A rambling of patient interactions

As I’m sure my colleagues would agree, our current service obligation with a mission hospital has done a great deal to our worldview. I’ve still 8 months to go, and as I sit here in a small village called Pratap Sagar in rural Bihar; I look back and see that its asked us hard questions about ourselves, our desires, our purpose and possibly most importantly our malleability. Along with which I’ve experienced all sorts of people and ideologies I didn’t think existed in this world. The ‘poor’ people that we serve are in a much larger debt to caste, religion, superstition, sexism, and ego/pride. The last one may surprise you, but its true. So here are a few patient interactions that are bound to stick to me for a while, in no particular order.

1    1. The Man and his daughter.

      A 18/female presented to casualty with breathlessness grade 4 and history of Anti-tubercular medication. On X ray we confirmed that it was a left sided pnemothrorax and patient immediately needed a chest tube insertion.

Me: Ji, your daughter really needs this surgery now or she may die. You don’t have to deposit all the money now.

Father: No its ok, just give me some medications and we’ll go home

Me: No seriously, its life threatening. It’s a small 10 minute procedure, and she’ll be fine.

Father: No. we’re going home.

(all the other relatives looked desperately at the man to change his mind, but he didn’t. at the back of my mind I was thinking: ‘would he have done the same if it was his son?’)

2    2. Most snake bites

16/male presented to us with history of snake bite 10 HOURS prior to admission. On examination there was severe respiratory compromise and bradycardia. We tried what we could, but it was much too late.

Me: Why did you come so late?

Relative: everyone in the village said to go to the baba first. So we went... but he only got worse…

Next day another patient came with a snake bite from the same village. He too was much too late. He too had gone to the baba. And the same relative appeared from amidst the crowd with his head hung low.

      3. Cancer

68/ male patient had been showing in our opd for 2-3 months for cough and hemoptysis. He had a large homogenous opacity in the left lung field. It looked like a mass.

Me: Ji, we’ve been telling you to get a CT scan for 3 months now, how will we give you proper treatment unless we know what the diagnosis is?

Patient: No need. I’ve no money to do it. Just give me something to make my cough go away.

Me: But baba it may be cancer..

Patient: So what? If its cancer then let it be cancer. I’ve lived a long enough life and whatever happens is in the mercy of God anyway. Just give me some medications, and your cough syrup.

      4.  Another Pneumo patient (which for all non- medicos means air In the pleural cavity which can be life threatening unless you put in a chest tube)

Me: Ji, you have air in your chest. Its not going to come out with medications. And it can become dangerous if you don’t do anything. The only solution is to put in a tube. You can pay all the money later, but its urgent.

Patient: No what are you saying? I need no such thing. I know my body. I’ll be fine. Just give me medications.

Wife: I think you should listen to him, it sounds serious.

Patient: No no I feel fine. Nothing will happen. Sir write some medications.

He signed and left against medical advice. His wife brought him back the next day gasping for breath. Thankfully he reached in time and he’s much better.

      5. My maid

She: Sir can I take off tomorrow?

Me: Why?

She: My husband got drunk and beat up my child yesterday. He needs stitches on his head.

Me: what?? Ya ya go. But can’t we do something? Like call the police? The panchayat?

She: No what will the police do..

-xxxxxxxxxxx-

She: Sir I’ll have to go home now, I’ve made the rice.

Me: why what happened?

She: Some people came and robbed my house and beat up my mother..

And I was left sick and furious wondering why people would do this to an already poor family!

      6. The locals

For this you’ll need some context. There’s a village nearby called ‘Chilheri’. They are somewhat an unusually proud group of people. The story goes that our hospital and land was given to us to run and treat by the maharaja of Buxar. It is an indefinite lease with the only condition that they will take back the land if at any point the hospital is shut down for 6 months. At the time there were allegedly protests from the neighboring villages with arguments such as: “my cattle used to graze there, how can you just give it to them?”  To which the Maharaja allegedly told them they could get free treatment here. However he never put it anywhere in writing, so its still a bit of a myth.

