First Tears

There was a moment when all the sounds became background noise and I could hear them just as noise as if it's some kind of background music which started fading and my view had zoomed on to her. I was hearing her, trying to understand her but barely understanding, also knowing at the back of my mind that other people present there were going on with their work completely oblivious to that not so little exchange between her and me. I could not understand her words but I could feel them, later reminding me that somebody had rightly said language will not be a barrier.

Curious to know about her family and support from them, seeing her grave diagnosis, I asked her who is looking after her and what I learnt next absolutely crushed my heart. She had no next of kin and was with her sister's daughter for now. What I had asked out of selfish reason turned out to be hope for her. It gave her warmth and she felt safe, seen and heard. I'm saying this because I saw how her face turned soft, her eyes became wet and her hands trembled to come sit on her stick. And how she talked her heart out. 

I'm privileged to have time, space to ask questions, listen and be empathetic. We as a primary healthcare center are not of much help compared to tertiary care center but I can listen to her, right? 

It broke me, completely broke me, hearing about her pain. She had no family to look after her, take her to her cancer treatments. She was in pain. So frail. So weak. So thin. She looked like she was in her 80s but she is only 66. She had lost her hearing during chemotherapy. She had to sell her gold ornaments during treatment. She stayed with her extended family during treatment. 

While sifting through her documents I had found a consented form for body donation. I wondered if she was aware of the meaning of that act of body donation or had she been conned. On asking her I was surprised yet glad that she was aware about her decision. I wonder what was her reasoning behind her decision. Maybe it was because she had no immediate family. 

I could see the loose skin on her body. It spoke to me and said that she had lost quite some weight in past few months only. I wonder if anyone ever say with her, asked her how she was doing, told her about her disease, told her what to expect and how it might go and asked her if she even wanted the treatment to extend her life or not. I imagine and am curious about her motivation and will to live. What is driving it? Does she want to live for herself at the cost of losing herself, her autonomy and a life and death of dignity?

I'm again focused out and the noise fills my ears as if someone had pressed the unmute button. How many times we are just zoomed in our problems and issues and life just goes by! And in moments like this I get epiphany that life doesn't just revolve around you but keeps going on, whether you are caught up in something grave or specific.

The thought of possibility of her being lost in Udaipur but feel seen and heard here lingers in my head because of her words saying that nobody had talked so much to her ever. While for me too when seeing so many patients she stood out and brought tears to my eyes.

I just have one wish for her that she dies a dignified death.

An extended Doctor Day at Bagdunda

It was a pleasant day with slight chill and bright sunshine at Bagdunda. Bagdunda is around 10 kms from the Gogunda city centre which is around 40 kms from Udaipur city, where there is no network. On Friday, when the weekly OPD happens with doctors present in the clinic, Sheetal along with her mother and neighbour dai came to the clinic. She looked sick.

She complained of pain in her abdomen and fever which was associated with chills for last couple of days. She had a baby bump suggesting end of the last trimester. Her vitals were taken and PV examination was done by a fellow doctor. Since it was her first visit to our clinic her ANC profiling was done. Although she had visited her nearby Anganwadi she didn't carry any documents with her. For the fever we checked for Malaria and it was positive for both P. vivax and P. falciparum. Her PV showed she was one finger loose and had weak contractions. We made her rest on the bed, gave tablet PCM for fever and then started on her first ACT dose intravenously. She was severely anemic with her Hb amounting to around 6.2 g/dL. Also her blood group is AB negative. Her husband works in Bengaluru and was there only. We started to plan for her referral.

But our dear Sheetal straight up refused for it. Her mother and dai agreed but Sheetal didn't budge. She was afraid that she would be operated upon. We tried to tell her the gravity of the situation but her fears were stronger. Earlier she had lost her 12 day old baby and had no other kid.

But now that unfolded left me awestruck and completely mesmerized. Our two nurses from the clinic offered to accompany her to the tertiary hospital along with her family members and be alongside her till the whole process of admission is done. The nurses told her that she needed the care in a tertiary hospital under the constant supervision of doctors and other staff. She was also told that she will not be operated without her explicit permission. Sheetal was in a dilemma now, her home is far away, around 10 kms from main road where there is no network and no car goes, outside the area covered by the clinic.

On further talking to her and knowing that nurses who gave her the first treatment would accompany her she agreed to go. It felt like a huge personal win although it didn't belong to me. Now, the two nurses left to prepare food for everyone including her and two nurses and Dr. Philrose and I stayed back at the clinic to monitor her contractions and dilations. And while waiting her urine protein came positive further complicating the peri partum period. In the meantime her male family members came to go along with her. By 8 PM we all had dinner and boarded the Amrit Ambulance to leave for Udaipur. Sheetal was accompanied by her 6 family members, 2 nurses from the clinic and 2 doctors.

During the whole ride all I could wonder was how selflessly our nurses offered to accompany her. They made adjustments in their schedules for this unforeseen event. One nurse accompanied other so that they don't feel scared and have company at odd hours. No one asked any nurse to come along let alone two. This tiny act of offering their help by just being present is very humble. The whole evening left me stunned and their actions were beyond appreciation. Luckily, it was that day on the clinic where doctors visited to see patients and hence we were present but in case we were not there, I'm positive the events would have unfolded similarly, making me realise how central are our nurses to providing care. Clinical care is a small part role played in holistic care provided to the person visiting the clinic. It then made me question the importance of presence or absence of doctors at first point of care.

The night did not end here. There was some issue in the documents needed at the hospital. The nurse was quick on her feet and contacted the lady's father for the necessary document. Despite hastening the whole process it still took a couple of hours more. And it was 1 AM in the remote lands of Bagdunda where the stars were showing at their brightest in the sky when our stars reached their home for the night. We got to know she gave birth to a 2.6 kg baby boy with cleft lip and palate who is otherwise healthy. Arrangements are being made for his surgery to be possible at earliest. Sheetal is otherwise healthy and happy. Inspired by this course of events, her sister in law gave birth to her child in our clinic only and the dai who had accompanied Sheetal on her visit to the clinic, seeing the cleanliness, polite and friendly staff, services available and homeliness brings along with her any lady about to deliver with any sort of issue or not.

(Name changed for confidentiality purposes)