Doctor-saab, there is nothing to fear, right?
Dr Karmaker bowed his weary head in exhaustion. Or was it frustration? Frustration at his inability to explain to the father, the dire predicament his son was in. Or at the incapacity of the man to comprehend the situation? ‘Why do I even try?’ he asked himself.
But trying was not an option here—more of a compulsion. If this eleven-year-old boy suddenly died, all hell would break loose. The bewildered parents and relatives would wildly search for answers, blaming everyone and everything apart from themselves.
In The Mahabharata, Yudhishthira was asked, ‘What is extraordinary about life?’
He had replied, “Every day we witness many deaths and still hold the expectation to live forever.”
There is of course, an unspoken expectation that apparently healthy young eleven-year-olds should live for a very long time, certainly outliving their parents and grandparents. But is that always true? Dr Karmaker wished it were.
It had started very innocuously on a late Saturday afternoon. Anil Karmaker, a busy paediatrician, was about to see his last patient of the week. A couple of his classmates living abroad were in town and he had planned to spend the evening with them playing bridge, just as they had done at least once a month in their college days. The day after would be a one of relaxation. They would visit their old haunt, a small coffee shop deep in North Kolkata. Other college mates would join them. The date had been fixed six months ago and e-mails exchanged from all over the globe.
‘Barun is walking clumsily over the last few days,’ the mother said. ‘He is tripping over objects.’ Dr Karmaker examined him carefully. Barun was a robust boy who played football for his school and was good in studies. Yet, something was not quite right. There was a lack of co-ordination in Barun’s legs which puzzled him. This would need checking. He suggested that Barun be admitted to run a few tests.
The parents were not particularly keen. ‘Barun has a class test on Monday,’ said the child’s father. ‘Besides hospitaladmissions are expensive, Doctor-saab. Can’t you just write some medicines? We live next to a diagnostic centre—we will run all the tests on Tuesday morning and show them to you on Wednesday.’
Dr Karmaker almost agreed. He was not too keen on visiting the hospital over the weekend either.
‘My feet feel rubbery,’the child said.
Something from his past training suddenly clicked, like a key word on a computer screen. ‘No, it can’t wait till next week. You have to admit him right now. He needs to stay under observation.’
The unhappy parents disagreed and went home. And that was the end of it—or so he thought.
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The first bridge rubber was at an exciting stage when his silent mobile vibrated. He looked at the mobile—there were seven missed calls from the same number. Should he call back?
Before he could collect his thoughts, the phone started vibrating again.
‘My son cannot walk. He has to be carried to the bathroom. What should we do?’ There was panic in the voice.
‘Admit him to City Hospital tonight.’
‘But we live in Uttarpara. There is no transport available. City Hospital is expensive. Can’t you admit him to Mahakali Nursing Home?’
‘No. He has to be admitted to City Hospital. We need an institution where all resources are available. Bring him first thing in the morning. I will be waiting at the hospital. Make sure you get in by nine. I will arrange his treatment and then leave. Don’t be late.’
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It was a bright Sunday. Dr Karmaker looked at his watch. It was noon—he had waited three hours, should he leave? His friends had already met up and were calling him every five minutes urging him to hurry up. The patient’s parents were not answering their mobile.
Suddenly, there was a flurry of activity and a blue gasping child was brought in. He was fighting for air. The next few hours were a blur.
The ventilator was now running at full throttle; IV lines and catheters in full flow. Junior doctors and senior nurses were running all over the place. Injections, solutions and infusions were connected, disconnected and occasionally reconnected. Venous and arterial blood, urine and sputum— samples were being rushed to the lab.
Guillain Barre Syndrome is a mouthful. It is a viral disease which affects the neuro-muscular system and spreads upwards. Death is not uncommon. Dr Karmaker tried to explain all of this to the patient’s parents stressing on the positives and negatives. But he was not getting through. Mum was just wailing away and not listening.
