Lady Hardinge Medical College (LHMC)
was perhaps the only Medical College Hospital in India which catered
exclusively to women patients. For this reason, most people thought LHMC took
in only maternity patients, though it had all other departments, of course. So,
the Obstetrics and Gynaecology Department lopped off a whopping 70-80 percent
of women seen here making the Hospital the Mecca for Obstetrics and Gynaecology
training.
With over 30-40 deliveries in a day,
LHMC hospital was more crowded than most crowded Government Hospitals in Delhi.
Being only a cycle rickshaw ride away from Pahad Ganj, one of the densest
populated areas of New Delhi, LHMC’s patient populace burst and spilled at its
huge compounds…literally. For there would be at least a couple of deliveries every
day, either at the hospital gates or just at its entrance doors. “Aagayi…aagaya…aayee,
ayee…” (She has come..the baby is coming..I am on my way) the attending staff
would rush, a delivery tray and baby towel in hand and a wheel chair or gurney
in tow. And for those who arrived in good time, there were of course not one,
but two delivery wards.
An hierarchy was followed while
admitting women to labor rooms after history taking and examination. Any one in
early labor (estimated time 6-7 hours hence) and with mild pains stayed in the
AN room (ante-natal room) and were advised to walk around, squat and have light
refreshments. When the pains increased and when we assessed they were due to
deliver in the next 1-2 hours, the women got promoted to the main labor room
with delivery cots.
The main labor room was a huge hall
with a dozen labor cots…a la delivery dormitory!! The dormitory set up favored
under-staffed working conditions though it did shamelessly compromise on
patient privacy. Attending doctor to delivering women ratio was often one to four
or more; and dormitory cots allowed us easy visuals of all patients in the room
even as we sweated out at the foot end of the current patient. Besides,
government hospitals could ill afford the luxuries of birthing suits or even
cubicles. The women too considered themselves privileged for having graduated
from ill lit homes or kitchens or open fields to the steel cots of LHMC labor
rooms!
On most days the labor rooms
recorded 100% occupancy and the other days it was 150-200%! I would never have
believed until I saw and got used to the scene of two patients, strangers to
each other, and awaiting delivery, sharing a cot in the ante-natal room! The
two alternated resting on the cot and ambulating and chose to lie down
anti-parallel when both of them wanted to rest at the same time! So that during
ward rounds, at cot three, I had to examine 3(1) patient and then switch over
to the other side and see 3(2)! Add to this their complaining about how the
other was un-co-operative or a request to give them a cot beneath the fan or by
the window (so that they could talk to their relatives outside or sneak in chai)…the
doctor doubled as mediator, manager and monitor. Classical scenarios of one
person, several posts…the scariest was when they thought I was in charge of the
labor room and wanted to discuss their patient with me. I could not discuss,
not because I wasn’t aware of the case, but because I was language-challenged.
My knowledge of Hindi was limited to film dialogues, TV jingles and few simple
lines of Hindi music lyrics…I hadn’t even learnt to swear and curse in Hindi,
how could I explain all that passage, passenger and power things involved in
normal delivery? Or detail the khoon, katna, dhaaga, ouzaar (blood, cutting,
sutures, instruments) details involved in a cesarean section or forceps?
