The Evil

It takes only few telephone rings to wake me up. After all these years, I still cannot sleep comfortably when I am on call. It was 2.30 in the morning and I guessed it must be something serious. The call was from the on call physician from the ER. A Bengali man had been just brought in with severe shortness of breath. There was no more history. Those who had brought him had left him in the ER and disappeared. He was found to have severe hypertension and was not improving on the usual lines of treatment.

I discussed with the doctor  and decided to shift him to the ICU and also requested to alert the anesthetist, in case we needed to place him on ventilator. By the time I reached the hospital, he was in ICU. He had severe breathing difficulty and was unable to answer any questions. His blood pressure was too high to be recorded, and it stayed so, in spite of receiving medicines through I V line. That was unusual. I guessed it must be no ordinary hypertension, and must have some serious underlying reason. We gave him a large dose of a diuretic    (a medicine to force the kidneys to produce urine) and another medication to reduce blood pressure. The lab results came in by this time. He was in end stage kidney failure. And that was why his lungs got flooded, making him struggle for breath.

It was impossible to get any history from him. Medical practice, without proper history, is almost like veterinary practice. In fact, half the diagnosis is made from what the patients tell us about their illness. When a patient is critically ill, the doctor is under the worst stress, the patient probably would have lost his consciousness. It took us a lot of stress and effort to get the many test results to come to a conclusion. He had severe hypertension and renal failure due to end stage kidney disease. He needed emergency dialysis. By this time the medications had started taking some effect. His BP was coming down and breathing getting easier. We alerted the nephrologist for emergency dialysis. The patient would die without it.

It was when I started to chart his file that I found he was removing his oxygen mask and calling us by gestures.  Morphia had taken its effect and he was drowsy. He couldn’t talk still, but was desperately trying to say something. Through the gasps for breathe I could gather some words

“ Kapda !, mera kapda !” (Clothes! My clothes!)

I couldn’t make out first. But he was frantically looking all around for something and again removed his oxygen mask and repeated

“Mera  kapda”

I understood it then. In the ICU, the nurses had removed his own clothes and put on him the hospital gowns .I told him there was no need to worry and his clothes would be given to him when he leaves the ICU. He was not satisfied and again kept on repeating the same slogan.

I was close to getting irritated. We were desperately trying to keep him alive, and here he was, worrying about his clothes!

 I asked him  “Bhai, why are you afraid ? No one will take your clothes. They are kept in the cupboard”.

This time he added” Hamara Paisa”, (My money!)  and I understood. His purse was in the shirt pocket and his money was in it. The nurse told him” Brother your purse is with us, and we have counted and kept 120 dirham also’

He appeared bit relaxed after that. He kept his oxygen mask back in place.

Making lives easier

I was held up at work and missed all of you. It is said, never ruin an apology with an excuse. So no regrets or apologies. But I will sure catch up with you.

When an individual becomes sick, a doctor is who they go to in order to seek treatment or get advice. But nurses play an equally important role in a patient’s care and recovery. When trying to separate the two jobs, a doctor is the one who does the examining and diagnosing, while the nurse has a “more hands-on role with physically treating a patient”. Do the two jobs intertwine? Absolutely, and that is why many nurses feel that on certain occasions they may have more insight into a patient’s case.

I had always seen  the hospital work as a simple routine and failed to recognise or acknowledge the kind of service offered by the nursing staff and the sacrifices they make.Everything was taken for granted.I havent paused for a minute to look at them with thankfullness and gratitude.I am glad that this event prompted me to do that.

Ahmed (Not his real name) has been with us in the medical ward for more than 18 months. He has turned 16 years now.From childhood, he has been suffering from a crippling illness called muscular dystrophy. At school, he started falling down repeatedly during games, and then had difficulty to get up from squatting position .He had been taken to many hospitals in and outside here, and was finally labeled with this diagnosis.There is a diagnosis, but no treatment. And there is nothing which stops its progression to crippling and death. This is the paradox in neurology. There is lot of scope for hair splitting academic discussions, but when it comes to treatment, often there is nothing much to offer. Our nerve cells do not have the capacity to regenerate, or if at all they do, they do it at a snail’s pace. And also we do not have an idea as to how and why many of these diseases develop.

