(6) The tipping point…
I remember those days vividly. I had just passed my pre-clinical exams with distinction and had stood 3rd for the Mysore University. We had just entered our clinicals and I was posted to the Internal Medicine unit headed by Dr.Jadhav at K.R.Hospital, Mysore (left). It was February 1984. As young, 3rd year students we were still fresh with the experience of having entered a hospital for the first time and of examining patients. All of us were carried away with walking around with our aprons unbuttoned and our stethoscope hanging proudly around our necks.
As part of our training, we were to attend bedside clinics every morning at the Kantharaja ward. One of the patients in the ward was a 44-year-old Brahmin cook from a village near T.Narasipur. He was admitted to the hospital much before we were posted to this ward and was a known face to the nurses and other para-medical staff. Those who know how the medical hierarchy works would be able to imagine the scene that I recount today. Every morning, we would have the Professor followed by a retinue of personnel in the descending order of hierarchy; the assistant professor, lecturers, post graduate students, final year students and finally – we the 3rd year students. Each patient would be quickly examined (in a minute or so) by the professor who would be briefed by the postgraduates about the patient. He would quickly bark out his orders that would be faithfully passed over to the ward nurse in attendance by the PGs. That was it. The patient lying in the next bed would be then attended to. Within 20 minutes the entire ward of around 40 patients would be examined and dispensed with. In this entire melee, we were expected to learn how to deal with our patients and how to treat their diseases.
This particular patient was turning out be a ‘difficult case’ for this medical team. Each passing day, they would hover around him discussing how he was not responding to any treatment. Finally the diagnosis of ‘Idiopathic Malignant Hypertension’ was arrived at. Everybody felt relieved that they could at least label this ‘case’ with a title. I was also carried away at the discussions – the intellectualization of disease, treatment and the elaborate logic in finally concluding that we did not know the cause (idiopathic). Looking back, to me it now looks ‘idiotic’ and not idiopathic. But then, an impressionable 17 year old does not question century old systems.
One early morning, as I walked into the ward, I found the cot empty with no bed on it. On enquiry, I learnt that the patient had died the previous night and the bed had been sent for fumigation. I found an elderly lady packing up a couple of utensils into a torn plastic bag. I remembered her as the widowed mother of this patient. Courtesy demanded that I console her. As I approached to talk to her, she burst out crying and showered the choicest expletives on me. I was unfortunately the first person with a white apron who met her that morning and she took out her anger at the entire medical profession on me. It was then that I learnt that she was 73 years old and widowed. They had half an acre of irrigated land near T.Narasipur which they had sold for paying for the costs of treatment of her son, who had died the previous day. He was the sole earning member and used to work as a cook in marriages and other local functions. Now she had not only lost her son, but also all hope. So much for ‘Social and Economic’ history that we were all supposed to take as we interacted with patients.
I suddenly felt that I could not take on the pressure of handling such situations. I was so numb that I did not know how to respond. Try as I might, I could not get to explain to her that the doctors had done all that they could and it was fate that had taken away her son. I told her that he had hypertension that was not responding to the treatment that our learned professors were giving. I explained to her that they had kept changing prescriptions, as he was not responding to any medication that was prescribed.
It was then she burst out, explaining that all that her son got were prescriptions and not medicines as I had explained. She told me that the Govt hospital had no medicines and all the prescriptions that were written were mere slips of paper. She could not afford to buy the medicines and her son had not taken any treatment at all! I was shell-shocked. It was not ‘Idiopathic Hypertension’ that had killed her only source of emotional and economic support. It was ‘lack of treatment’ born out of poverty. It was then I realized that all the while the entire team was discussing his non-responsive condition for the last 2 months without actually understanding the root cause. I felt completely lost and hopeless. What kind of medicine was I being trained to practice, if I could not understand the ‘social’ and ‘economic’ dimension of disease and its treatment?
This incident changed my life completely. It was also my first attempt at charity. I collected money from my friends and other ‘poor’ patients in the ward and helped transport her son’s body to her native village.
The next few days were the most difficult ones for me. On one side, I felt that I had probably chosen the wrong profession. I felt totally inadequate and impotent. I looked around and realized that I had no ‘idol’ or ‘role model’ to turn to. I had a thousand questions raging on in my mind and had no answers for them. I started thinking that I probably did not have the courage to look for the answers. It was then I decided that I could not look ‘outside’ for support to come. I had to turn inwards, within myself, and to the thoughts of Swami Vivekananda. I found my strength coming back. I felt that I needed to change the system by not trying to fight it, but by understanding it from within and bringing about slow organic and permanent change. I decided that I would be my own role model. I would start an organization that would ask these uncomfortable questions and try and find practical and actionable answers. I would try and start a movement, which would usher in ‘ethical, rational and cost-effective’ medical care in rural India for people who will be seen as ‘people’ and not mere sufferers of diseases waiting for treatment.