Reader's Quotient:Transforming the DNA of Society

Authored By Ashutosh Ratnam:

The life cycle begins with a cadaver. On day one, into the care of every greenstick medical student is turned over a corpse flushed with formalin and embalming fluid. It offers every organ in the human body for uncomplaining examination. It holds the answer to every anatomical and physiological question conceivable. Technically, as a compendium of all the knowledge the medical practitioner is supposed to possess, it is perfect. But as a person, it does nothing but look the part, that too badly. It is cold, uncaring, voiceless, lifeless, well and truly dead. So strong is the aldehyde stench of what it is so undeniably full of, that any attempts to get close are rewarded with revulsion and nausea.

True, the novelty of it all is unique. The spectacle does inspire some awe and certainly shakes confidence.

But this thing’s existence as a person is an event in the past tense. You badly want to believe that a medical education is a crusade of internal sublimation and private civilisation; that the beginnings and the ends of doctoral tutorship are incomparably different continents. But considering the traits the savages and the Salvation Army share, can you really? If you have met one of them, you’d be surprised how accurately and how completely the above description of the demised fits most practitioners scuttling speedily through the corridors of most hospitals. Ironic though it may sound, the kind of people peddling our healthcare is enough to make you sick. Normally, sitting on this end of the stethoscope, these are things I would deny or at least have been reluctant to admit. But my allegiances got skewed and my belief system took a beating this November at one of the country’s apex public sector medical establishments. Narrated fables and fairy tales of low-cost succor and salvation, the country’s sickest, poorest and most wretched are drawn to it by an awesome centripetal force – each year the place’s OPD registrations outnumber the combined populations of Zimbabwe, Cuba and New Zealand. I had ventured there having heard the same stories. The catalyst for this trip was the imminent death of a 21 year old girl I knew, both of whose heart valves had been destroyed by a bacterial disease and needed replacing.  Her family’s collective monthly earnings were Rs.2800, and if you planned on just buying the thing off the shelf, this double valve replacement operation would cost Rs.2 Lakhs. We had managed to raise somewhere near half this amount through donations from local political and administrative dignitaries and general petitions for aid. But unfortunately, though not unexpectedly, our letters to the Prime Minister’s Relief Fund was not replied and responded to. Armed with little more than a BPL card and the Indian’s innate ability to stand in queues and inherent tolerance for hunger and humiliation, we would clearly have to sell this girl’s poverty and physical wretchedness for enough of its worth in pity to buy her two prosthetic heart valves and the ensuing open heart surgery. The routine OPD system of pubic treatment here has given way, collapsed and died completely.

The mechanism of registrations and routing patients to designated doctors has been reduced to a frustrating formality. As I was to learn, you’re being embryonically naïve if you just show up at a registration counter at the annotated time and expect to end up on an operating table receiving our nation’s best healthcare regardless of how poor you are. The usual scheme of things involves there being someone you know who knows someone you don’t know working in some department you’re not concerned with who knows someone working in the department you are concerned with. Usually you will not get the phone number of that someone you need to meet. You will certainly not get a chance at acquaintance beforehand. He will remain some mythical creature living in legend and spoken of in rumour - you only hear things of and about him. He is just as likely to be imaginary as he is to be of any possible help. After spending the night at a criminally overpriced lodge nearby, we got to the hospital bathed and breakfasted at 730am on Wednesday. It is one of three days a week when the Cardiothoracic wing surlily rises from slumber and opens its doors to all who gasp and wheeze. I had been told to meet this man that would ‘help’ us inside a room where they did treadmill tests. I knocked and entered, and encountered someone who looked nice enough. This distant, sanitized preconception of mine was to be the highlight of our interactions. A snippet of the subsequent conversation: “Hello sir, my name is ____ and I was told to come and see you here.” “So?” “So, I came here?” “Why have you come here?” I wondered whether he hadn’t been told of my imminent arrival by someone #2 in the information algorithm, or whether he was trying to scare me off. “Well sir, you see there’s this patient of mine who’s incredibly poor and will die if she doesn’t get double valve replacement done and….” “So let her die Na”. Though relieved to have encountered it this early, this was a nadir, rock bottom, as low as things could go. Anyone who hears it or reads it will know as much, and that once you’ve encountered this degree of decay, things simply cannot get any worse. At the time you begin to break. You realize you’re in a city of total strangers, that there’s a girl who’s staying alive is banking on your ability to broker this deal, and that the one person you’re turning to for assistance is encouraging if not your failure then at least your surrender. It doesn’t announce its arrival, but the immunity you have just earned plays itself out now. It cellotapes together all the pieces you have been broken into and forces you to somehow spit out: “I really don’t think so. She sort of trusts me, and letting her die’s just not the done thing.

