by Aman Sethi
or Forsaken
1
The old man adjusts the bandage on his head, looks about, and beams widely at all present.
To his left, a middle-aged man uses a large cotton swab to staunch the blood that gushes from a large hole in his throat, even as he tries to soothe his hysterical wife. On his right, male nurses strip a plump eighty-year-old down to his underwear, rub his arms, feet, and chest with conductive gel, and stick him with electrodes. Somewhere down the hall, an elderly lady suddenly keels over and goes into a faint. ‘This, Doctor, this! This is what we were talking about,’ a swarm of relatives babble, relieved that the old lady has shown her symptoms in so unmistakable a fashion.
‘Move back! Give her air. A nurse will handle this. Nurse! Monitor vital signs.’
The middle-aged doctor nervously scratches the bald patch on his head. Scribbling down a rash of prescriptions, he moves to the next bed, to the eighty-year-old now sprouting electrodes.
‘Symptoms?’
‘Sharp pain in the chest, sweating, breathlessness. Possible cardiac arrest.’
The doctor scans the readings, stares closely at the man’s face. He reaches out, checks his pulse, examines his pupils, and asks the patient to say a few words. A few nervous scratches, and he is ready with a diagnosis.
‘Acute indigestion! Stomach pump, and overnight observation.’ A few hurried assurances later, the doctor is ready to move on.
‘A round of dressing for patient on Bed 2—recurrent post-operative bleeding… Bed 4, oxygen. Bed 12, saline drip. Bed 7? What is he doing here? Refer to Orthopaedics!’ Onward ploughs the doctor, wading through a sea of fevers, concussions, and sunstrokes till he finally arrives at the old man with the bandage on his head.
‘Yes?’
‘Doctor, for the past few days I have been troubled by incessant itching all over the body. I cannot rest, I cannot sleep, my mind is in turmoil. Doctor, I must be admitted at once.’
‘Don’t worry, Uncleji, it is a normal part of the ageing process. Nurse, possible senile atrophy of the skin.’
‘No, no, Doctor, this is not normal. I have been old for many years now. I must be admitted at once.’
‘Don’t worry, Uncleji, skin conditions do not require hospitalization. I will prescribe an appropriate cream for your skin, and a sedative to help you feel better. Do you have any other trouble?’
The old man thinks for a moment. ‘I have no sensation in my legs,’ he proclaims. ‘Fainting fits, dizziness, nausea, splitting headaches… I must be admitted at once.’
‘Sir, I understand you are unwell, but we have an admission policy.’
‘No, Doctor, you do not understand. I cannot go home!’
The harried doctor and a now nervous old man stare at each other, each aware of the silence that has settled over the emergency room. The masked ward boys take a welcome moment of rest before wheeling out the next stretcher; the nurse looks up from her patient on Bed Number 4 and critically examines her shiny red nails through her translucent latex gloves. Prone patients raise themselves up on their elbows to watch the unfolding drama, unsure of who deserves their sympathy: the doctor strapped with limited resources, or the old man cast out from his home.
‘We have a shortage of beds in the general category, Uncleji.’ The doctor seems to have made his decision. ‘I am transferring you to the Neurology Department. Maybe they will have some space.’ He scribbles a referral on the old man’s pink slip and calls for a stretcher.
Satish and I sit quietly as we wait our turn. Satish is dying, even as I sit by him. He is a young, slender boy— in his early twenties—with a hollowed-out chest and a wispy moustache caked with blood. The nurse has placed us right at the back, far away from the other patients. She knows what it is; I know what it is. We just need a doctor to write it down on paper.
•
Down the road from Azad Market, up past the morgue at Baraf Khana, a wave of peaks and troughs ascend from North Delhi’s market districts up to the more rarefied realms of Delhi University. Cycle rickshaws stop at the base of the hill, defeated by the steep first section of the ascent. Passengers are directed to the line of autorickshaws that, for a fee of five rupees per person, ferry patients and visitors up the hill to the small tea stall outside Bara Hindu Rao Hospital, Malkaganj.
