The main question

It was a regular busy night in the casualty section. 

The lone CMO was all run down with all kinds of patients turning in that night. Though he was directing the patient-traffic, he was nevertheless fatigued. There were some cases of poisoning, diarrhoea, heart attacks and strokes, who were sent to the Medicine ICU/ wards depending on their severity, some accidents, who were directed to Orthopaedics, emergency surgeries.  The JRs(Junior Residents) from various departments were strewn all over, looking at their respective patients, trying to see how many patients could be sent home with some basic medicines and who needed admission. It was chaos. Everyone speaking at the same time. Everyone trying to listen above the noise levels. Crying, wailing, waiting, exasperating. Emotions run high at such times. For everybody present- the doctors, the nursing staff, the suffering patients and their attending relatives. 

There are no back ups and team Bs in the government hospitals in India. There is only one shift. It is called ‘everyday’. The residents just slog on. It builds character, and an unearthly ability for hard work. It develops the capacity of clear thinking even in the middle of the night. Three years of rigorous hardships. Physical and emotional. The first year (JR1) for your ability to follow orders. The second year (JR2) for thinking and analysing. The third year (JR3) for learning to take charge and responsibility. This was the rough idea, one would suppose. In addition to the knowledge of their core specialty, it also builds people skills for those who are interested. The professors teach the core knowledge and skills. But there is no one to lead the students in the people skills. It’s a random luck factor for picking up these ‘soft’ skills. One learns by observing. Like sponges, one imbibes the habits and manners of the seniors. Or if one is aware, awake and alert, one consciously develops the individual emotional skills. 

The medicine ward was also busy. Tackling the patients who had been sent up for admission. Some were diverted to the ICU. Others were being managed in the wards. 10-12 ‘floor beds’ had already been laid out. The capacity had been exceeded by 7 pm. It was quieter though. Much quieter than the casualty. As the relatives and patients settled down to digest the diagnoses, the nurses got busy dispensing the medicines, the JRs got busy completing the papers after all the history taking and examinations. The JR3 was shunting between 2 wards. Notes of 40 odd new admissions to be written. 

It was 11 pm when the phone rang in the male ward. The JR1 was called down hysterically by the CMO. ‘Come down quickly, there’s this guy who wants to get admitted. I can’t handle him! Stupid fellow! Just doesn’t listen!’ The JR1 went to the casualty section. It was 20 minutes later that he  came up and reported that he had had a tough time in convincing the guy in casualty that he did not need an admission. It was some young fellow who had got it into his head that he needed emergency care. ‘He argued a lot with me, but he was totally stable’, reported JR1, ‘and could be attended in a regular clinic next morning’. And then everyone was back to the droll routine of making all the case-notes of the endless patients admitted since morning. Heads bent over either patients or case sheets, work went on in relative silence. 

When around midnight, the whole ward was disturbed by shouts and scuffles. The JR1 was having rough words with a young guy. The words had soon turned into a brawl and by the time the JR3 arrived from the other ward, the two youths were almost in a scuffle. Two strangers. And yet brought so close in a fight. Like Chekov’s antagonists. It took some time and people to separate them and talk to each one to find out what was happening. It was only then that three other people were noticed. A young girl and a couple of old people. How had all these people come up into the wards? Were they with this young man? Why were they here at midnight? What was the fight about? The JR1, frustrated with all the pending work and the preparations for the morning ward rounds, the patients already admitted demanding his attention, was in a rage about the whole thing and blurted out, ‘This is the same fellow who was in the casualty an hour ago. I told him he doesn’t need admission but now he is back with his parents and his sister, trying to force me to admit him as an emergency. I have been telling him in all possible ways that he has to come to the OPD tomorrow and get himself checked and investigated further. He just doesn’t want to listen.’ ‘But why does he want to get admitted? What has happened?’ asked the JR3. JR1 calmed down a bit and said, ‘He has been tested positive for HIV. He got that report today evening and wants to get admitted for that. I have tried to explain to him that it is not an emergency and he has to be in the HIV clinic tomorrow morning so that all his other tests and checkups will be done. He insists on getting admitted now. Right now. He is pressurising me. He came up to the wards after having a fight in the casualty now. Go ahead. You handle this. There is so much more work to be done’, and he went back to his already admitted patients. JR3 was in the arena now. Few nurses, some ward-boys and random relatives of admitted patients had gathered around to watch. Some even appeared ready to accost and hold down the angry youth. JR3  looked at the youth. She saw his parents, his sister, their faces. Worried. Confused. The youth. He was angry. So angry. Fuming. Additionally heated up by the fight. She could almost see fumes of rage. This could turn unnecessarily ugly! Must to something. JR3. Young. Alone. Bits of experiences. Some fleeting thoughts. Deep breaths. And action. 

She called the enraged youth aside. Took him near a table, made him sit on a chair. Put her hand on his shoulder, bent down closer and asked him just one question, ‘Are you afraid?’ He looked up at her. Stared for an endless second. And collapsed in a heap on the table, crying. A metamorphosis in fast forward. There was no anger anymore. It took him some time to be able to talk. ‘Yes. Afraid. I will die now. I can see my end. Look at my parents. They don’t even know what has happened. And I am being refused admission! What will I do?’

She pacified him. Told him gently about the HIV clinic. Spoke to him about possibilities. He calmed down, wiped his tears and agreed to come back the next day with his father to the HIV clinic. Brave but not battered, he left from the ward amidst an empathetic silence. 


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