Through the Haze

I stood there biting my lip in apprehension, wearing jeans, a full-cord white shirt, a side sling bag for my mobile, and notes for important drug instructions. My hair was tied in a back bun with a regular black clutch. I was wheatish in complexion with an average height. One could even call me plain, if not for my eyes and smile. Both of which were lost in a haze for a better future. Something about this night shift seemed not quite right as if the peace was a silent alarm to the screams to follow. A senior doctor crossed me and waved, “Why so nervous, first night shift?”. I simply nodded and smiled. He winked back, but it did not make me feel better, his rounds were over, and he was returning to the comfort of his dear home.

This was a 20 bedded hospital with an emergency, pharmacy, and routine OPDs. The building was not that old, but it looked worn out and somewhat forlorn; as if the daily struggle of life and death, hope and despair, smiles and tears had made it exhausted.

As I entered the medicine floor, Mrs. Asha, the head nurse, gave me a big smile. I waved a quick “Hi”, settling myself in the duty doctor’s table and chair. Which was a pseudonym, it was the only piece of furniture available to the ground staff. (duty doctor, nurses, ward boys, etc). The privilege of cabins was only for senior consultants and owners. Mrs. Asha was a dusky lady with an infectious laugh, her dark black hair was put up in a long meticulous braid. She was nearing her forties. She was one of the senior staff nurses, her accent had a typical Malayalam flair to it. It is famous in Indian hospitals that south Indian nurses are the best, this is not a regional bias, as they are usually hard-working and dedicated to their jobs.

This was my second attempt at cracking a post-graduate entrance medical exam. I was not a bad student but was not good enough to make it in the score brackets that could land me in my desired specialty choice. So my perspective was straight: do the rounds for all departments, follow the specialist's instructions, keep a special lookout for emergency cases, and read the preparatory guide if some time is left to spare.

My current chain of thought was broken by a sharp ring of the white landline phone, the attendant on the other end screamed emergency case, “Ask the duty doctor to attend”. I picked up my stethoscope, hurriedly wore my apron, and rushed downstairs, emergency cases were like war, you never knew what you were up against. The emergency was a stand-alone building with two beds, ventilatory support, restitution gear, medicines, and basic surgical support.

An old gentleman was lying breathless on the bed, his old wife looking pale as death holding her wet saree pallu to her mouth and sobbing. I rushed through saying I am your attending duty doctor, She started wailing louder “Are there no senior doctors?! She looks like a child.”I patiently asked her to move aside. After a preliminary examination, I had ruled out the respiratory system, his chest was clear, and there were no splenic or liver enlargements. He had not given any significant history except for slight pain in the left shoulder intermittently. The head warden at emergency was a bit arrogant, so when I asked for ECG, He frowned at me saying heart rate was normal, but I wanted to be sure while palpating I felt it was a bit erratic. There could be multiple reasons, but I wanted to be sure.

With profound displeasure, he started the procedure all the while ranting about the new generation of doctors simply being not good enough. The report had an ST-segment elevation in one of the electrode readings(This usually denotes an impending heart attack). I prepared a bedside report and suggested the patient be shifted to ICU, and the list of medicines be started on priority to be followed by ECHO tomorrow.

The attendant from the gynecology ward rushed in and said a patient had gone into labor, he looked flustered. I followed him to the second floor’s dimly lit corridor as he entered room no 104, my heart skipped a beat. This was a primigravida with Preeclampsia .

Preclampsia was always an emergency, the mother or the baby could die. I asked whether the consultant had been informed, and he said she was unresponsive. My mouth went dry, this could cost my degree if anything went wrong. Ideally, she should have had a cesarean, but she was already fully dilated and the baby was too much down the vaginal tract. The woman's relatives had already gathered outside the hospital and created a huge ruckus.

Mrs. Asha and I fought a long battle that night. After the baby was delivered healthy we heaved a sigh of relief. We had given all the prophylactic medicines like magnesium sulfate, and were praying nothing would go wrong. But suddenly her vitals started dropping, sweat broke on our faces, and I remembered a similar situation from my past training. She must have had massive internal bleeding due to post partum haemorrhage.External uterine message and bimanual compression were only hope.This procedure involves intrauterine compression as well as simultaneous supporting abdominal pressure.It is tricky,so the very thought of it made my stomach flutter.Mrs.Asha stared at me, nervous as hell.I nodded at her and said “This is our only chance”.She murmured a prayer and we began. By the time the consultant arrived , both our hands were numb.

Early in the morning, we both felt dazed. I looked at her and said, “I don’t know how long I can do this.” She pointed me to the patient we just saved, feeding her baby, I felt a lump rise in my throat. She said, “See you tomorrow Doc”. I simply nodded my head running short of words. I could for the first time see through the haze that clouded my eyes and my smile.