Auto drivers wait till they have at least six passengers packed into their vehicle designed for three, and only then do they begin the slow trek up the hill—an agonizing journey played out in the company of complete strangers. The strangers, in themselves, are not a cause of concern: Delhi is a city of chance encounters spawned by the failure of public transport.
Along the city’s extensive roadways, strangers hang out of the open doors of the same public bus, holding onto each other like lovers, reaching out for reassurance whenever the bus hits a bump; harried commuters come together to hire autorickshaws that charge per trip rather than per person; a gaggle of sleep-deprived passengers exchange notes over cups of tea as they discuss the repercussions of delays at the railway station.
But the ten-minute journey to Bara Hindu Rao has none of the intimacy witnessed when groups of people are crushed together and forced to ‘adjust’. Here, passengers stare straight ahead, refusing to make eye contact with each other, unwilling to converse with anyone apart from the driver. Conversations might go beyond discussing the rising price of dal to more uncomfortable places: places where the man with a raw open wound covered with a somewhat clean cloth discovers he is sitting next to the lady with a fungal skin infection, and the boy burning with fever leans against the man who might have leprosy. The driver plays his part in enforcing the no-talking rule; the person breathing down the back of his neck could be a pukka tuberculosis case. He leans forward on his seat and guns the throttle. The engine howls like a whipped dog.
•
‘Phoot Path, Bara Tuti, near Garg Sweet House,’ the conscientious receptionist writes with a slow and heavy hand. All patients must register before they see a doctor; all fields on the registration card must be filled. An address must be found—even when there isn’t one. ‘Lawaris,’ he adds for good measure. ‘Casualty Ward—through the door and take a left.’
The senior doctor on duty sits deep inside the Casualty Ward, his desk screened off by green curtains. Various other doctors sit adjacent to him along an L-shaped table, conducting spot examinations on patients and assigning them to different departments.
Today, the ward is populated by a large number of policemen accompanied by forlorn-looking ‘suspects’. Bara Hindu Rao is the accredited hospital at which all suspects arrested in the northwest zone must get their formal medical examination before an appearance in court.
‘What happened?’ asks the doctor, noting the bruises on the young man’s body.
‘I fell down. Hard,’ says the suspected chain snatcher with the red hair. ‘The road was slippery.’
‘But you have bruises, not grazes.’
‘Some people in my cell were drunk. They attacked me. Only the intervention of the police saved my life.’
The doctor nods thoughtfully, but makes a note in his record: ‘bruises; suspected muscle contusion due to heavy compressive force w. blunt object.’ It is unlikely that the court shall notice his observations, but he is duty-bound to make them; he is a good doctor.
Another suspect lies on the bed next to the doctor’s table. His eyelids flutter gently as a constable attempts to revive him. He is a slight, mousy man with a dejected face; he went into a swoon when they brought out the syringe for the blood test.
‘Probably has a fear of needles,’ remarks the ward boy.
‘He is here because he ran away with a girl he loved and her parents reported it as a kidnapping,’ says the constable. ‘He says she loves him too, but let’s see what she says in court.’
‘Turn your back to me, and now breathe deeply.’ It’s Satish’s turn to be examined by the doctor. The doctor prods Satish’s stomach suspiciously. ‘You smoke, don’t you?’ Satish shuff
les nervously, unsure if he is still eligible for treatment if he smokes. ‘Do you get the shits?’
‘Yes, yes.’ Now on surer ground, Satish nods vigorously.
‘Medical Emergency Room, second floor. Warden, send the next patient in.’
Most patients approach Bara Hindu Rao only when a mild fever, ache, or pain has been ignored to the point of exacerbation—so even when their illness is far from life threatening, the patients arrive convinced that their condition qualifies as an emergency. Upon entry, they are surprised to learn of the existence of not just one, but at least four different emergency wards—Medical, Neurological, Orthopaedic, and Paediatric. What then to do with a hyperactive child who has broken her arm? With an ageing aunt prone to spontaneous fainting fits? With a mazdoor who has a seemingly incurable cough and fever?
