Most horrible days as a Doctor: Part 1

© Dr. Rajas Deshpande

As I held the knife, Dr. PTJ said: “Hold the knife like a pen, keep the tip on the skin, and with a controlled but firm pressure downwards, swipe its edge down as you feel the skin resistance. Don’t go deep at all. I am here. Start”.
Sweating a little, I prayed and looked at the open abdomen in front of me. It moved passively, slowly, breathing, albeit tense. Everyone waited impatiently. Dr. PTJ was known to be short tempered even by surgeon’s standards.

As I cut open the first alive human body, tiny spurts of blood oozed out, he wiped them away. This is the “second take-off” in surgery, the first one starts when the patient is anaesthetized. I kept on assisting Dr. PTJ, as he opened different layers of the abdomen below the skin, stopping the bleeding at each level. He opened the innermost layer called peritoneum, and the swollen intestines, blue-black by now, popped out. He showed me how to clamp the swollen part at both ends, and cut it open, cleared the gangrenous, dead parts and sutured the open ends in layers. That surgery of that complicated intestinal obstruction took above three hours. During pauses, he showed me the ‘danger areas’ where one could cause fatal bleeding. He then taught me the stitching back of abdomen in layers.
One life was saved in a thousand steps, I was euphoric like a child. I had done nothing, but the seniors still praised, maybe just to encourage. Looking at my face, Dr. PTJ joked “You cannot smile until the patient is discharged”. I thanked him and came out.
It was 11 AM. Ecstatic, I went out and went with my friend Manoj for a smoke and a tea, A casualty servant came rushing there: “Sir, come to casualty, fast”. I ran there leaving Manoj alone.

There was a chaos. Police had brought 4 cases of stabbing in a religious riot. There was blood all over the floor. Dr. PTJ was shouting: “Call the other three surgeons and anesthetists. One stay here. Rajas, you check vitals, start IV and put in a feeding tube, send blood for grouping and lab, then wait till the anesthetist gives fitness. When your reliever comes here, you can join me in OT”. He was tense.

One of the new patients had already arrested (no heart sounds), and the other intern was trying to resuscitate him with a CPR. There was only one working “curtain stand” in the casualty, now occupied by a dead body. So everyone else including other patients and relatives could see the CPR, where the chest massage caused oozing of blood from the abdominal wounds.
The other three were all in shock, very low BP, bleeding from chest or abdomen. Just as we finished starting IV lines and covering the bleeding wounds, ordering blood sampling and ECGs, another ambulance came over with six more. In next five hours, over 30 patients filled up the 10 bedded casualty. Stabbed or shot. Some came in pairs, having stabbed each other. Some brought dead. The casualty floor was all blood. Every medical officer, intern, nurse, wardboy, was in the hospital, working on their best steam. The blood bank techs were about to faint.
I went to the OT. Four of the surgeons were operating already, with combined staff. They were from different religions, including the communities fighting outside. Dr. PTJ and Dr. AM, with whom I was posted, both sobbed as they operated. They knew the outcomes when they opened the abdomen.
The rioters had used swords, knives, blunt rods, almost anything for stabbing. But where there was a sword or knife used, they had not only stabbed, they had rotated the blade inside the victim, thus cutting many vital organs like liver, spleen, lungs and blood vessels. Intestines were cut open in many places. In most cases, it was ‘stabbing to kill’, not only to hurt. This was professional work or that of the insane.
Over 15 died that day, and many more next week. Almost from every religion, but with one common thread: they were all poor.
The hospital turned into a large mourning station those days. Mothers and sisters, sons and daughters, Brothers and Wives, young and old of all religions mourned in shock while there were calls of “Religious Harmony” by the leaders surrounded by bodyguards, from their gilded bungalows.

The TV kept on shouting: “All leaves of all the doctors and hospital staff are cancelled, doctors not reporting immediately to work will be suspended. Negligence will not be tolerated. All hospitals have been ordered by the govt. to deal with the situation adequately, necessary funds are being generated through donations. Leaders of our country have expressed shock and pain. More blood is required, they have appealed the public to donate blood”.
No talk of the responsibility, of the perpetrators, or of the criminals.
No talk of unprepared and severely deficient health services and severe shortage of medicines, equipment, manpower, ambulances, everything.
The wardboys and mausis (female helpers) who cleaned the blood on the casualty floor were unusually silent for weeks later, many lost weight.

The sane in the society: the middle and lower classes, as always, lent their shoulder to the situation: People helped victims reach the hospital, bought them medicines, called their families, and donated money, clothes, blood. They carried the dead bodies for funeral with the shocked families. From every religion.

We all were aggrieved beyond repair, for lifetime, for we had seen a face of our society that stays hidden: right in our backyards, ever ready to pop up again at the wish of the powerful. In future I met many doctors from different parts of India, and they all have scars of various religious and other riots, bleeding scars that refuse to heal.

Months later, the two surgeons from two warring religions, who were in the OT in those horrible days, were in the casualty late, having tea with us all. Dr. PTJ asked Dr. AM: “How’s your cute son?”.
Dr. AM was in tears. He replied: “I hit my son today for the first time. He asked for either a gun or a sword after seeing a hit movie where the hero shoots point blank, cuts the enemy’s head, stabs their tummies through and through, and blood spurts out. He wanted to do that too. There are a million laws against love in this country, but none against killing on the screen, which stimulates kids. We proudly say India never attacked any other country, but forget that we have an internally violent, warring, illiterate and poor society, where a common man is never secure”.

He left India in a year.

© Dr. Rajas Deshpande

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