LANGUAGE – FOR LOVE OR HATRED?

TEXTBOOK

It was a busy night in the orthopedics emergency ward of the government hospital where I was doing my internship. Emergency ward duties were exhausting, and required constant energy and commitment despite our body`s plea to rest. Responsibilities of our duty went on like clock work, though most of the time our brains were numb, but our hand, feet and mouth continued to work, disconnected from our emotions and thoughts. As an intern, my tasks included inserting IV cannulas and drawing blood for investigations, giving injectable drugs, catheterizing and checking vital signs, to name a few. On that particular day, some patients from a neighboring district who had survived a bus accident and needed super-specialty care, were shifted to our hospital. Around 2 AM, the case files of the new patients had arrived.  I found the big list of patients allotted to me and shouted out aloud to the huge, crowded and animated ward to find the first patient.

“Nandini!!”

A distraught forty-something looking woman responded to my call and took me to the patient, who was her daughter. I went to her, a 19-year-old girl, and mechanically inserted the IV cannula, drew blood, labelled and sent the blood samples for the lab and immediately went on to the next patient. I did notice that her whole body including face was covered in white bandages streaked with blood. I cannot deny that I felt pity for her, but it was momentary, as I was focused on the multitude of tasks that lay ahead. Now a reader from the non-medical background may feel that it was inhuman on my part to describe something so gory with so much ease, but familiarity dampens and conditions our small overcrowded brains. Sometimes, duty becomes more important than pausing to talk and soothe a patient, because our human instinct can wait but not our duty. Moreover, as doctors, if our emotion gets the better of us, our efficiency and decision-making capacity may decline. I cannot deny that there were some occasions when I shed tears in duty rooms, toilets or on a friend`s shoulder, and came out with a tissue-paper covering half my face and blaming the “common cold”.

Nandini was shifted to a private room the next day. From then on, every day I visited her in the morning with my orthopedic resident to check on her and change her dressings. She underwent multiple painful procedures like reduction of her numerous fractures, grafts, vascular and plastic surgeries and so on. I could only imagine the agony she went through. She refused to look at herself in the mirror and was always sullen and depressed. Often, we could hear her tantrums at a distance. After a few days, I realized that whenever I went to her room, she seemed happier. She would watch me intently through her tears as I changed her dressings or assisted the resident. I started smiling at her and she reciprocated. Soon she started getting ready in the mornings, and asked her mother to apply face-powder, kajal and bindi on her face. She seemed excited to meet me every day, though all I had to offer her was excruciating pain, albeit veneered with a smile.

One day I was late, and her mother was waiting anxiously the door. “Oh madam!”, she sighed in relief, “Nandini was getting upset thinking that you may not come today. I just asked the nurses whether you are coming today. She is refusing to have breakfast”. As soon as I entered, her scarred and bandaged face lit up. She looked beautiful, with her eyes lined with kajal and a bright red bindi on her forehead. I sat on her bed and spoke to her, “Nandini, come on, you know that you cannot get better and leave the hospital unless you eat. Now won`t you eat?” She smiled and asked her mother for food.

I could not comprehend her liking for me. The next day I spoke to her mother for a long time. The bedridden and scarred Nandini, with multiple broken teeth and bones, and mummified in rolls of white bandage, was not the real Nandini. She was a beautiful, smart, intelligent, talkative and ambitious girl who aspired to be a successful engineer. As a family, they had gone to a temple to offer prayers for her future. On the way back home, she decided to sit in the front row of the bus. A few hours into the journey, a bus coming from the opposite direction rammed into their bus and all occupants of the front rows were either killed or terribly injured. She was lucky to be alive. Immediately after she regained consciousness, all she wanted was to die. She begged doctors and nurses to stop treating her so that she could die and escape the physical and mental agony. Then, for some reason, she started liking an unimportant, inexperienced, diffident and busy doctor who came every day to check her vital signs and change dressings. She liked the doctor`s patience, hard work and smile. She was so thrilled to see that the doctor saw the soul behind the façade of plaster of Paris and bandages, and it gave her a hope and reason to live. After all, someone saw her as a human being with emotions, understanding and intelligence, and not merely as a “case” to be attended to.  She decided not to give up. She decided to fight back. She was sick of being sick, and wanted to look good every day. She wanted to be the old Nandini, and be able to run around like that doctor. And that doctor was me.