He had been confined to a bed for few years now, and then the worst part of his illness took over. When the muscles to breathe got involved, he became unable to breathe by himself. After many attempts of non invasive ventilator support, finally he had to undergo a tracheotomy and then connected to a ventilator.

He is unable to move. His muscles are wasted. The only parts which move are his fingers and the face muscles. He is fond of soccer matches, and so we have managed to get a television for him and given him a remote control by which he can choose his favorite games .He has no voice, but can move his lips. His face muscles are intact so he can express. He has to be fed, cleaned and given all the daily care by the nursing staff. His world has shrunken to the hospital bed. The ward is his home and he is a part of the family there.

We start our morning rounds in the medical ward by visiting him. I stay for some time and try to entertain him with some silly questions and jokes. He always welcomes me with a smile. Through the middle of his tears, he has learned to smile. He likes to have someone around him, but hardly gets any visitor,except his parents.

I walked in to his room last Sunday as usual, but was in for a surprise. The room looked bright and colorful.  A big banner stretched from one end to the other. Written “Happy Birthday, Ahmed ”. Balloons floated everywhere. Ahmed was dressed in a color shirt which one of the nurses had brought for him. Beside him, on a table was a beautifully decorated cake. Soon after I entered the room, all the nurses and cleaning staff walked in and started singing “happy birthday’. Ahmed was all smile and cheer. While we made him cut the cake, a big bouquet of flowers was brought in, sent in by the Matron (She is very fond of him too).The celebration was short and sweet, and I know it has filled his day with memories he would cherish for the rest of his life.

I felt so happy that those nurses had the goodness in them to remember his birthday and make a day for him. These are acts of kindness that make them truly human and earn them the names  ’ nurses’ ‘sisters’ ‘angels’ and nightingales ’. Their routine is not an easy one and their work so demanding.

Wounds need to be dressed, patients need to be fed, reports for the hospital must be filled out, and medical records must be documented for continuity of care, and prevent the ever present fear of litigation. The doctor is here and wants to see the patient with her and asks how they're doing. He writes some orders that they must document, then carry out and then finally document them again.

Patients need to be walked, tracheotomies need to be cared for, the patient in 19B is complaining of  pain, IVs need to be started and some restarted, and the next shift nurse has called in sick ,so someone has to work 12 hours today. There is going to be a transfer of a patient to Abu Dhabi and another nurse who is off duty has to be called in. The patient in 22 B has passed stools and soiled his bed and had to be cleaned immediately because his son has come to visit him and can’t stand the odor.

It goes on and on with endless telephone calls and constant moving around. It is said that a nurse walks around an average of 8 KMs during her 8 hour shift .At the end, everyone complains, and very few say at least a word of thanks. 

Seldom are they remembered after people walk out of hospitals. No one thinks for a minute that they would seldom do the task of carrying the feces and urine of even the closest of their relatives. How many would dare to clean their own relative who has soiled his bed and is bathed in urine, leave alone putting their fingers in to the rectum to remove the impacted feces.

 Many patients do not feel the need to tell nurses thanks, but telling them that you appreciate them would add a little more meaning to their lives. After hearing curses all day, it is so nice to have somebody come back and show their appreciation. Never mind the last eight hours have been spent without food or water as you run like a chicken with your head cut off,  trying to keep people alive and out of pain. This profession is for stronger minded people, with high coping skills, and definitely a sense that we do not live in a perfect world, and therefore you cannot expect perfection, you can only do your best to try to give good care. It occurs to me that there will eventually be no one who will become nurses except those who have no choice like life term prisoners. The stress is unbelievable, the rewards few, the perks even less. 

It is an unusual profession, it is a calling.

Doctor ! You are sick !!

I was taken ill last week. It started as a simple cough and cold, and soon, I lost my voice. When I tried to speak, only a hiss would come out. The difficult part was that I was not looking badly ill. I used to fresh up every day and would go to hospital. For few days, I managed by giving written down instructions to the staff and avoided the outpatient clinics .In between, paroxysms of cough would come and who ever happens to see me would ask

“Doctor ! You are sick !!”

