Sunday, 5 August 2018

part 7: To Err is Human

"Armaan…..Rahul….and Riddhima…..the three of you are posted in the Oncology (cancer) ward for the next month." Dr Kartik handed out the intern's rosters, "please proceed to the 4th floor and look for Dr Shubhankar….he is waiting for you."

"Thanks sir," Riddhima spoke for their group. Rahul led the way to the elevator as Armaan chose to follow a limping Riddhima. Rahul was pleased they were going to start their rotations with his favorite subject. He had always been fascinated with cancer research, and this would be his chance to outshine the other two interns. In his zest to be the leader, he marched ahead without waiting for his injured group member. Riddhima did not expect anyone to wait for her, but was pleasantly surprised to see Armaan matching steps with her hobbling ones.





Rahul was anxiously waiting for them with the elevator door ajar.

"Armaan….go ahead….I will take the next elevator." She gave him a faint smile.



"Riddhima jee….yeh internship koi race nahin hai…..main yahan jeet ne nahin aaya," he rolled his tongue mischievously and with a twinkle in his eyes, added, "aur kuch haar bhi gaya tho mujhey afsos nahin hoga." Riddhima was a bit confused but appreciated his gesture.




An impatient Rahul held the door open as Riddhima and Armaan walked into the elevator. Rahul's sharp eyes did not miss the smile on Riddhima and Armaan's face. As Rahul pressed the UP button in the elevator, he thought, "lagta hai aaj kuch zyaada hi Riddhima par impression jamaa raha hai….well….Riddhima will soon find out who the impressive guy is!" Rahul stared at the ceiling as the elevator roared up to the floor of his dreams.



After assigning duties to the rest of the interns, Dr Kartik glanced at the only remaining three interns with him. He smiled at them, "So Kripa….Prithvi….Angad…ready for the OB-Gyn ward?"


"Sir….uss ward mein tho ek din sirf Ms Kripa Sharma hi patient ki tarah daakhil hongi….Prithvi and I don't have to worry about that!" Angad grinned impishly at Kripa. Kripa turned red and snapped, "aur jab wahan daakhil hongi…bhagwan kare tumhare jaisa chor wahan aas paas bhi na ho!"




Angad lifted his eyebrow and whispered softly into her ear, his lips gently brushing against her ear, "don't be so sure madam!"



"What?" she was mortified.



"Well…..I am going to become an Obstetrician Ms Kripa…..so you might have no choice," Angad laughed.



"DOCTORS…DOCTORS…." Dr Kartik shushed them, "hum yahan sab doctors ki haisiyat se OB ward jaa rahe hain…..abhi patient ban ne ki zaroorat nahin hai……because I cannot afford to lose an intern that soon…..you know we don't encourage pregnancies during Internship."




Kripa was not pleased with Dr Kartik's statement, "sir….aap aisa kyun kehte hain?"



"Oh….come on Dr Sharma…..you know how strenuous and demanding our Internship program is….imagine a pregnant woman working through this….waise bhi maa ban ne ke baad…most women should just stay home in my opinion." Dr Kartik gave a smug reply and walked ahead towards the OB ward.




Kripa was incensed by Dr Kartik's chauvinistic remark. To her surprise, she spotted a frown on Angad's face and a vacant expression on her only friend in this group, Prithvi's face. Kripa's eyes met Angad's angry eyes; he obviously disagreed with Dr Kartik's statement too. Prithvi was too scared to agree or disagree with anyone in the group so just lowered his head and followed Dr Kartik.



"Tho sir aap auraton ko admission kyun dete hain?" Angad could not help asking.



Dr Kartik was not used to being questioned; and that too by a freshie! He frowned back at Angad, "our Institute is open to anyone deserving….I'm just being pragmatic….anyways…..let's talk medicine for change….who can tell me the different stages of labor?"



"Sir…I can," Prithvi lifted his hand slightly. Angad suppressed his grin and muttered, "isey koi bataa do yeh school nahin hai." Kripa heard Angad's mocking comment. She glared at him, "leave him alone….will you? He is a good man."



