The Straight Line

Dr. Rajas Deshpande

1 hr · 
© Dr. Rajas Deshpande

“Her stomach tube appears blocked, she appears to be in lot of pain, her BP is low” my sister said, crying, panicked. 

My mother was in the ICU last four days, critical and fluctuating. I was returning home to change in the morning after spending the night there. I took a U-turn, but was stuck again in one of the worst traffic jams that fate reserves for your hurried days. The curse of being a doctor acts most cruelly when your parent is sick. Worst fears throng an already emotionally tortured mind, and the fear of losing the parent smothers your scientific ego.

I remembered, my colleague Dr. Nitin Pai was in the ICU too last night, his father was also critical. “Check if Dr. Nitin is in the doctor’s room” I told my sister. “His father is admitted in the next cabin. If there, please request him to see Mom”.

She found Dr. Nitin with his brother Dr. Ketan in the side-room. She told him about Mom. He rushed to Mom’s cubicle and checked her. He checked the tube, and clarified that the tube was not blocked, but we’d require a CT scan of her abdomen. He instructed the ward doctor about it, and explained to my sister. 

Then as he was leaving, my sister thanked him and asked “How is your father?”

“He passed away 20 minutes ago” said Dr. Nitin, turning his face away. 

He is the type who would never publicly display emotions.

As I entered the hospital, Dr. Avinash Nanivadekar, radiologist, caught hold of me and said “Dr Prashant Dev had already done the sonography, I got the CT scan done, there appears no surgical cause for her pain. As you were not reachable, I took the liberty of proceeding”. Dr. Joshita Singh had already co-ordinated and reported the CT scan. Dr. Neeraj Rayate, on the way out of the town, returned to stop bleeding from her wound by an emergency procedure. Dr. Prachee Sathe and her team brainstormed each morning, for each of the several serious complications that Mom was going through. Daily changes, umpteen parameters to keep in mind while making the tiniest changes.

So many complications. So much uncertainty. Tubes all over. Over 14 blood transfusions. Oxygen downing. Dialysis. Sudden changes in blood sodium and potassium. Heart rhythm going awry. Infections that we know threaten life. Metabolic functions oscillating between normal and abnormal.

“Please do best, whatever possible” we told the ICU team.

All these are the daily happenings 24/7 in every ICU across the world, but it is so much more difficult and different when this happens to your parent, and you are a doctor. Not because you are more concerned about relatives (for one cannot be less concerned about any other critical patient), but because you fear the worst. Because you know better the list of ‘bad turns’ in medicine. Because you know that death lurks around every corner like a wolf, and will pounce upon life without fail every time it gets a chance.

What if some decision is wrong? What if some doctor uses a wrong medicine? What if someone misses her correctable problem? Of the worst paranoias in the world, the medical paranoia of a doctor is the most unbearable. It helps us to better deal with other patients, thus avoiding mistakes, but also strangulates us when one of our own is sick.

Dr Sanjay Sagar came at midnight, to relieve me for sleeping for an hour. Just as I told him I won’t be able to sleep, he got a call from emergency OT, had to run there. Dr Murarji Ghadge and Dr Vikrant Vaze visited many times to ensure good airway.

She became unconscious. What if she wanted to tell me something? What if she never woke up? A quivering soul begs for relief from that moment. I frantically kept calling many consultants, they patiently answered my doubts. The nurses silently and patiently carried out every instruction: there were thousands of things to be done for so many patients. Many doctors shouted at them, sometimes relatives humiliated, mocked their language, but the nurses carried on their duty unaffected. Almost every night one of them brought me tea, without a word.

There is a shameless self sitting upon your shoulder, which comments about everything irrespective of what goes on, and how intense. “Come on, be the scientific and strong Doctor you like to think you are. Is this new? Haven’t you handled this many times over now? Are you afraid what people will think?”. . I punched that imaginary myself in his face, and told him that I never cared what people thought, I just wanted my Mom to wake up. It was ok if she was bedridden, if she didn’t talk to me, but I desperately wanted her to wake up and keep looking at me.

Two days, three nights. Minutes crawled in, spewed their poison, and crept away. Problems so complicated, their answers cannot be found in any medical textbook. There was no time to pray. Like most intensivists prefer the world over, prayers come later, after stabilising the patient.

Whom to blame? Every doctor, such classified specialists, trying their best. Who was causing this downhill course then? What am I fighting against? Stay calm, I reminded myself. Emotions blunt logic. Think what all you can solve, wait for other things to improve.

I kept on looking at my unconscious mother, holding her hand, for many hours. “I am trying my best” I told her, and apologised for all that she was going through. Always in my mind like inner sunlight, her reassuring, loving voice echoed from somewhere deep: “I know”. She always knew! To hear her voice once again inside myself was too strong an emotion to face without breaking down.

“Excuse me sir, can you please see a patient in the CCU, he has suddenly become unconscious” asked a junior registrar. I washed my face, and went to see the patient.

When I returned, one of my relatives was standing near mom, visiting after many years. My sister was talking with him.

“Where were you?” he asked me.

“I was seeing a patient in another unit” I replied.

“Your mother is critical, why do you want to earn more money at this moment? Has this become an addiction, to keep on earning more? You can earn a little less and look after your mom” said this uncle. On the verge of the worst calamity in life one can face, I searched for the right words to answer him. There were no words in any of the five languages I knew, to deal with that allegation. Like most doctors who face this question daily, I preferred to be silent.

As night fell, the memories of hundreds of difficult nights of battling for life came alive. Only an intensivist can understand how important it is that the patient pulls through till the daybreak. Mostly tragedies strike pre-sunrise. No doctor in the world can stop the inevitable. We are all mere mortals. I know. But she is my MOM, and I didn’t want to be a doctor in that moment! Someone work out a miracle, please save her!

That night etched upon my life the pain of having to see a mother gradually worsen to death. When she arrested early morning, Dr Manoj and Nurse Nelson started the CPR. 

My sister collapsed, her husband tried to comfort her.

Knowing most CPRs fail, I stood outside the cubicle, now praying, looking at the monitor. Various rhythms kept struggling with the straight line.

The straight line won at the end, as it always does.

In the abyss that followed, I searched for God. I searched for solace. Not everyone can cry or express pain. Silent pain hurts far more, soaks your blood with bitter flaming poisonous agony. Such a pity that people cannot understand pain when not expressed aloud!

Dr. Nitin, unable to bear that agony in solitude, returned to work early, seeing patients was his only diversion possible to suppress the killer loss.

I am yet struggling to face the reality: that for the first time in life, I return to a home where a smiling, sunshine welcome of Mom’s eyes is not there. Whatever happened, whether she liked or disliked my deeds, whether she was happy or upset with me, my calling out her name whenever I entered home was always answered wrapped in utmost love and care.

Three days later as I returned to work, my sister asked: “How can you go to the same hospital building, the same ICU again?”

“Because I am a doctor, and someone needs me. We don’t want to be defeated by death.” I told her.

For we doctors live upon another straight line that always wins too: the duty of serving human life beyond personal losses.

Dr. Rajas Deshpande

PS

Thank you Dr. Nitin Pai for permission to reveal name.

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