And so I avoided briefing sessions,
relegating it my other colleagues, who were only too happy to be out, chatting
up and admonishing at the outside desks than catching babies in serial inside
the cacophonic labor room! For me the repetitive, limited vocabulary of ‘lagao,
lagao’ (push, push) coaxing of the woman with impending delivery, offered a
comfortable range of Hindi conversability. It also provided me with Hindi-observerless-opportunity
to try out new phrases that I learnt daily-“Keelo, keelte jao,” (go on, bear
down) or feigned exasperation-“Rani, mein toh chod ke jaane wali hoon! Kar
tumhare marzi” (Lady, I am leaving you to yourself now. Do as you wish!) or,
“aagaya, aagaya” (here comes, here comes) with a perfect Eureka flourish to the
voice!! (I have still not fathomed why some of my seniors addressed patients as
‘rani’. It sounds so incongruous under such circumstances)
For a post-graduate in Obstetrics
and Gynaecology (Obs-Gyne), the labor room postings made up over 50-60% of the
total training. Of course, the postings came in broken periods of two months
interspersed with posting to other wards like the family planning, oncology or general
gynaecology. Even Obs-Gyne professors weren’t sadistic and daring enough to
sentence a post graduate to over two months of continuous labor room duty! They
knew they might face allegations of perpetrating suicide or even be the indirect
cause of student-death due to stress and exhaustion! However, the hours of
labor room work ensured that, at any given hour of the day, you could be sure
to find us in only one of the two places-sweating it out in labor room or
sleeping log-dead in the hostel room. Many a morning have I returned from night
duty and just passed out-room door wide open and radio blaring. Only to be
woken by a friend who would gently suggest it was time for the next night duty!
Apart from the labor cots, the
neonatal reception/resuscitation area and wash area, the sanctum sanctorum was
sparsely furnished. There were two backless steel stools, not meant for resting
overworked butts, but for parking ourselves for the few minutes when we needed
to apply forceps for delivering a patient. The only table was ancient and
crowded with log sheets leaving no room for an occasional resting of head even!
That left the labor room doctor forced to perpetually stand or walk if not
peering, PV-ing (Per Vaginal exam) or writing examination and delivery notes.
Slumped shoulders and bent backs, almost all of us lost weight during labor
room postings. Eating took a beating too! Between resting and eating the latter
took the second priority, simply because we were too tired to even eat, let
alone cook! Mess and canteen worked human hours and no one kept food for labor
room skeletons. Living off noodles (The cup ones where you just poured hot
water and ate the concoction) and bread and fruits helped me knock off flab so
rapidly in two months-something I would have taken over six months normally!
It was only natural that what little
social life I could squeeze in as a weekend visit to my uncle’s house or an
occasional movie would also be out of bounds during the labor room postings.
However, I had to look for alternatives if I had to stop thinking, talking,
reading and dreaming about deliveries! That was when I began to read romance!
All my high school and undergraduate years I had sneered upon the Mills and
Boon series as silly but suddenly I found myself scouting my friends’ book shelves
for those very insanely unnatural books! I needed to resort to some fantasy
amidst all the high tension reality of labor room. The other release was the
radio cum cassette player. I even carried a small red transistor to play in the
labor room. It served well as music therapy for the women in pain and the poor
things were always grateful for it!
The working conditions worsened
during summer months. The sanctum sanctorum became a smoke-less cauldron and
the surface body temperature of the patients and doctors inside rose a good two
degrees higher than the ambient outside temperature! Exiting out of labor room
into even the 40 degree corridor outside felt like a cool relief!!
So it was then, that one hot and
sultry June night, being handicapped by the absence of my colleague, I could
barely keep standing or even sitting at three in the morning. The senior
resident who came in for rounds felt immense pity. (Very uncharacteristic of
her)
“I think you need to rest for some
time. Besides, the two remaining patients are due to deliver after a couple of
hours. Why don’t you get shut eye for an hour or so? I could hold fort. Or ask
some junior to hang around.”I did not wait, lest she may change her unfeeling
mind!
“Ok.” I said shedding off my coat
and keeping my stethoscope away.
“Hey, but don’t go off to your
hostel room. I might want you back if there is an emergency. Casuality is
usually quiet at this hour. Rest there. I will know where to get you if I need!
