Patient abuse

We barely had eight weeks for the final MBBS exams. As a part of preparations, we would scout the hospital wards for interesting cases, examine, and discuss them.

So when we heard of an interesting case in male surgical wards, Unit C, we decided to see the case after lunch. In the ward, it was unnecessary to ask about the interesting case because there were already a dozen of our classmates around a cot in the farthest corner. Just then the patient, Mr. Ramappa, who had gone out for a late, hurried lunch came in.

He looked at all of us- in white coats, dangling steths, manuals and notebooks in hand; and with an audible sigh sat on his cot. A sudden vision of pithing slimy frogs in second MBBS floated before me. (Pithing- to study physiology of muscle and nerves, we had to make a muscle-nerve preparation from the legs of a frog. For that, we had to ‘boldly’ stick a long thick needle at the bent neck of a LIVE, wriggling frog! And, as its spinal cord severed, it would go limp and we would proceed dissecting the poor creature!) Discussions died down and each one of us began taking turns examining him.

Ramappa was a case of Thyroid swelling. (Thyroid- a gland that is present in the front part of the neck and is not visible as an obvious swelling in health) The examiner is required to stand behind the patient and the patient has to bend his neck for examining any neck swelling. So Ramappa sat, his head bent and turning from time to time when ordered as each student took an average of seven to ten minutes to examine him. Looking at his neck from front, we would ask him to swallow and note down in our books whether the lump moved with deglutition (swallowing) At one point after he had obliged twelve of us, he asked: “Could I drink water? My mouth is dry and I have to drink something to show swallowing.”

It was my turn next and as I started with inspection. (The first part of any examination is inspection-that is to see before we touch) I noticed that the skin of his neck appeared sore. Were he a little lighter skinned, it would certainly be evident as a bruise. So many of us had handled his neck since past two days, that it must surely have been painful. But he had not complained. As I looked up from his neck, our eyes met. I could have well been looking into the eyes of a trapped animal. Pain, anger, helplessness were all there, coated by a thin film of a threatening tear.

‘Interesting cases’ are admitted during exam times for the benefit of students and as cases for examinations. These people are often poor and come to government hospitals for treatment. When they are admitted and scores of students come to see them, they initially believe that many doctors are seeing them. Few days later, the knowledge dawns on them that they are being kept as examination cases. Many of them oblige, probably because of the fear that they may not get the necessary treatment if they do not. Some of them run away from the wards either during student rounds or permanently.

Ramappa’s thyroid swelling was diagnosed as Cancer Thyroid. It was a very obvious diagnosis given his change of voice, fixed swelling, palpable lympnodes etc. Yet he was kept in the ward, pending treatment, so that he could be examined by future doctors who could get the ‘feel’ of a cancer lump!

This is where our Medical curriculum errs. No one ever teaches us how to empathize with patients. It is only mentioned as if an abstract emotion by some teachers. The soft-firm-hard –cystic feelings in diagnosing lumps, that we are taught in surgery, do not reach beyond our physical capabilities. When it comes to feeling for patients, we are on our own, without guidelines.  

But that day Ramappa had taught me an unforgettable lesson. I refused to lay my hands on his neck. It did not matter to me if I missed the feel of one cancer thyroid. I had felt his pain and I valued it as a greater clinical acumen than diagnosing cancer. Since then I have forgone examining Shivu (a ten year old with Hereditary Spherocytosis), Shankar (a seventeen year old with Wilson’s disease) and others....They have all spent not less than 2 weeks at the hospital being examined by innumerable number of students. Shivu’s large dream-filled eyes and Shankar’s wobbling gait, toothless smile and ambition to become a D.C stay with me as reminders of my final year days. They remind me always how lucky and privileged I am and that the least I can do to alleviate their suffering is to understand them as human beings and not as interesting cases!

Vases's eight (pastels on paper)