Recently, a 56/ male was admitted the previous night with the suspected diagnosis of lobar pneumonia. Investigations were done and treatment had started. The relatives were thoroughly explained as to the diagnosis and treatment plan. They were from Ghazipur in UP, around 2 hours from here.

The next day morning a man walks into my chamber, he was from Chilheri. He throws some tablets on my table.

Man: I want to know what this patient has and what treatment you are giving him.

Me: Yes I will explain, but please give me 10- 15 minutes to finish these cases here, they’ve been waiting since a while.

Man: why? No I want to know now.

Me: What is your relation to the patient?

Man: what is that to you? I come with lots of patients.

Me: then I’m sorry I’ve explained everything to the immediate relatives, you can understand from them or wait till I am free. (the patient was absolutely fine btw)

Man: No you have to tell me now! Don’t act smart and all. I am a Rajput!

Me: No I’m sorry please step outside.

He didn’t move. He got a chair and just sat in my room. I told him ok if you’re gonna sit here and create trouble you are free to consult another doctor. And while you’re at it you can explain to all the patients waiting outside why you’re not letting me see them. Finally I got frustrated and called the supervisors who are from the village itself and they pacified the guy.

      7. The ASD patient

A 20/ female came to our casualty gasping, with anasarca (whole body swelling due to fluid overload), and bilateral crepitations in chest. It was clear to me that she was in cardiac failure and a murmur confirmed she had a heart defect. On looking through her reports I saw that she had been to many private doctors since she was a child and they all treated her symptomatically, not bringing any relief. I was stunned. A recent Echo report confirmed that it was a large atrial septal defect. Which means no one till recently had correctly diagnosed her condition which can easily be managed on correct medication and a simple surgery. It was too late for her, even the relatives knew it. I could do nothing but refer her to a place with atleast a CPAP, a monitor, inotopes, infusion pumps.. How I wished at that moment I had all those things. How I wished that there was a simple procedure to correct her defect. How I wish I wasn’t as helpless as how her parents felt.

So there you have it. Different facets to ‘service’ in rural India. Perhaps it will take years for ideologies and superstitions to change. But of all I’ve seen thus far, the question that keeps me up at night is: Why is finance still a factor for people to live?

#righttohealth

For all those who missed it, this is my friend Manu and I singing our version of the scientist:

CMC Ludhiana

There’s a lot to love about CMC; but if I had to choose, I’d say the teeming and collective love of music and drama, and the numerous people I had the pleasure of interacting with, top the list for me. I remember when our council vice president called me on the day of play auditions in first year and asked if we’d be interested. And all we said to each other was “if you’re in, I’m in.” and in a split second decided to run towards fellowship department and give it ago. The outcome? Being a part of a hilarious play directed by the brilliance of Drs Dhruv Ghosh and Arpit Mathew. The musicals I was part of, the cantatas, the concerts, the systoles; It was never just about the music; it was the friends, and memories I made along the way.


But what really grasped me about the place was the people. I’m not a very social person, but the ease with which one could slip into conversations leaving all inhibitions aside almost instantly, cannot be exaggerated. There’s something about putting people from different backgrounds, faiths and states together in one place and watching them grow into something more than themselves, and changing their perspective as to what life really is about; and changing yourself to possibly the best version yet.

