I can teach you all about the diseases, said the book. And I can teach you all about life, said the hospital.
Over the course of rural posting, one invariably has to do a fixed number of casualty duties, where we stay right in the rural PHC for 24 hours and attend to any patient that shows up, which mostly will be some emergency. The responsibility of manning the casualty rests on one pair of Interns, one sister, ‘mama’ and ‘maushi’ and the Medical Officer (who is on call). During the day some paramedical interns are also there, but not in the night. Knowing only this much information beforehand, I thus set out for my first casualty.
The casualty is not exactly busy round the clock. In the morning time till 2, our job was to perform the ECGs on the patients referred from Casualty. Since most patients were managed my OPD during these hours, only the very severe injury and core emergency patients would present to us. After 2 oclock though, we were at the forefront.
In the first casualty we had a lot to explore and learn, and familiarise ourselves with the way things usually worked around there. Two female interns in the entire hospital did not sound like a very comforting thought but as it turned out though, there wasn’t any immediate reason to worry as the supporting staff there were more than capable to handle any unforeseen event. I became quite reassured that we can sleep easy at night with them on the watch.
In the first casualty we saw a few cases of suture removal,and few minor cases that just required dressing and wound care. The complex is quite pleasant, so as the evening set in we strolled outside, went out nearby for tea or sugarcane juice. As the sun went down, a melancholy set in, birds slowly stopped chirping and the sky slowly pulled the blanket of darkness. Usually as the trend goes, interns go out for dinner at restaurants nearby, but we just decided to order in some food from nearby hotel.
Just as we were settling down for dinner, we heard the siren of the ambulance, and immediately braced ourselves for an emergency. Sure enough it was a man brought with head trauma following a road accidents, with multiple lacerations over his scalp. He was conscious though, and kept asking us if he was going to make it out alive or not. That, is enough to make anyone go numb with dread and freeze in our tracks. But first step to being a medico is to overcome the panic and act – act fast. Until Medical Officer arrives, we are the first line of contact for the patient and thus we have to start acting on it immediately. The crucial calls are all made by M.O though. Being a very preliminary centre however, all critical cases are referred to Nagpur after primary care. After the adrenaline rush had subsided, exhaustion crept in, and I hoped that there would be no further cases in the night. That was not to be, as there were a few patients who came at night, but none too worrisome and gave no trouble except disturbed sleep.
Morning time brought great cheer and relief but our duty wasn’t over. After getting dressed and having tea and breakfast, we set out to a health camp where we were posted for the day, our role being measuring BP and RBS. By the time we were done by 2 in the afternoon, it had been nearly a thirty hour duty.
My second casualty a few days later was quite similar to the first, actually even lighter. In the evening we snuck up to the terrace of the building, and sat up there for a while looking at the pleasant view of the town square, a reverie in the gentle breeze, till sundown.
In my third casualty however, we saw a rather disturbing case of a middle aged lady brought with very minor head trauma after on obscure road accident, but upon further exploring we realised that she was already dead. We tried in vain to find any sign of life – pulse, ECG but she had already flatlined. Her relatives were also shell shocked and inconsolable. One moment she was absolutely fine in the morning setting out for work, and the next moment her relatives are being called up to identify the body. Makes you realise how fragile life is, and almost hanging by a thread always. The overall mood remained sombre for the rest of the day.
My fourth and last casualty, was also my last day of rural posting and I was aware that even though I couldn’t wait for it to be over, I would look back at this time as one of my fondest memory. One case we saw that day however, will always haunt me. At about 2 in the afternoon, we heard the sound of a child crying in pain being rushed in by his mother. He was entirely wrapped in blanket, and when we prodded and removed it we saw to our horror that entire left half of his face had been burnt and lacerated and almost blown away, like something had exploded in his face. True to our suspicion, a battery had exploded right in his face as he was toying with it. It was gut wrenching to watch but all we could do was put him on saline, give antibiotics, painkillers and rush him to Nagpur. This case did cause a few ripples and we heard it in the news next day that the child is still critical. I hope he recovers.
What makes a good doctor? I realised in rural posting that being a doctor goes so much beyond books. You have to have compassion for the patients and make them feel understood, an ability to make split second decisions and act fast – and act right and precise. Blink back your own tears as you fight to stop those of the patient. Manage several patients at once and mentally triage them. One evening we had a person with head trauma losing consciousness, one lady with ascending paralysis, three people with monkey bite all presenting at the exact same time and it was the wildest frenzy managing them all. In these casualties we learnt dressing, suturing, gastric lavage, managing crowds and also managing our own self on 24 hour duties.
As we left for home in the bus, I smiled wistfully to myself thinking how much I will miss this posting once I will go back to our own hospital. I have an inkling that this posting might be the best of all, but I shall know about others only as they come. Rural posting was indeed a memorable, productive and fruitful one.