I have completed my internship, which was just for one year but felt as if it is an end of an era. This year was the best so far in terms of learning medicine but it was also worst ethically and has left a deep impact somewhere deep down in my conscience. I have been shown a glimpse of reality which I used to feel was only a part of books and newspapers. From abandoning an unknown patient to slapping a pregnant woman in labour, I have seen the worst possible scenarios which I would like to share here. This is what you go through when you work as a doctor’s apprentice.
You wake up at dawn, iron your clothes and apron, open up your newly bought stethoscope and are ready, totally pumped up to serve patients on the very first day. But the whole excitement crashes as soon as you enter the hospital chaos and the hospital staffs leave no room at all to humiliate you in worst possible way. ‘Aye Intern!’, ‘Aye Intern!’ and you turn back, that’s an instinct, because it takes a while for a mind to adjust to the reality, and you see a Mausi (ward maid) shouting at you to get off the recently mopped floor. On the first day itself they make you regret your decision to join this profession. You are startled at the trailer itself and you don’t feel like watching the movie anymore.
A month passes by and you get acquainted to the routine insults and are compelled to treat the patients in an unhygienic way, yes, you heard it right, unhygienic is the right way. You spend few hours in the casualty and you will see the resident doctors fighting over a patient. Nobody wants the patient admitted in his own ward. They call it ‘Batting’, you would see them proudly blabbering around – ‘Hey! Aaj Maine 6 Bat Kiye’, meaning he got rid of six patients that day. Where do these patients go! You wonder. They get admitted to the wrong department where they don’t get a proper treatment or else they are encouraged to go home, in spite of their vulnerable health.
You are just getting yourself accustomed to batting, when your eyes suddenly catch the sight of a patient sitting outside the casualty (shown in the picture below), inside the hospital campus. You inspect him to find out a ‘diabetic foot’ totally necrotized till an extent which requires an amputation. You want to help him; so you talk to the person in charge and try to take the patient inside, when you hear a roar… the CMO (casualty medical officer) is shouting at top of his voice; he is shouting so loudly that you tend to focus on the loudness rather than listening to what he is trying to say. Then over a period of time you start understanding his rhythmic squawks; you are shocked to learn that you are not supposed to help patients like this. Bringing patients in will increase the workload!
Instead the CMO asks you to shoo the patient away. Now, it is unethical for you and you refuse. But his smell becomes so unbearable that the guard shoos him away with a stick. That’s the moment when you feel helpless for the first time in your career. It makes you think, “Are you really treating a patient in need?” A government hospital is not expected to show such a behaviour towards the poor; wasn’t it bloody built for the poor?
You feel like you have seen everything when you land up in the worst possible departments one by one. You are trying to insert an intravenous catheter into a patient’s vein, when your ears fall on something which pops up a memory of Aamir Khan (from Satyamev Jayate) in your mind.
“I have sent the patient with Code Blue.” And the resident puts down the receiver. You then find out that he was talking to the chemist regarding his own ‘cut’ (the per cent income he gets for a referral of a patient to that chemist’s shop). If you have read carefully, the first question that baffles you is: What is Code Blue? Codes are implemented for secret communication:
• Code Blue: Make a Bill of Rs 4,000
• Code Black: Make a Bill of Rs 7,500
• Code Red: Make a Bill of Rs 10,000
The chemist gets this code from the resident and accordingly he formulates a bill, 35 per cent of which goes to the resident doctor. Aamir Khan was opposed by so many doctors for his proclaiming episode on doctors. You now realize the essence of it and understand the reason for the opposition.
“Giving birth should be your greatest achievement not your greatest fear,” said Jane Weideman since a woman needs a lot of support during pregnancy. But in an Indian government hospital giving birth to a child is not a unit less than suffering the third degree torture in jails.
Pregnant women are beaten like anything and, worst of all, the doctors feel it as justified. Before delivery it’s obligatory for an obstetrician to do a Per Vaginal (PV) examination, which according to norms is to be done with rubber gloves on and with the use of a lubricant. You will not even once see a government hospital using a lubricant over rubber gloves during a PVE. It’s discernible that the woman will be in pain without a lubricant and would shout out of pain but the thing you find implausible is when the doctor hits her and asks her to keep her mouth shut.
Unreasonable usage of Buscopan and Drotaverine to speed up the labour and unwanted episiotomies with accompanying fundal pressure manoeuvres (which are contraindicated) leave you baffled. You decide at that very moment that none of your loved ones will ever deliver in a government hospital hereafter. It’s better to be childless than making a woman go through such crucifixion.
You meet malpractices at each and every step. You discover that the true sense of ‘noble’ (profession) is lost somewhere. For one whole year you have to suffer both physically and mentally. You try to fight your inner conscience. You try to make changes, bring reforms. But after myriads of attempts when nothing works, you realize that ‘ignorance is bliss’ and learn to live with it and instead write an article about it.
Dr Varun Patel
Junior Resident (Emergency Department)
Lok Nayak Hospital, New Delhi