The Casualty Ward is designed to eliminate such confusions—which is why it is on the ground floor adjacent to the reception (the signs say ‘Reception cum Casualty’), while the emergency rooms are tucked away in the building’s far corners: Medical Emergency is on the second floor, adjacent to the Paediatric Emergency; Orthopaedics is on the first floor, near the X-ray room. The receptionist sometimes forgets exactly where the Neuro Emergency is, but the ward boy then reminds him that is another wing altogether.
The Casualty Ward functions like a sorting station in the warehouse of illnesses that is Bara Hindu Rao Hospital. After a perfunctory examination by the senior doctor, patients are dispatched to one of several different departments scattered across three floors in two separate buildings. The urgent cases are dispatched to the emergency wards, the rest are directed to OPDs.
‘Third door on the right; bald man sitting behind the smallest desk; toilets are on the first floor; skin specialist is not available on Thursdays; the doctor is in; the doctor is out; the doctor will be right back.’ Sharmaji is the gatekeeper to the doctors’ chambers, a position he has held for the last eighteen years. His job is to regulate the flow of patients into the Examination Room. A skinny, perpetually tense man, he speaks in the short staccato bursts of a professional giver of directions.
On most days, each doctor is sent two patients at a time so that, having finished with one, he can instantly turn his attention to the other. On crowded days, Sharmaji sends patients in batches of three so that two sit in front of the doctor, while the third stands to one side—waiting for a free chair. Of course, each patient is accompanied by at least one ‘next of kin’, and so the Examination Room, at any given point, has between ten and twenty people jostling for space.
Sharmaji breaks for lunch at two o’clock when the registration counter opens once more. Afternoon registration lasts for exactly one hour and is reserved for what Sharmaji calls ‘hard diseases’: heart trouble, arthritis, rheumatism, and other chronic conditions. In the thirty minutes of his lunch break, Bara Hindu Rao Hospital reconfigures itself into an entirely different hospital.
As a multi-speciality health services provider, it is several hospitals at once: each room doubles up as a different department depending on the time of day. In the time that Sharmaji takes for lunch, Room 201 transforms from General OPD to Chronic OPD; the adjacent room 202 switches from Diabetes to Nephrology, with a Respiratory Diseases doctor coming in three days a week. The OPD is shut on Sundays, except on the second Sunday of every month—when it functions as a free health camp for senior citizens. On other floors, entire departments are often clubbed together in associations that offer an insight into the mind of the sarkar: the Department of Dermatology also functions as the Department for Sexually Transmitted Diseases with a special focus on VD, and the Department of Gynaecology doubles up as the Department of Family Welfare and Child Health which distils itself into the Department of Family Planning. The only rooms that never change position are the Casualty Ward and the emergency rooms—they are the fixed poles around which the hospital orbits.
The last door at the end of a long dark corridor, the Medical Emergency, where we now find ourselves, is a cramped but well-lit room with large, grimy grille windows that look out over the Delhi Ridge.
When they aren’t taking rounds of the ten-odd beds, doctors sit on a tiny table pushed against a window in the front, cramped into immobility by another large desk that is piled high with bandages, cotton wool, and IV bottles, and talk through a connecting aperture to the nurses who have a large comfortable room of their own. Conversation is usually brief as the glass pane of the connecting aperture is rendered opaque by the plaster strips that cover the pane’s surface, with the result that the doctor is unsure who he is speaking to. On the left side are large square patches that are probably used to cover messy gaping wounds like those of the man on Bed 2; the right side of the frame has longer, rectangular pieces meant for securing IV needles, and on the bottom edge are long, thin strips used for taping up gaps in dressing. One broad strip of plaster runs along the length of one of the panes—its function appears to be to hold the pane together. It isn’t easy to manipulated a roll of plaster when wearing latex gloves, so a ward boy has been tasked with ensuring a regular supply of sticking plaster in its various shapes.
‘Show me your slip.’ Having dispensed with the last two patients in record time, the doctor has turned his attention to Satish’s admission card. ‘Hmm, you smoke, do you?’ Satish’s head oscillates in a non-committal fashion. Undeterred, the doctor directs his next question to me, ‘Attendant, how long has he had these symptoms?’