When I failed to attend the clinic for few days some patients started complaining .Worse, when they happen to meet me at the wards, they would think I was faking illness and avoiding the clinics. The best thing would have been to call in sick and take leave, but then, that would bring further resentment among colleagues, who have to put up with the extra work. Personal days and sick days are frowned upon in the physician world, yet daily I am writing work and school notes for patients. I sit in the clinic giving sick leave for those who come to me with pharyngitis , and asking them to give ‘voice rest’, all the while, talking to them  in my husky voice. Physicians are expected to be superhuman. In the last fifteen years, I have never called in sick, not that I had not been sick. There were many times I continued working at the hospital with the troubling pains of kidney stones, which is a constant companion these days.

It was interesting to see how people look at us when we fall sick.

It may be hard to believe, but we get health problems too, like anyone else out there.

I see this odd view surprisingly often. People somehow expect us to be beyond the health concerns of ordinary people. We may be doctors, but we’re also humans. Prone to the same illnesses, bad luck, and erroneous judgments the rest of mortals are. Being a doctor doesn’t protect you from the things that affect others. The chances are that we might catch infections more often than others, because of the frequent exposure to illnesses.

I also learned something. For a person who is sick, his own sickness is the worst. If the nose is blocked, the nose becomes the most important organ. If a leg is injured, that is the worst situation possible. We forget those with heart attacks or cancers.

On the flip side, sometimes we’re surprised when something serious happens to us. At times, there seems to be an unspoken belief that by devoting ourselves to caring for others, it should magically protect us from those same diseases we fight. I wish if it were so.

If anything, the high stress nature of our work makes us more likely to have bad things happen. We often ignore our own issues because of the time needed to care for others. Most of us live sleep deprived, stressed up lives, and survive on food that we’d never advise others to take. When I come back from the hospital, it has become almost a routine for me to pick up a sandwich from Burger King or Mc Donald. That is exactly what I ask them not to do.

I get angry at patients for not exercising, or a poor diet, or forgetting to pick up their prescriptions. I call them ‘non compliant’!  But I do the same stuff as much as, if not more often, than they do. After a long day at the clinic and tiring hospital rounds, and dealing with un ending problems at home, when do I have time to do my exercise, pick up my aspirin and get something decent for dinner?. And hope that over the weekend I’ll find time to exercise. Or get up earlier in the morning and go for jogging. It never happens.

An apology

A doctor’s world is very small. Before I became a doctor, I could go around anywhere, meet relatives and stay with them, travel or just do whatever I wanted. I had time and people.


It is almost 25 years since I started practice. Ever since, life has been different. My world was shrinking. It became smaller and smaller. My life was full of patients and colleagues and nothing else. With no time left , there is almost no social interaction. There are only those who come to us for pain and suffering. No one ever has walked in to my clinic to say a simple hello. Never, even those who got better.

It is not surprising, that the world, for me has become so small. Naturally, life become full of stories related to patients or colleagues. I had tried to avoid many personal details in my blogging, except on one occasion. That was when I mentioned a colleague of mine. But, with all sincerity, I can still say, like I had written, that he is probably one I still respect as a good physician among colleagues. I had clearly written that he had set examples for me in life and career .I had mentally accepted him as a teacher and secretly admired him. The only mistake was that I mentioned the use of some words by him. With so much of good things said, I thought this was nothing important and I had also clearly mentioned that he didn’t mean anything bad about those words .Still, I shouldn’t have mentioned it.

I learned another lesson from him now and I will not forget it too. From deep within my heart, I am begging him to forgive me, if I have hurt him in any way by my words.

In my entire career, I never tried to butter up people to get things done. Naturally I might not be called very friendly with senior colleagues. Along with such friendships come many obligations.

The most important thing for a physician is his professional reputation. And the best judge to know his capabilities are his colleagues. Every doctor thinks so high of himself. It is very unusual to hear good things about a doctor from another one.

