The Impasse

I started my emergency medicine posting exactly 8 days ago, and I’ve been bubbling with stories to share. But a galore of experiences in the casualty comes with its fair share of exhaustion.

Sitting down has never been more underrated, finding a bathroom break in between the chaos to empty your extremely full bladder only to realize your pee burns because you have forgotten to drink water all day, having dinner at 3 am in the morning during a lull moment and considering yourself lucky for getting two hours’ worth sleep, when did ordinary biological functions begin to seem so important?

Like I’ve been telling all my friends who’ve been asking to catch up with me, “I’m sorry guys, if I’m not in the hospital, I am sleeping”, I extend the same excuse for not having written a blog post.

But I’m the right amount of tired today and as I head back home at the end of my shift having cried over a patient, I know a new story is coming.

At 4.30 pm while I was cleaning the wound of a four year old boy, another man was wheeled in on a stretcher, moaning and quite evidently in a lot of pain. “FALL FROM HEIGHT, POLYTRAUMA” screamed the paramedics.

I de gloved and ran to this man, trying to get a story out of him. “What is your name?” “Did you fall?” “When did this happen? “Are you alone?” came my barrage of questions. And in return I got some words, lot of groaning and a constant chant asking for some water to drink.

I understood that he was a daily wage labourer, who had fallen from the first floor of the construction site, with some machine and landed on his right arm. I looked at the right arm and it was mangled and bleeding. He pointed at his hip and that was deformed too. I choked back panic, and hurried on with the preliminary examination, rushed a pint of fluids and ran out and got the orthopaedic residents on call. The minute they moved him to examine his injuries, he started screaming in pain.

Cutting it short, he had a dislocation of his elbow, fracture of his forearm bones, a dislocation of his hip, some fracture of the pelvis and probably some spine injury. We needed to shift him to radiology to get scans done to confirm our diagnosis. His employer was brought in and updated about the next plan of action.

The man on the stretcher though, He didn’t care about any of this medical jargon, all he wanted was for us to do something about the pain. He held the resident’s hand and said to him “Sir, my parents are dead, I dont have siblings. I don’t have anyone else, please take care of me.” The resident patted him on his head and said we were going to fix him, and it didn’t matter that he doesn’t have anyone to look after him, because we’d take good care of him.

The patient had to be shifted to radiology and I didn’t have anything much to do there so I left the room for a bit to see the other patients that had lined up outside the trauma room. When I came back, assuming the xray films would be up, I saw the orthopaedic surgeon in a heated discussion with the man’s employer.

Apparently the guy wanted to take him to the district government hospital for the lack of money. He didn’t have funds to pay for the man’s xrays or surgery or the hospital cost. And my staff was trying to explain to him how imperative it is for us to reduce the fractures to put the patient out of his misery.

“I have a wife and kids to feed too Sir, I cannot spend so much on him”, was his closing dialogue and just like that I knew we had lost this battle. The surgeon sighed, defeated and asked us to get him ready for discharge.

We splinted him and signed his “discharged against medical advice” papers and put him on a stretcher. All this with the patient still screaming his lungs out, drenched in sweat from the pain, begging us to help him.And just like that, my heart shattered into a million pieces. The urge to help him, the helplessness at the fact that I could not, the unfairness of the situation got to me and I broke down.

From my very humble one week’s experience in the ER, I have come to realize that in our country, each diagnosis comes with a price tag. Your mother has adenocarcinoma of the colon, we need to operate and get the tumor out. Oh okay, but how much will that surgery cost us?

Your son has a broken bone, ma’am how much will the xray be? The patient has ARDS and he will need to be put on a ventilator, ma’am I don’t have money to pay for ICU, can we admit him in the ward instead?

Only the rich are privileged to the healthcare that this country has to offer. Just how every child has the right to education, something as basic and essential as healthcare must become every citizen’s right. People seem to misunderstand this as to every sick person has the right to see a doctor. That one definitely does, I, as a doctor will do my part. I will talk to you, examine you and give you my diagnosis, and then what? What happens to the story after the diagnosis?

I don’t know how to fix this situation, or what I can do to help or how I’m going to tell my heart its okay to not worry about things not in my control.

I don’t know if this is something I will ever get used to; I sincerely hope I do nnot.

But for now, as I go to bed tonight, tired, all I pray is that patient with multiple fractures is doing okay.