"Man?" Angad raised his eyebrow, "Oh….thanks for clarifying….I thought he is a boy."



"Dr. Sharma and Dr. Khanna!" Dr Kartik rebuked them, "please behave more maturely….we are amidst women in labor…..they expect some dignity from their doctors!"


Prithvi lowered his arm, embarrassed at Angad's comment. He was glad Kripa defended him but somewhere inside he wanted to prove to Kripa that he could be a real man too- a daring man just like Angad and Armaan. Prithvi was unhappy with himself and forgot what he was about to answer to Dr Kartik.



"THE STAGES OF LABOR?" Dr Kartik raised his voice, "I AM HAVING DOUBTS ABOUT THE CALIBER OF THIS CLASS OF INTERNS!'



"Sir…there are three stages of labor," Kripa answered confidently.


Dr Kartik raised his hand to stop Kripa. "I'm sure you know Dr Sharma." He glared at Angad who was busy scrutinizing the medication in a drip being infused into a pregnant lady, rather than paying attention to Dr Kartik.



"Is sawaal ka jawaab the Mr-know-it-all…..Dr Khanna denge!" Dr Kartik gave him a harsh look.



Kripa rolled her tongue; absolutely sure that a troublemaker like Angad would probably not know the answer. She was dying to see his fallen and defeated face. Even though, she disliked Dr Kartik's views on women, he was her ally against Angad and she was willing to tolerate him just for that reason.




Angad, without looking up at Dr Kartik, continued to check the drip, "this is running too fast…..this rate of Oxytocin infusion can be hazardous to both mom and baby."



(Oxytocin or Pitocin is a medicine used to induce labor in women who have not gone into natural labor or to augment their labor but if a higher dose is infused it can cause severe contractions of the mother's womb and be dangerous for both mom and baby.)



"DR KHANNA! JO AAP SE POOCHA JAAYE….WO HI BATAAIYE!" Dr Kartik was offended by Angad's attitude.



Kripa's jaw fell to her knees, when Angad yelled at a ward nurse, 'SISTER! Please check the rate of this infusion."



Dr Kartik stepped forward and checked the drip himself. To his horror, Angad was absolutely right. He turned the rate down and scolded the nurse, who was at the patient's bedside by now, "SISTER! BE CAREFUL NEXT TIME!"


"So…sorry sir…..wo…wo…senior resident ne order diya tha." The nurse defended herself.



"Ok….you may go now….I will deal with the senior resident later." Dr Kartik snapped back. A flustered Dr Kartik adjusted his tie and looked at his interns, "this is an anomaly……we are very careful in this hospital….let's go now….follow me."



"Sir….aapke sawaal ka jawaab? The three stages of labor? The first stage accomplishes the shortening and then the dilation of the cervix. It starts when the cervix is 3 cm dilated, and ends with full dilation. Contractions begin in the first stage of labor although they may be irregular and sporadic at first. The second stage, often called the pushing stage, starts when the cervix is fully dilated and ends with the expulsion of the fetus. In the third stage, the placenta detaches from the uterine wall and is expelled through the birth canal.[1> Preceding the onset of labor is a period called the latent phase." Angad rattled confidently in a single breath.




Kripa just stared at Angad's face in disbelief. Prithvi smiled and nodded at Angad. Angad had risen to the status of an idol for him- he was what Prithvi wanted to be- smart, brave, daring and not afraid of anyone.




Dr Kartik just nodded, "Good…..well….I would have been ashamed if you guys could not answer such a simple question."




Angad smiled and muttered under his breath, "Dr Kartik ….the real simple question is sitting at your home…I hope you have answers for her."



Kripa's ears had become antennas for Angad's murmurs by now. He had definitely impressed her by rescuing the poor woman in labor and answering Dr Kartik's question, but was confused by his last statement, "kiski baat kar rahe ho?" she whispered.



"Mind your own business!" Angad snapped back as usual. Kripa was aghast at his rudeness and turned around in fury.


"Waise sir," Angad raised his voice, "us lady ki drip ka rate agar kum nahin karte na…..she would have ended with a cesarean…..imagine the hospital would have made more money that way…..ho sakta hai senior resident wo hi kar raha ho…..I would love to meet that senior resident….he is my idol now."