“He is such a kind hearted doctor. He is so good to patients and talks so well, but he doesn’t know medicine. I hear all his patients die”

“Oh…him! He is a very tough guy. He is said to be rude and arrogant. But people are crowding because he is very good professionally. They say he is the best around”

It is hard to get a perfect combination. Given an option, I would like to hear the second.

In life, there is no perfect situation. No perfect person too.

A love story

It was the warmest campus story those days. He was handsome and always wore a beard, perfectly trimmed and we used to call him ‘the zodiac man”. There was an advertisement of the zodiac apparels, featuring a handsome bearded man, and he looked similar. No wonder so many girls were after him. He belonged to a lower caste, which was the only difference. Annie was the best student in her batch and they had met during their clinical rotations. Soon, it became the sensational romance of the campus. They were often seen together, at the coffee house, at the garden in front of the college, which would be deserted by evenings, and always at the hospital wards. At evenings only the lovers used to go to the darkened corners of the garden. "Lover's corner", we used to say. And the campus was so full of lovers those days.


Her parents were senior professors in Medical College. Because they were working in another college, it took some time for them to gather the news. By the time they knew, the lovers were inseparable. Her father was so unpopular among students because of his tough and arrogant attitude to students. He was equally tough with his children. He tried all his tactics with the girl and everything failed. And one fine morning, the campus was thrilled to hear the news that the lovers got the marriage registered in a court.

Her father simply sent her out of his home. He refused to accept Kumar as his son in law and had no hesitation to say that on his face. He publicly declared that she was no longer his daughter. Annie was my good friend and would confide in me with all her problems. She would tell me, Kumar could not take all problems as he was very sensitive.

Both of them were good at studies and completed their course and got direct admission to the PG classes. The professor tried to harass them at every opportunity, especially during exams, by using his influence among the faculty.

They survived all the ordeals and remained inseparable. Everyone knew Kumar was obsessed with her and would never leave her for a minute. It was as if he had nothing else in his life. She was everything for him. Both joined the teaching faculty after studies. Somewhere along the time, they had a son and then, I lost touch of them. We were working in different parts of the world.

It was after ten years that I got a call from Annie. She got the number from my wife and called me when I was in Dubai.

I guessed something must be wrong, from the time I got her call. Her voice was dull and she was no more the talkative and cheerful Annie. She said she wanted to come to Dubai, and wanted me to find a job for her. I asked about Kumar and she was not very enthusiastic. By the time I got her papers, she already had received an offer of employment from the ministry. It looked as if she was frantically trying to come out.

She would come to visit me when she was not on call and slowly I got her story in bits and pieces. She said she could no longer live with Kumar, even when it came to losing custody of her child. Reasons were simple. He was suffocating her with his love. She couldn’t go out anywhere, or spend time with some friends and was answerable to each and everything. There was no breathing space. It was embarrassing to see him waiting outside if she would be attending some conferences or meetings. He would even take time from work and come out, as if she were a child. She just wanted to breathe free. In her words “to live normal”

I just couldn’t make heads or tails out of it. Too much love and attention! That was the first time I was hearing such a story. I didn’t ask her anything more and just listened to what all she said. I expected some more stories, but nothing came out. I honestly do not know if there was something more to it.

Once when we were sitting at the edge of a pool at Safa Park, she filled the palm of her hand with some water and held it before me. “You see this water carefully contained on my hand? It symbolizes Love. As long as you keep your hand gently open and allow it to remain there, it will always be there. If you attempt to close your fingers round it and try to posses it, it will spill through the first cracks it finds”

That was a  statement I would never forget. This is the greatest mistake that people do when they meet love. They try to posses, own, demand, and expect… and just like the water spilling out of your hand, love will retrieve from you. For love is meant to be free, you cannot change its nature. If there are people you love, allow them to be free beings. Even the greatest of love would become boring, if there is nothing else in the background.

Love is a bumpy road.

I have seen relationships collapse due to a possessiveness overdrive and power struggle. Well, we can never reason out our actions in relationships, but awareness always helps in defining our perspective. Love, like joy and cheer is meant to be shared and isn’t limited, like a piece of cake or candy. Still, we feel as if we own the person and haggle for our share, how strange!



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