I mean, we’ve come all the way from Arunachal Pradesh…..” “Why the hell have you come? Did I ask you to come?” Clearly, he wasn’t surrendering either. “Erm, no sir, I’m pretty certain you personally didn’t ask me to come, but I exchanged correspondence with Dr.___, the cardiothoracic surgeon, and he said to bring a BPL card and as much money as we could raise, and come here. I’ve brought printouts of the correspondence if you’d like a look….” “Oh, so, now you’re namedropping are you? You think that’ll impress me? You know what your major problem is? You’re too arrogant.” Aside from not actually giving the man my word that I’d name my first-born after him or showing I was indeed overcome with terror-cum-gratitude by soiling myself in salutation, I really didn’t know what I’d done that he found such an illustration of arrogance. When every other sentence it is exposed to embodies mental torture, the human mind begins to gauge the pros and cons of not kicking the source of such noise in the gonads. Tragically, because I was in the hospital, and this guy was in a position from which he could be of assistance if he wanted, in this case the cons won. I was never more certain that this girl would now not die. To the man’s credit, in between ignoring every question I asked him, looking at the ceiling as he talked at me and pontificated on my newfound identity as an arrogant name-dropper, telling me I risked castration if I actually went and met the Director of the CTC for help(“You better believe he actually makes you watch as he feeds them to his dogs afterwards”), unearthing more pearls of ineptitude from session #2 of my ongoing slur-laden psychoanalysis, and graciously letting me watch him drink his coffee, he did help me get an echocardiogram and told me which line to stand in to get an ecg done. It would have been nice if I’d been told that a squiggly by the consultant cardiologist was required on one of 6 documents they hand you on registration (and not on the other) to get clearance for surgery – it would have saved me a runaround for the next 2 days for that same scribble. But as the Samaritan had amply clarified, expecting communication only further reinforced how ignorant and arrogant a twat I was. The tutelage was invaluable. Now as luck would have it, just as I got clearance for surgery courtesy the above mentioned squiggly, a grant of Rs.50,000 from the State Chief Minister’s Fund fell through. A notable charity engaging in such causes footed the balance amount. It was all very swift, very statesmanlike, and very sweet – the girl was admitted 3 days later, and operated 6 days hence.

And as for triumph, it refused to turn pasty. Afterwards, I many a time thought of going back to the hospital and rubbing the subsequent series of fortunate events in the ceiling-facing face of the man who ‘helped’ me. But perhaps in doing that, what had happened would have ceased to be a triumph over people like him, and instead have become a victory of his kind of creed. When you go back to beat them afterwards, haven’t you already joined them? If what happened was the sort of hospitality a supposed clan kinsman like me was privileged to, I presume the average nobody who approaches a veritable army of people of this ilk stands no chance of going about his or her healthcare quest with any semblance of dignity. Not only are the statistical and the economical strains on our healthcare system crippling it, our healthcare system is also rotting from within. It is gravely sick at the individual drug-dispensing, patient-engaging practitioner level. Medicine has become just another job. Admission into its ranks and acumen within them has never had less to do with a personal caliber to care. One is gauged instead by the severeness of his case of factual bulimia – how well he is able to retain data and then how acutely and forcefully able to vomit what was being retained onto a question paper. There is an aspect of assessment that is being disastrously overlooked, and the dimension in which it is killing a supposed art is staring the ceiling in the face. The life cycle is ending in cadavers. (Some six months later, the Medical Council of India was dissolved as its President Dr Ketan Desai was caught taking a Rs.2 Crore bribe)