Dr Kartik was a few feet away and did not hear Angad's comments but the person they were intended for heard it loud and clear and she detested that statement. He loved irritating her just like she irked him with her constant jabs at him. The little respect Angad had just gained in her eyes had been dashed once again. She shook her head and caught up with Prithvi and Dr Kartik. She mumbled to herself, "hey bhagwan…..yeh aadmi kis type ka hai? Kayi baaton se lagta hai ki shayad ismein kuch acchayee bhi ho…but I doubt it…..he is just money hungry….everything is just a business for him!"


"You are right Kripa!" Angad whispered in her ear from behind.



A startled Kripa jumped up, "about what?"



"I am an enigma!" Angad grinned and walked off to the next patient's bedside where Dr Kartik and Prithvi were anxiously waiting for them.



Kripa was stunned, "how did he know what I was thinking?"



"DR SHARMA!" Dr Kartik called for her, "Kuch problem hai kya? You seem a little lost."



"Sorry sir," Kripa hastened her steps and cursed herself for being distracted by the obnoxious co-intern time and again.



ONCOLOGY (CANCER) WARD:



As soon as Armaan, Rahul and Riddhima stepped into the cancer ward, they were greeted by the soft spoken Dr Shubhankar, "welcome interns…..let us start our day with some young cancer patients….Pediatric cancers."


Rahul was pleased once again. He had just read up about the common childhood cancers last night, so he was well prepared to answer any questions and rattle off statistics about common and uncommon cancers. Riddhima smiled back at Dr Shubhankar. Her father had mentioned to her several times how dedicated Dr Shubhankar was in his field and she looked forward to learning from such a learned doctor. Armaan wanted to run away at that moment. Cancer ward was the most depressing place in the world and that too cancer in kids!




"Ok…doctors…let's start with our first case…..this young 5 year old girl you see on bed # 3 has Neuroblastoma…..can someone tell me how common this cancer is and the various ways it presents in childhood?" Dr Shubhankar asked.



Without giving anyone else a chance, Rahul came forward and started rattling all the facts and figures about the childhood cancer. Riddhima was obviously impressed by the way Rahul recalled all the details. Armaan could care less. He hated statistics and facts and to date had never been able to remember all these gruesome details about diseases. He knew that once he was a practicing doctor, he would never need to remember so many details. Those details were available in textbooks and on the net.




"Rahul ko textbook ban na hai tho bane," Armaan sighed to himself and then glanced at the morose five year old patient, the subject of their bedside discussion. She was bald from all the cancer treatment and sat in her bed with a blank expression. The TV in front of her was playing the cartoon network but she was least interested in that.


The nurse walked up to her, "Minnie beta…yeh dawaa le lo."



Minnie just pursed her lips and fumed angrily.



"Please beta le lo…..yeh bahut zaroori hai," the kind faced nurse urged her little patient.



Dr Shubhankar gestured the interns to step away while Minnie was receiving her treatment as their flow of discussion was being interrupted by the nurse. Rahul and Riddhima complied but Armaan stayed back at her bedside.




Armaan knew why the little girl was adamant. Minnie probably felt like a prisoner in the cancer ward. When she should be out and about playing like other kids, she was trapped in this depressing environment of medicines, needles, nurses and doctors. He smiled and sat down on her bed, "Hi Minnie."



Minnie looked up but frowned harder when she saw a man in a white coat on her bed. Those white coat men and women were worse than the nurses with the caps. Minnie had found out that it was always the white coat people who ordered the painful tests and bitter medicines for her. She hated all of them!



Minnie folded her arms angrily and shut her eyes, as if trying to block out visions of the white coat monster on her bed.



"Sister….dawaa mujhey de deejiye…..I will give it to her," Armaan said gently.