We may be friends, lovers, family, or acquaintances; but on entering a sarkari hospital, a couple is immediately divided into ‘mareez’ and ‘attendant’. The hospital is committed to assisting the mareez; but a shortage of nurses, assistants, and ward boys implies that every mareez should ideally be accompanied by an ‘attendant’ who may get a day pass made at the gate and provide doctors with a vivid description of the illness—a description that the mareez may or may not be in a position to provide.
‘At least a month; we came here because today he started coughing blood.’
‘Blood? Chest X-ray, first floor. Don’t look at the patient directly in the face. Please keep your mouth covered at all times.’
•
‘One second, Bhai saab, ladka ya ladki?’
The X-ray has been taken, it will take about forty-five minutes to develop. Satish is lying on a stretcher somewhere in the large hall. My reverie is interrupted by a middle-aged woman carrying a large basket.
‘What?’
‘Ladka ya ladki? Boy or girl?’ She repeats in English. She rummages through her basket and holds up a set of tiny overshirts. ‘One hundred per cent cotton. All different colours. Cheap prices.’
‘I don’t have a baby,’ I mumble.
‘Oh, then don’t wait outside the maternity ward.’
2
Held up to the light, the darkened plastic sheet reveals a latent image of the criss-cross lattice of bleached white bone wrapped in a milky haze of flesh and muscle. In the centre of the frame lie the two large dark sails of Satish’s lungs bisected by the clearly etched mast of his spinal cord. At the bottom, just slightly off the centre, his heart shows up as a burst of bright light oozing into the dark shadows of his lungs. ‘The cardiac silhouette is enlarged,’ muses the doctor. ‘But that could just be a problem with the X-ray.’
The worry is the creeping lesions that appear as localized conflagrations on the dark green X-ray. The doctor asks for Satish’s card once more and scrawls out a diagnosis.
‘This is a referral slip,’ he explains, ‘for RBTB Hospital at Kingsway Camp. Go there right away.’
It’s a ten-minute drive from Bara Hindu Rao to RBTB but the auto drivers always ask for too much. En route to Bara Hindu Rao, a patient might still retain a degree of privacy regarding his ailment, but when I ask an autorickshaw to take us to RBTB the driver doesn’t need to look at Satish’s X-ray to know what’s wrong.
‘RBTB case?’ he asks. ‘Eighty rupees.’
Originally called ‘Silver Jubilee T
B Hospital’, the Rajan Babu Tuberculosis Hospital was set up in 1935 to commemorate the twenty-fifth anniversary of the coronation of King George V, and renamed after Independence. Spread out over seventy-eight acres of green, leafy land near Delhi University’s North Campus, RBTB is the largest tuberculosis treatment centre in Asia with over a thousand beds housed in four-storey wards, but a surfeit of patients means that admission is far from easy.
A panel of masked doctors sit behind a long table, occasionally nodding the next patient in. The patient is seated on a wooden bench approximately six feet away from the table and instructed to place a handkerchief in front of his face and to look away while coughing.
The masks are not necessary as long as the patient does not cough directly in one’s face, but, at this stage, patients are still unfamiliar with the mannerisms of their disease. They are still caught by surprise when a cough suddenly wells up, still unnerved by the sight of blood. If admitted, they will, in time, unlearn the habit of looking at people while talking to them, of making eye contact while listening. After a few weeks, the hand shall instinctively rise to cover the mouth even as the diaphragm convulses for that distinctive gritty cough that brings up mucus, spittle, and blood. At present, patients are still capable of that occasional careless sneeze that could cover the entire panel with a cloud of deadly germs.
‘And what will you do then, huh?’ says the gruff attendant to the sneezing patient. ‘Who will cure you if you infect the entire department?’ The attendant is unmasked—the doctors have told him that the size of the TB bacillus is smaller than the pores of the mask filter.
‘Next!’
Though committed to providing free treatment to TB patients, RBTB Hospital is a tertiary hospital; it is meant for those who have already tried to treat the disease at primary and secondary care centres and failed. Centres at every stage provide the patient with a referral slip that offers entry to the next tier; and so patients who approach RBTB directly are directed to a care centre on a lower tier.
