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..

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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: