It was my second night of start of internship rotational posting. Before this, I had been to wards before but just to search for exam cases and “Hear a Murmur” through my novice ears to diagnose a “Cardiac Condition. In final year we all are cardiologist and nephrologist in our own little world. We all very diligently start reading the bible of medicine Harrison which gradually shifts to Indian writers and then to local circulating notes in respective colleges. I also was a plastic surgeon in my own little world. Every murmur I could diagnose or every fact I learned about my body made me think that there was just an exam in between me and my destiny. I was too smart to be anything else but a super specialized doctor. But life has a harsh way to teach you things, it hits you really hard where it hurts the most. One incidence changed the whole perspective of mine at the way I looked at things and I dealt with patients. It was a fine Tuesday evening, the second day of my start of internship rotational posting which fortunately or unfortunately started with general medicine posting. It was my units admission day and I had been working very hard since morning in taking blood samples and fixing intracatheters. I was very sincerely taking all the history by asking all the right questions my quiet clinically premature but loaded with recently crammed up facts brain could form. I thought I was working really hard and really helping my junior academic residents.
Suddenly a fiftyish man walks through the doors of the ward with a really cachexic looking girl in her twenties on a roll on the mobile stretcher. She was breathless and could barely speak. By taking the history I came to know that she was an antitubercular treatment defaulter who had taken treatment for two months and stopped and now the disease had mutated and grown into multi-drug resistant type which was like cancer(again forgive my then novice mind) and untreatable. My third-year resident who was in a hurry to go was furious at the way the girl has been “playing” with her life and her frustration and tiredness came out too harsh on both the girl and her father. My senior went on for about five minutes on how she would die in a few hours given her condition and there was nothing that could be done. I was ordered to wear double gloves double mask before going near one meter of her vicinity. Once my senior was done blabbering ( of course then it felt that way but now as I myself am dealing with frustration and constant tiredness of residency, I cannot blame her ) she ordered the treatment and went. Once that part was over there came the nurse part about how she could not be placed in the general ward and should be kept isolated as much as possible so she was given a bed next to the public bathroom as far as possible from the normal patients.
I stood there the whole time looking at the chaos but then my clinically untrained and inexperienced eyes could not see the defaulter in the girl. All I could see was her eyes and count each labored breath she took and how much effort it took to take that single breath. I could see the helplessness in the father’s eyes, to see his own child this way and to hear that she may pass in a few hours.
A new issue had risen in the ward and I could hear the heated conversation between the father and the ward nurse. There has been the issue of attendants and the father was the only available relative and there was no female relative available and he didn’t have enough money to pay for the personal attendant. Left helpless he had to leave her daughter in hands of god and leave with teary eyes. I stood there till he collected his meager belongings and as he started to leave the folded his hands in front of me and said nothing but rather just stared at me for thirty long seconds. That stare has somehow stayed with me until now.
I made a silent promise to him and to myself to not let that girl die alone that night. When everything got settled and there was no chance of getting scolded by the nurse for going near the girl I went to her. I stood at a distance of 1 meter from her (the facts loaded mind knew that there was no treatment for multi-drug resistant tuberculosis) and I asked her how she was feeling and did she need anything. Through labored breathing, she told me that she had not slept for three nights and she was too tired to even breath. Suddenly sole aim of a “future plastic surgeon” was focused on how to get this girl some sleep. I was too afraid to call my on-duty resident and too egoistic to ask an on-duty nurse for advice. Before this drugs to me were just a name in KD Tripathy with the mechanism of action and adverse reactions. I didn’t have the courage to give some hypnotic to her on my own.
Gradually I gave in my ego and asked the on-duty nurse for some drug which could be given to her. She promptly replied alprazolam as the drug of choice and how she herself had self-medicated and so many doctors were regularly taking it putting a stamp of safety on it. I googled the drug and carefully studied it as a ten mark nonoptional question. At last, I came to the conclusion that the drug was safe in all aspects except that it may cause respiratory depression. And given the girl’s condition, it seemed a very big risk to me.
I nebulized her twice and pumped her with all the bronchodilators possible(as adviced by my senior). Still, there was no significant change in her breathing pattern. She again asked me if she could get something for the sleep and I mustered the courage and gave her one tablet of alprazolam(0.25). I waited for the magic to happen as soon as she gulped the drug and see her peacefully go to sleep but nothing happened. I told her that I would come back and went to roam around in the ward. It was 2 AM in the morning and I had been working for straight 18 hours now but I didn’t feel tired at all. All I wanted was to give that girl a last peaceful sleep before she died.
Roaming around the ward a sat on the bench in the doctor’s area and dozed off without realising. Suddenly I sat up with a jolt and the clock showed 3:25 AM! I was angry with my self and ran to the girl and saw her still sitting in tripod posture counting each breath she took. Still no sleep. My senior came on the rounds to see the patients and asked why I was still roaming in the wards. This was my chance and I told her all about my mission to give this girl one peaceful night. She had nothing new to suggest and she advised second tablet of alprazolam. I was silently shocked in my mind and thought what if she goes in respiratory depression?!. I told her that I would give her second tablet but I didn’t.
I told her to lie down and try to sleep but it was impossible for her to even lie down. I sat there whole night silently guarding daughter of a man whose eyes had asked for something and I silently had agreed. The girl didn’t sleep neither did her breathing improved but my shift ended. Surprisingly nobody had a solution for her problem, not even the consulting physician who came on morning rounds.
I wrapped my scut work and all the pending files and before going to my room met her once again. As she sat there leaned forward, with not a single layer between her skin and bones, sunken eyes with dark circles around. She weighed not more than 30 kilograms. This was the first time I saw her in sunlight and with such clarity. I bade her goodbye and went to my room
I came for the evening rounds and found that she had died in afternoon 1 hour afterwards I had left. My cointern was not interested to talk about her as she was already “ declared” dead when she came and she was a lost cause.
Till this date I can not forget her hollow sunken empty eyes and how they begged for one last paecful sleep. It has been 4 years to this incident and since two years three months I have been in touch with more patients and lesser books. I have become more clinically trained and emotionally untrained. There has been a huge difference in the way I now see patients and how I treat them.
Probably residency and my experience in medicine has made me more of a doctor and lesss of a human. But I still regret that could give that girl her dying wish. What if I would have given her the second tablet.. what if..