(no cell phones those days)
“Ok.” Even a discounted reprieve was
a blessing! I hurried off not bothering to even find out who would be the
junior replacement. The casuality was not entirely quite. The doctor on duty was
attending to some outpatients and he acknowledged me as I went into one of the
ante rooms. It was door-less and windowless and had a ceiling fan which worked
sometimes. The single low cot that sagged at the centre with an apolegetic
mattress with jute fibers sticking out beckoned me. Of course there was no
pillow. I always tried not to register how dirty the bed spread was or wonder
how many bed bugs might be lying in wait. However, I had to nap-wherever and
whatever- if I were to get back to another 3-4 hours of duty till eight in the
morning! At that time, someone had pushed a gurney carrying a patient next to
the cot. The staff often did that, though they were not supposed to leave any
patient unattended. The paper work for admission must have been underway and I
expected the ward boys to come in any minute and wheel away the trolley. A pale
looking woman lay on it and I was so sleepy I did not bother to ask her which
ward she was being shifted to. (Besides, if she replied in Punjabi or Haryanvi,
I would lose sleep trying to figure out what she meant!) Thankfully, she did
not talk to me either. I did not have the heart to wheel her out and leave her
in the corridor. They’ll come and wheel her out….I simply sunk into the cot
centre and must have slept almost immediately.
It took me a whole groggy minute to
return to wakefulness and register where I had gone to sleep. Loud cross-talks,
shuffling feet, shifting….I could tell that an emergency had just come in.
Looking at the watch, I realized I had slept for nearly an hour and was happy I
got the whole of 55 minutes of undisturbed sleep. As I got up, I knocked my
feet against the trolley.
Arrey! This is the same trolley..and
the patient looked the same too! I was aghast! How can they leave an emergency
patient so alone and unattended? What if something happened? It was by a
professional instinct that I immediately put my fingers on the wrist of the
women. It was dead cold! The poor lady had died! Oh God! I had death on my
hands-quite literally! What a commotion this would kick up in the hospital! A
patient allowed to die as the doctor actually slept by her side! I cursed
myself for not talking to her or checking out with the doctor outside what this
case was! The senior resident…Unit chief…Head of
Department…Principal…Dean…Patient’s people…public ire…What did I get myself
into? And home? What do I tell them?
Damn this bloody fatigue and
drowsiness. If only I had hung on till eight…I could have slept all of the
morning, noon and evening! Reflexly I began preparing my defense…” Sorry, ma’am
to have slept in the middle of my duty…” That sounded lame and callous rather
than diligent… “I did not volunteer, sir. The Senior resident suggested I
needed rest…” She loved her skin and would probably deny…I toyed with the idea
of fleeing to my uncle’s house and then flying back to Bangalore….but
remembered I had four more hours to labor. And two more waiting cases at the
last count! God! Yes! He is my refuge! All my prayers began playing in my mind
while I simply stood rooted, not daring to leave the place of ‘crime’.
“Hatiye madam ji,” (Make way madam) Two
orderlies came in and wheeled out the gurney. I glimpsed a few teary faces
beyond them. Was there belligerence and anger also? How do I break the news to
them first? As I stepped out of the room, the relatives made no attempt to even
approach me, let alone rain me with blows! They simply followed the trolley and
beyond the main door I could see a hearse van waiting to be loaded.
It was then that the fact struck me.
The woman had probably been brought dead or had died in the hospital even
before treatment or admission. That explained why she was there unattended,
while the doctors and relatives completed the certificate formalities! Only the
dead were not fussed over in casualities! I was awash with relief! It was the
only time in my professional life that I have felt relief at the death of a
human being! Thanking my stars I made back to labor room.
As the elation settled, it dawned on
me that, for a full hour that morning, I had shared room with a corpse! Saw the
dead, failed to recognize the dead and slept next to the dead! What a zombie
the labor room had made of me!! I stepped into the labor room just as a patient
was about to deliver.
Even as I ran across to deliver the
baby, I realized happily, that catching life was more fun than dozing with the
dead! I wasn’t a zombie! It was just that I had so much of life around that I
could afford to forget death!
(P.S:
The logo of LHMC is Per ardua ad astra, meaning 'through struggles to the
stars!')
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