"Ok doctor," the nurse was more than happy to pass the buck. She was very fond of Minnie and hated to see the little girl in pain every day. The nurse stepped back and gave the medicine cup to Armaan. Armaan thanked her and placed the cup on the bedside table. He saw a pad and crayons lying on the table. It was a drawing pad but Minnie had not touched it. He felt sorry for her- she was so depressed that she probably did not want to draw or color either. He remembered when he was a kid, his only outlet against angry teachers and his strict dad was drawing and coloring.




Armaan picked the drawing pad and started sketching with a pencil. Minnie opened one eye when she heard some scratching noises on the paper. She peered with half open eyes and was amused to see what this white coat monster was drawing. Armaan looked up from time to time and smiled at her. Whether it was Armaan's endearing smile or the sketch he was drawing, Minnie felt a little more relaxed. She unfolded her arms and opened her eyes.



"Yeh dekho…kaisa laga?" Armaan turned the pad towards her and placed it on Minnie's lap.



Minnie's eyes widened and there was a faint smile on her face. Armaan had sketched a caricature of a little bald girl standing with a broad smile on her face; her foot on top of a man lying on the floor in a white coat and a stethoscope dangling from his neck. The man, obviously a doctor was pleading to the little girl to leave him alone. Minnie cracked up finally as Armaan's sketch had portrayed her innermost feelings so well. She would love to be the girl crushing the white coat monster with her feet one day.



"Yeh main hoon?" she asked with a glitter in her eyes.



"Haan…aur yeh main hoon," he pointed to the doctor on the floor.



"Nahin….aap nahin ho…..aap achche ho….yeh tho doosre doctor hain…jo pehle yahan aaye the," she giggled.



Armaan giggled back and held out his hand, "phew…thank god….mujhey darr tha kahin tum mujhey aise na maar do."



"Nahin…aapko nahin maroongi," she looked up and pointed at Rahul, "wo….wo naya doctor hai na…..usey aise maar doongi jab theek ho jaaoongi."




Minnie's answer had made Armaan's day. He would love to see Minnie dancing and jumping on a defeated Rahul one day.



"Theek hai…deal!" Armaan gave her a high five, "lekin pehle aapko theek hone ke liye yeh dawaa khaani padhegi…..warna aap strong kaise banoge…..wo doctor tho kitna strong lagta hai…haina?"



Minnie frowned but assented, "aap theek kehte ho….lao…dawaa de hi do." She sighed.




"There…that's a good girl," Armaan gave her the cup of medicine. Minnie shut her eyes and gulped the bitter medicine down at last. The nurse thanked Armaan and charted Minnie's medicine on her record.




"Ok Minnie….I will see you later." Armaan got up to join his group. To his surprise, Rahul, Riddhima and Dr Shbhankar were all at the bedside by now.



"I am sorry sir…wo…wo," Armaan tried to explain.



To his surprise, Dr Shubhankar smiled and said, "aaj tumne wo kar diya jo koi staff member nahin kar saka…I am proud of you Dr Mallik."



"Jee sir?" Armaan was baffled. Rahul was shocked. Dr Shubhankar had not once commended him for his in depth knowledge about Neuroblastoma but was proud of Armaan? He was probably being sarcastic, Rahul thought.



"You made Minnie smile…..yaad rakho interns," Dr Shubhankar glanced at his group, "jo dawaa patient khushi khushi le le….wo hi asar karti hai…..now I am more hopeful about Minnie's recovery…..good job Armaan." He patted Armaan's back and smiled at Minnie, "Dr Armaan…..aaj se aap hi Minnie ke intern honge….is that OK Minnie?"




Rahul was stunned- he was hoping to get Minnie's interesting case- how could Dr Shubhankar do that? He was the one who knew all about the case…the cancer…the treatment….he had even researched the latest cancer therapy regimens on Neuroblastoma and Armaan, the cartoonist was getting the case?????




Minnie grinned, "haan…haan….aur Dr Armaan roz mere liye cartoon bhi banaayenge?"



"Absolutely!" Armaan gave her another high five and glanced at Riddhima. He would have collapsed at that moment if he had not caught hold of the bed- Riddhima was smiling at him….a genuine smile…..a friendly smile……a smile that could light up the room…..a smile he would cherish forever……and would be close to his heart all his life.



….to be contd…

bheegi

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