Every day on my journey from Ross to the hospital, every 10 seconds I’d see a familiar face, or a bunch of them. It’s not that we don’t see them every day; for some reason there’s a renewed freshness every time we meet; and they ALWAYS greet you with a smile. A walk around ross itself, and there’s always someone you can talk to; a senior to ask for advice, a junior to enforce your advice, or simply a chat between brothers. And this for me is the real beauty of CMC; the people. Yes there were experiences to put you down, and unfair circumstances that keep recurring but in the midst of all that are these gems of grace, fireflies on a night walk, the watchers on the wall…


CMC is not what it was. I became sad when people kept referring to the glory days in the past tense. The vision of our founder, the people who once taught in these halls, the mission that once united us despite diversity. I believe we can bounce back, and I envision greater heights for CMC. It gave me friends to last for a lifetime, mentors just a phone call away and memories to cherish. I dream and long for the day where I could work there again with the people I love, and be a part of the miracle to others as it was to me.
Let's make it a place of light, laughter, healing and music :)

Everyone has a few select moments in life that they’ll always remember, and cherish. You get a unique feeling at the time; some would describe it as if your heart skipped a beat, or a long breath of fresh air, or simply goosebumps. I remember feeling it as I heard poetry recited and discussed the way it should on a student exchange trip to Australia, when I stood on a boat in close proximity to the Niagara falls feeling a gush of ice cold water and wind on my face, when I played lurch in adams family and sang to an audience finally unleashing all the accumulated desire to do so ever since I understood what a musical was, scrubbing in for my first surgery, the immense amount of gratitude I received after directing the Christmas choir 2016, the final goodbyes at the Ludhiana railway station…

I remember getting this feeling one night as I was coming back to hostel at 3am after taking samples while posted in urology. It was the peak of winter, the wind was rusting through the leaves as I passed by mallu mess, the dogs barked from afar, the light flickered as it usually does. I turned around and got a glimpse of HSB, and the top of the hospital. Began to think of the motive with which this was established, the years of toil and sweat along with laughter and love, to become a beacon of light, an opportunity to be to others as Christ has been to us. And I thanked God that I was there at that time and place, knowing exactly that he’d put me there and being excited for what is to come..

Psalm 118

Psalm 118

The first time I read this psalm properly was quite a few years after I accepted Jesus. I was just going through the motions, wondering what the point of all of it was. Life, purpose, suffering… Why suffer at all? It hit me like a rock, this psalm. It talked to me, like nothing or no one ever had. It understood what I was feeling. Like a friend, David told me what he had done in a similar situation. Since then, it’s my ‘go-to’ buddy. Every time I desperately need God to reassure and put me back on track no matter what my circumstance is, I fall at its feet; I cry out for it. So I’d like to share it with you, it may help you too.

Oh give thanks to the Lord, for he is good;

For his steadfast love endures forever!

Let Israel say, “his steadfast love endures forever.”

Let the house of Aaron say, “his steadfast love endures forever.”

Let those who fear the Lord say, “his steadfast love endures forever.”

What stands out for me in this passage is the word: endures. His love endures forever. Its not a simple ‘I’ll love you forever’ but rather an understanding of our nature to run away. The song ‘Come thou fount of every blessing’ puts it best when it says: ‘Prone to wander, Lord I feel it. Prone to leave the God I love.” But carries on to say: ‘Take my heart, O take and seal it, Seal it for thy courts above.’ God knows it, he understands. And so his love will endure. Whatever comes, how ever far you run, his love for you will endure it. He’ll keep knocking on your door, persistently carrying you out of trenches you fell in or that you made for yourself, because he can’t help himself. His love endures! And that is ultimately the love story of our existence. A constant pursuance of pure, genuine, altruistic love. He showed that by giving his life for us. 1 Corinthians 13: 7 says- “Love bears all things, believes all things, hopes all things, endures all things.” So whatever you think is too grievous for Gods love to encompass, its simply not.

Out of my distress I called on the Lord;

The Lord answered me and set me free. 

I don’t know about you, but when I first read this I thought to myself; its not that easy! It cant be that easy.. but that’s just what I did. I called out to God, begging for an answer. And I got it from the next verse.

The Lord is on my side; I will not fear.

What can man do to me?

