Winding Down

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Dr. M studied the toddler. Unconscious, the whites of the child's eyes were partly visible, and her mouth was widened by the long tube which had been carefully guided through her mouth, past her throat, and into the terminus of her windpipe. And then the good doctor noticed something amiss. The left hand. Why was it so blue...and swollen? He studied the right side. Perfectly normal, nothing to be concerned about over there. But what about this left side? He touched it, manipulated it, felt for pulses, checked the capillary refill. Not good. The IV line, which had been placed on the dorsum of the left hand, was surrounded by evidence of multiple placement attempts. Suddenly, the source of the cyanosis and swelling became clear. He dropped the puny hand, summoned all of his residents into his office immediately, and closed the door behind him. I did not hear what he said, but I would bet that he was chiding his residents for overlooking seemingly simple but enormously significant aspects of patient care. Due to traumatic attempts at IV placement, the child's hand had developed compartment syndrome, which is a large-scale increase in pressure inside the hand (in this case) that was threatening the viability of the limb. He called the surgeons into the ward, and they performed an emergency fasciotomy, which thankfully relieved the pressure and saved the child's hand.

And this was a totally honest mistake that went largely unnoticed by everyone except one keen physician. It was especially tough because the child was not conscious to tell us about the inevitable pain that compartment syndrome generally causes. As someone who will be a full-fledged medical resident in 4 months, it is this kind of scenario that frightens me. A situation when things are going terribly wrong, and I would have no idea that a problem even existed. One can only hope that the Gods of Medicine will be looking over me with angelic wisdom. I think it's unlikely. Mistakes are going to be made, and there is going to be a lot of stuff I will just have to deal with. Maybe even tragic stuff. I guess that's part of the job description, which is both exhilarating and mortifying at once. But for the first time, I know I am ready for it.

A hilarious story: so there is a hospital here in Mumbai that specializes in Infectious Diseases called Kasturba Hospital. From the very beginning, I was told that I could spend a few days at Kasturba, where I could be introduced to diseases like multi-drug resistant tuberculosis, measles, mumps, chicken pox, etc. Basically, the kind of pathology I don't see at home. Well, I received verbal (key word) permission from the Head of Pediatrics here to go to the hospital. But when I showed up, I was directed to the Kasturba chief medical officer and then to the chief medical superintendent, both of whom told me that I would need written authorization to make this happen. Blimey. So then I returned to KEM to reunite with the Pediatrics Dept head, and he informed me that he was not allowed to give me written authorization or anytihng else of the kind. Something about my contract as an international student. But then came his big suggestion: he instructed me to just "show up" in the Kasturba wards, and that it would be totally OK. "Oh yeah, we have visiting students do that all the time. No problem. Just find one of the residents there and see their patients."

So my friends and I decide to return the next day to Kasturba...this time in stealth mode. James Bond style. We must not be recognized. We must be quick. But we have no idea where to go. The campus is pretty huge (it's what I picture a lepper-colony to look like). So we stumble through the hospital campus searching for the Infectious Disease ward. My friend Khalid suddenly decides and takes it upon himself to ask someone for help. Before I know what happens next, he flags down the first person he sees and poses his question. But not just any person. It's the chief medical officer. Of all the hundreds people on the campus. We're caught, I think to myself. But somehow, he either doesn't recognize us or he simply doesn't care. He actually points us deviants in the right direction and into the proper ward. Close shave! Obstacle #2: the doctor in the ward asks me point blank, "Do you have permission to be here?" "Uhhh yes," I blabber out. So she reflexively picks up the phone and dials the superintendent to make sure. She begins speaking to him. OK, now we're really in the soup. I turn to Khalid and say, "Let's make a run for it." But he calmly says, "No wait...look," and points at the seated doctor. She calmly puts down the red, Batman-esque phone, and performs the classic bobble-head Indian signal of affirmation. No way...we received approval? She gets up out of her chair and leads us into the ward. Amazing. Obstacle #2 somehow overcome.

That ward was filled with chicken pox patients, young and old. Most of them, surprisingly, were pregnant females in their 20s. When I asked about potential birth defects from the antenatal infection, the doctor insisted that the teratogenic effects of the varicella virus were overstated. Most of the time, the babies turn out normal. I'll have to look further into this. Aside from having had chicken pox myself when I was younger, I have not seen a case since I've been in medical school!

At the completion of our tour, the female doctor suggests that we visit the adjacent ward, where there was a mumps patient and a few other interesting cases. So we walk outside, and almost immediately, we run into Obstacle #3. The chief medical superintendent. On his morning walk. The last person I wanted to see. The jig is up. He looks livid too. "You?? What did I tell you yesterday? What did I tell you to bring to me before you could come here?" "Buhhhh I don't remember, sir." That was the first thing that came to mind. Mega fail under pressure. "What? Do you have amnesia or something? Are you sufffffering...form amnesia?" he inquired. "Yes sir, it must be something like that." The superintendent gritted his teeth, and then just walked past us, huffing and puffing as he did it. The two people we could absolutely not afford to run into during this episode of trespassing were almost the only people we ended up interacting with.

I turned to Khalid and Nasir. "OK, we should probably go now." We casually strolled out of the hospital grounds and into a cab. And the rest, as they say, is history.



Sunjay

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