -
“Since the inception of pandemic, all my bhoole bhatke rishteraars asking about my whereabouts.
About my shifts and rounds.
There have been messages and calls on a roll from friends, family and nearly forgotten acquaintances, telling how proud they were of me being a COVID warrior.
I was the first medical doctor from the family.
Pre COVID, we as interns had just administrative work, writing discharge summaries, organizing patient transfers from wards to wards, sending for laboratory tests and such little things.
I could not imbibe of feeling of being a doctor as much.
And now directly to 12-hour shifts in an Intensive Care Unit.
From never using a defibrillator, connecting leads of ECG and other thigs was so close to being a full-fledged specialist in Critical Care.
The technology and advances in medical science is very powerful in terms of keeping people alive but less powerful at turning things around.
These are the few challenges we have been encountering Didi”
(scene shifts to conversation between Golu and Mishti)
“Those conversations still lay over in my mind, Golu!
It is so hard to see him in the same ICU where we treated patients.
Heart wrecking!
He was a PG aspirant. AIIMS was his dream college.
He used to light heartedly say that the preparation phase had few essentials –
IV drip of 500 mL coffee or tea,
One tablet of false hope to finish the entire syllabus overnight,
Liquid infusion of Maggie, or rather shared,
One table spoon of syrup of ‘ill do it tomorrow, let’s party today’
One capsule of ‘God save me’ for support,
One band aid to cover all our miseries and hardships.
Along with that ink tinted aprons, measuring tapes, magnifying lens and loads of syringes.
This depicts our untold story!
He wanted to be a surgeon like you. And depicts now he is struggling for life and death.
I know he will recover soon. The fighter in him will never give up!
How is it in Seattle now, Golu?”
I had tears trickling down as Mishti was telling about the intern. Replying to her, -
“Indeed, Puta!
The future of every aspiring medical graduate and post graduate is hanging on the edge of a cliff.
Remember our NORMAL Post Graduate life?
Running from ward to ward with stacks of files, with various medicines to be written, to pre and post operative preparations.
Life of a Post Graduate was a roller coaster ride!
Now the situation is completely different. Junior residents are clad in plastics running from one ward to another with medicines for cold, cough and other multivitamins.
They are facing countless problems. List goes on and on and on….
Right from delay in thesis due to less cases in other diseases apart from COVID to delay in final examinations as more manpower is required to be catered.
Along with this, there has been loss of surgical training period, and fear of catching the infection and passing it on to the other colleagues and family.
Mental trauma with unremitting hours in the covid wards, loss of gained confidence while diagnosis and treatment protocol, performing surgeries.
Since student distress and untreated anxiety are reported to negatively impact academic performance, professionalism and empathy towards patients, and contribute to academic dishonesty and attrition from medical college.
Adding to this was uncertainty of future, job and professional security.
This leads to dilemma in them. What a sad state, right?
Being in their late 20s and early 30s, yet no financial stability, and fighting this battle inside within themselves and outside with the virus is situation we are in.
This slavery of the interns and junior doctors need to be curtailed.”
Conversation was going very deep and emotional. Yet that was true. That was the fact.
Doctors are always looked to be serving selfless, but we forget they have a family to cater, and our own needs.
“Exactly Golu.
Fate of PG aspirants is no less than any bhatakti hui aatma. Na ghat ka, na ghopar ka.
The date of examination has been getting delayed and postponed time and again. They have also been asked to report to wards and Covid Care Centres due to lack of man power.
Our health care is definitely in shackless with disproportionate doctor patient ratio.
And the pandemic has been a perfect mirror to all our incapabilities as a system in the country, in the world, as a whole.
What a despair!”
(scene shifts to present)
While I was driving to the hospital in thoughts of sinking patient, one relief was that system got better with more equipments and technology.
“Thanks to Corona!” – I thought in my mind as I entered the hospital.