The Casualty – Aditi Chinchole

Posted on Oct 25 2011 - 8:12am by Litizen
Rocking back and forth with absentminded vigour, the surgical intern at King George Hospital was at war with the MCQ book he was bent over, squeezing in every last word.  He wondered from time to time what the point of it was.  No matter how many papers he solved, they always came up with new, unanswerable questions which everyone would invariably get wrong.  But then he would have to grudgingly remind himself that unlike his multiple choice book, he had no choice.  One couldn’t question decisions long since made.  Especially not three months before the big exam.  Now was the time to switch off all intellectual thought processes and run through every MCQ question ever asked as fast as possible.
To his sheer bad luck and dismay, he had been posted in Surgery, one of the busiest departments in the hospital at such a crucial time of study.  That meant working from 9 to 5 for 6 days a week in addition to emergency duties. In other words, at a time when every minute counted, he was painfully sacrificing precious hours doing menial jobs that nobody else would do for his sadistic, blackmailing professors.
But he had one respite.  Calls. The first thing his resident had taught him on an emergency duty was how to ‘bat’ our send away without treating a patient to another ‘higher centre’.  Patients were a burden on the life of residents and interns who had other more important things to do like study for higher exams so that they could treat patients.  His resident on call, it seemed, was permanently plastered to his residence, fully living up to his title, as no amount of calls would ever budge him from there.  If by fluke he did pick up a call, he would simply dictate instructions to the intern telephonically, after ascertaining that every method of ‘batting’ had been exhausted.
Thus, with no professor or lecturer to breathe down his neck and no resident to supervise him, the casualty ward was solely the intern’s territory.  He was king.  He would bat patients left, right and centre, and use all the free time he bought this way to pour over his CET books.  His resident was of course, more than happy with him for not admitting patients.  And the older doctors of the department were blissfully ignorant of all this.  All was thus hunky dory till this particular day, when yet unknown to the folks at the 24-hour casualty ward of King George Hospital, all hell was about to break loose.
Jai, the surgical intern was sitting in the casualty ward, busy attacking his book as described.  A male nurse, or Brother, sat across him doing some paperwork.  A servant or Mama was sleeping on one of the empty beds.  The medicine intern, Sapna, was tending to a patient with fever.  It was 11.00 o’clock in the night.  Jai felt his stomach grumbling.  He had been waiting for Sapna to finish her work so they could go to the mess together and have dinner.
Presently, Sapna came out of the ward.
“All done. Let’s go. Brother, just give him an injection Fibrinil and send him home.” she said.  Brother nodded and went back to his paperwork.
Both of them were at the door when at the other end of the corridor, they saw a man limping towards them.
Jai groaned, “This one’s mine.  Wait up. I’ll take five minutes max.”
The limping man came into the casualty ward, a fresh gaping wound on his thigh dripping blood over his knees and all over the floor.
“What’s the problem?” asked Jai needlessly.
The patient seemed too scared to speak. He simply looked at his wound and began to cry.
“Let me have a look. Brother, give him an injection TT stat.  Hmm.. Chacha, its looking pretty bad.  You may possibly need emergency operation.  But the thing is, we don’t have specialist doctors who can operate at this time of night.  Why don’t you go to a bigger hospital like Vaidya?  Its just five minutes from here.”  Actually Jai knew the minute he saw the wound that it was a simple uncomplicated contused and lacerated wound needing only 5-6 stitches and a sterile dressing.  But even that would take up at least 2 hours of his time, not to mention cost him his dinner.
Brother came in with a TT injection and pushed the contents into the man’s hip.
The man looked up at Jai, his eyes shining with tears, “Will I lose my leg, doctor?”
“Only if you don’t hurry up and go to Vaidya Hospital immediately.  Come on now.  I’ll help you till the door.”
Jai winked at Sapna as he came out.  One more patient successfully batted.  But as they made to leave, two more patients trickled in accompanied by their relatives.  One had a bad wound on his head and the other had burns over his hands and legs.  Jai asked Sapna to go on and have her dinner as this could take a while.  It was always tricky  to bat when relatives were present.
Jai quickly went to the burns patient first.  He asked the petrified relative what had happened.
“Sir, there has been a bomb blast on GM road.  I don’t know this man here.  I just saw that he was alive so I got him here as fast as I could.”
Jai couldn’t believe his ears.  He felt his heart fall into his stomach.  Bomb explosion.  Mass casualty.  He turned to Brother and saw the same look of dread in his eyes.
Without wasting time he asked Brother to inform his resident while he began to secure an iv line and clean the burns wounds with saline.  His mind was racing.  Was there still a chance he could get away from here?  Maybe he could send this patient to some place with a burns unit.  Even then there was still the matter of the head injury patient lying on the next bed.  And who knew how many more were on their way here?