I achieved a smile on my face. Most problems we go through are people related; either they don’t talk to you, talk badly to you/ of you, instill fear/ physically assault you, betray your trust, make you feel that you’re not worth anything. In my experience, everyone has the capacity to do that, be it family or your best friend. There’s a small activity I like to do when faced with a problem; to ask myself what’s the worst that can happen? This verse makes you ask just that. And the answer is a resounding: not much. What can man do to you? When you have God on your side with a truck load of promises and plans to keep you safe, who is man to say any better? When you hit rock bottom, and you look around realizing there’s no one/ nothing to hold on to; you finally understand and get reminded of the person that’s been there with you from the start, and he never left. So, forget man who’s simply made of dust; and look at your creator. Man will constantly disappoint you. We’re quite incompetent that way. So instead of looking towards them for a constant flow of joy, peace and love; verse 8 onwards reads:

It is better to take refuge in the Lord than to trust in man.

It is better to take refuge in the Lord than to trust in princes.

“Friends of the earth may let you down but Jesus never fails!”- Is a song we sang at an EU camp; and how true it is. He’s never failed me. I have failed, definitely; multiple times. But he’s never failed me.

All nations surrounded me;

In the name of the Lord I cut them off!

They surrounded me, surrounded me on every side;

In the name of the Lord I cut them off!

They surrounded me like bees;

They went out like a fire among thorns;

In the name of the Lord I cut them off!

You can feel the intensity building in this passage. David must’ve been going through so much; enemies on all sides wanting to kill him. Is there a more fathomable justification to surrender? Thank goodness most of us reading this aren’t and hopefully won’t be in that position. But sometimes you can feel like just that in a social situation- like you’re at the bottom of a well and surrounded with people who despise and torment you. You feel ‘life’ is against you and theres no escape; you’re suffocating. Here I’ll bring in a verse from psalm 23: 4 which reads: “Even though I walk through the valley of the shadow of death, I will fear no evil, for you are with me; your rod and your staff, they comfort me.” David survived and he lived to tell his story; now that we’ve established that God is with us no matter what, we’ve got to remind ourselves this especially when we’re in the battlefield. And God’s never lost a battle!

I was pushed hard, so that I was falling, but the Lord helped me.

You will be pushed hard, You will fall. But, the Lord will help you.

The Lord is my strength and my song;

He has become my salvation.

Glad songs of salvation are in the tents of the righteous:

“The right hand of the Lord does valiantly,

The right hand of the Lord exalts,

The right hand of the Lord does valiantly!”

I shall not die, but I shall live, and recount the deeds of the Lord.

This was it for me, my search was over. I will be brave and admit that the fleeting thought of ‘what is the point of living’ has crossed my mind, and perhaps it has crossed yours too. But after reading the above statement, it never dared to enter my mind again. This was all the purpose I ever needed; it’s a clear commitment. No metaphors here. It’s a testimony from David, and we’re free to adopt it. If we can make it through life doing only this, I think we and the people around us would be quite happy.

The Lord has disciplined me severely,

But he has not given me over to death.

If God has to make the best version of yourself during this life on earth, where you would be truly happy and content with so much to give, he will discipline you. We may mistake it for something else and may feel it’s beyond us. But the verse resonates with 1 Corinthians 10:13 which says: He will not let you be tempted more than you can bear. That’s like a school teacher telling us our syllabus at the beginning of the new year. You will overcome it.

The next couple of verses are a thanks to God. Cause once David (and I) realized this, of course he wanted to give thanks!

Open to me the gates of righteousness,

that I may enter through them and give thanks to the Lord

I thank you that you have answered me and have become my salvation.

The stone that the builders rejected has become the cornerstone.

Like all of us, I think God loves the story of an underdog. A person who against all odds and challenges is victorious at the end. Which is why 2 Corinthians 12:10 says: For when I am weak, then I am strong.

The last two verses read:

You are my God, and I will give thanks to you;

You are my God; I will extol you.

Oh give thanks to the Lord, for he is good;

For his steadfast love endures forever!

‘Nuff said!

Psalm 34:8 “Oh taste and see that the Lord is good! Blessed is the man who takes refuge in him!”