It was incomprehensible and perplexing for me. I could not envision, even in my wildest dreams, that I could inspire anyone, and definitely not someone so utterly broken and crushed. I was busy, unkempt and always on the run. I lacked the knowledge, poise and confidence that patients would want to see in a doctor. I used to get shouted at in front of her, by my seniors, for not doing a procedure or notes perfectly, which is one of the most humiliating circumstance for any junior doctor. I just obeyed the orders given to me, many of which were beyond my understanding.  How did she even look up to me?

From that day, I started paying more attention to her. I used to smile and talk with her every day. I could break through the wall of stubbornness that she built around her. Her mother used to offer me face- powder and bindi whenever she saw me disheveled and exhausted on busy admission days– which I politely declined. She would tell me, “Doctor madam, you should not look so tired. You should wear nice clothes, put powder and bindi and always look smart!” She would ask me whether I slept and had food, and I always replied in the affirmative, though it was not always true. Nandini made me feel that as a doctor I had a purpose beyond IV cannulas and dressings. It was rewarding to see her progress so fast, especially regaining her mental strength. Time flew and it was time for me to go to another hospital for my next rotatory internship posting. Nandini was upset. She kept requesting me through her tears to promise that I will visit her daily. I agreed. And I really meant it.

My next posting was in labor ward, that too in another hospital. All I was doing was 12-hour day and night shifts, coming back and collapsing on my bed for the next 10 hours, and waking up at timed intervals for few spoonsful of food. Amidst splatters of amniotic fluid and squalls of fresh lives, she slowly migrated to the back of my mind. I tried asking my colleagues about Nandini, but nobody told me anything I wanted to know. After one month, when I had finished my labor ward posting, I came back to the private ward where Nandini was admitted. I was certain that she would be there, since a patient with such extensive trauma needed long hospital stay. I happily asked the nurse-in-charge, “Sister, Nandini is in the same room, right?”

“Which Nandini?”, she asked. I replied in shock, “Nandini, the bus accident patient”. “Oh her!”, she replied with a smirk, “they took discharge against medical advice long time back. It seems the patient was not happy with the treatment here, they told they will get admitted at some hospital in their hometown. Such arrogant and ignorant people! Thinking that they will get high quality treatment in their small village! Her mother had asked a few times for you. I told her that once junior doctors finish their posting, they won`t come back. How silly of them to think that one doctor will treat them for life time!”

“Yes, how silly!”, I mumbled. I was crestfallen and disappointed with myself. I felt like I had let her down. She admired me so much but I could not even bid her a goodbye. Yes, I knew, as a doctor I should not cross limits of emotional attachment with any patient. For a doctor, the priority was duty and only duty. “Madam are you suffering from common cold?”, the nurse asked as I walked away.  I replied, “Yes”. I could barely complete the statement.

Years have passed. I never met Nandini again. Wherever she is, I wish and pray that she will conquer her ambition, and continue to inspire many with her smile, just like she inspired me. It took me a while to realize that it was her trust that boosted my morale and not the other way around. How petty-minded of me to assume the contrary! She taught me the restorative power of a simple smile even on the busiest and toughest day. She taught me that healing is holistic, and not confined to medicines and surgeries alone. I learnt from her that even one seemingly unimportant, kind and compassionate gesture can work wonders for a depressed patient. I realized why being a doctor is a calling, and not just a career - you need something beyond mere medical knowledge to touch a person`s life. She taught me that each patient is more than a  thousand-page textbook.  After all, compassion and empathy aren`t things that can be learnt from a textbook!