“Not picking up. I’ll send him a written call.” said Brother.  As he sat to write, the phone rang.  Brother answered it.  Just then, two more patients arrived.  Jai gave them a quick head-to-toe; they didn’t look too serious.  He was now applying silver sulpha ointment over the burns wounds.  He had started a pint of iv fluids.  The head injury patient began to get irritable.
Brother said the phone was from Vaidya.
“They’re taking the brunt of it…  Sending minor casualties over here.”
“How bad is it?” asked Jai, half not wanting to know.
“Around fifty.”
“Fifty coming here?!” gasped Jai.
Brother shook his head. “Fifty dead.  Many more coming here.”
By then a serious patient was brought in by a couple of lay persons. She was intensely breathless and disoriented.
“Minor casualties, huh?” muttered Jai rushing to her with his stethoscope.   Okay concentrate, he told himself, supressing his nerves.  He couldn’t hear any breath sounds.  Pulse, thready. BP, not recordable.  ”Get me a veinflow quick!” He yelled at Brother.  All the veins were collapsed.  Her nails were turning blue. He checked the pulse again.  Nothing.  She had stopped breathing too.  What on earth could have happened to her?  Pneumothorax?  Hemothorax?  He needed a chest X ray, but there was no time.
Brother handed him an ET tube and the layngoscope.  Jai had never intubated before.  But it didn’t matter now. He threw her mouth open and pushed in the scope, guiding the tube into what he thought looked like the opening of the wind pipe.   He asked Brother to attach the bag and mask and begin ventilation while he gave strong thrusts against her chest with his hands, putting all his weight into it.  He didn’t dare use the defibrillator: he had no idea how to use it.  A while passed.  The woman’s lips were blue by now.  She wasn’t moving.  Jai flashed a torch on her pupils.  No reaction.  She was dead.  Jai’s hands were trembling.  He couldn’t save her.  He wondered if he had killed her.  His head had begun spinning.  He needed to get away from there.
He suddenly noticed that the ward was by now full of patients, all of them looking at him.
“Where the hell is the resident?  Call the bastard down right now!  Call every resident in the hospital!”  Jai roared at Brother and Mama, who was now wide awake.
Sapna just came in.  Clearly she was completely oblivious of what was going on. “What the-??”
“Stay here.” Jai said to her and strode out of the ward.  He went straight to the operator and instructed him to connect him to Dr. Pai, the HoD of Surgery.  It was 11.30 in his watch.  He could hear the blaring siren of an ambulence approaching.
“All the phone lines are jammed, sir. I’ll keep trying and send the call through to casualty as soon as I connect.”
But Jai was hardly listening.  He saw the silouettes of three figures emerging from the stairs that lead to the residents’ quarters.   Jai breathed out, suddenly relieved.  Help was here.
“We just heard about the blast.  What’s the scene here?” one of them asked.
Jai briefed the doctors of whatever he knew as they walked towards casualty.  One of the three turned back, saying he would get more doctors down to the scene.
By the the time they reached the ward, the crowd had gotten rowdy.  They were ganging up on Sapna, each wanting to be treated first.  By the looks of it, Jai knew by instinct that had he not escaped from there in time, he would certainly have been assaulted by this angry mob, and that the only reason they had spared Sapna was because she was a girl.
The crowd settled a little after seeing that more doctors had come.  The five of them began triage.  Sorting patients according to their prognosis and need for immediate treatment.  More residents and nurses poured in. Even more patients poured in.
From that time on, Jai was working non-stop, splinting patients with fractures, dressing burns wounds, applying stitches, starting drips, giving injections… hours went by without anybody realizing it.  Something was soaring inside him.  For the first time in his life, he felt like a doctor, like his life wasn’t a complete waste.  The team of doctors worked incessantly all through the night.  The phone kept ringing off the hook.  Many concerned citizens queued in to donate blood.  The specialists were here too, pitching in.
The bodies were piling up.  The Director of the hospital was briefing the media which had gathered to cover the scenes at the hospital.  One of the senior doctors came up to Jai and said, “You did good today.  Go home now.  Get some sleep.”
Startled, Jai realized for the first time that the sun was up.  He hadn’t felt tired for even a moment all night, but now all the latent weariness abruptly surfaced back.  He was about to leave when his eyes suddenly fell on his MCQ book, lying open on the table, just as he had left it last night.  He packed it in his bag, smiling a rueful smile.  This was no time for thinking, he reminded himself again.  Not if he wanted a good seat in a good hospital.
Back to batting patients from tomorrow.
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