Dad had a different problem. ‘The hospital just asked me to deposit thirty thousand rupees. Where will we get the money on a Sunday afternoon? We are not that well off. I work in a private firm and barely earn ten thousand a month.’
Dr Karmaker went down to the administrative block and requested the person on call to give the parents a 24-hour moratorium on payments. The young officer did not look happy. ‘Sir, the family has only deposited five thousand rupees. We normally do not admit patients to the ITU unless they put in fifteen. You are absolutely sure that they will pay, Doctor? I am new at this job. The child I am told is very unwell . . . on a ventilator. If they refuse payment, I will be in soup.’
However, he had no choice. Dr Karmaker was too senior in the hospital. Refusing him could also jeopardise his job.
The child was now convulsing. Vomiting. This was bad news. If the vomit got into the respiratory tract which was highly probable, there would be pneumonia in addition to everything else.
Dr Karmaker looked at his silent mobile. It was vibrating ferociously. Bibhas his close confidante from school and college was on the line. ‘Hey Anil, we are waiting for an hour in coffee house. What’s taking you so long, man?’ Bibhas was a top shot psychiatrist now settled in Sydney.
‘I don’t think I can make it today, Boss. Got a really sick child at the hospital.’
‘But we planned this day six months ago! You promised to keep yourself completely free. And guess who can’t wait to see you—Priya, all the way from New York! She is dressed for the kill, Anil. Hurry up.’
He heard loud guffaws from the surrounding tables including Priya’s vociferous protests. Priya and Anil had been a hot item in their early college days, though the relationship had never progressed. She was now a happy mother of two who rarely ever visited India. Anil had not seen her for ten years, though they were in contact over WhatsApp and Facebook.
The child was breathing better now. But this could be deceptive. Chest infections usually develop three to five days after ventilation. He decided to review the antibiotics. The ventilation parameters and the fluid regime also needed tinkering with.
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Anil entered the hospital the following morning at 9am. There was a surly crowd waiting for him. In the centre was a dhoti clad man wearing a Gandhi topi. This was not going to be a pleasant. ‘Doctor-saab I am Pratik Khasnobis, a councillor from Uttarpara,’ he said in a belligerent tone. ‘We heard about Barun and rushed here. Barun is a good football player. He played a match last week. How can his life be in danger? How can he be on a ventilator?’He looked accusingly at Dr Karmaker. ‘Of course Doctor-saab, you are like gods to us. We are lay people. But these corporate hospitals—they are like dacoits. I have heard they do unnecessary treatment for money. These people are not well off—we are holding a collection for them. How could they put a healthy child of 11 on a ventilator? It is monstrous.’
Dr Karmaker wondered which line to take—be aggressive and throw the man out, ignore him and get on with his work or befriend him and get him on his side? He chose option three.
He explained the problem with great patience and the uncertain prognosis, holding nothing back. The councillor however was still playing to his gallery of hangers-on. ‘Sir, if he is that serious- should we take him to Vellore?’
Anil was tempted to say yes and let them get the hell out of here. Why did he bother? Did they not realise that the child would die on the way? And what about the costs of transport? Did they have any idea about the logistics involved?
The next week was a roller-coaster ride. The chest infection did develop but could be controlled. The heart beats were erratic occasionally and the blood pressure fluctuated like a yo-yo but somehow the treatment remained ahead of the curve.
Anil now knew that he was within yards of victory. But he needed one specific drug – an immunoglobulin infusion to score the decisive goal. But the patient’s payments were behind schedule—they still owed fifty thousand to the hospital. And this new drug would cost an additional one lakh. Dad collapsed when he heard the figure. The hospital CEO phoned Dr Karmaker regarding the failing payments. ‘How can we keep doing charity? Our costs are rising every day.’ Anil Karmaker wished he could be far far away from all this. Maybe a small island in the middle of the Pacific, out of the range of human communication.
Dr Karmaker finally sent for Pratik Khasnobis. ‘Do something—we really need this drug.’
IV gamma was administered that Wednesday. On Friday, the ventilator was taken off and Barun managed to eat something two days later.
‘Sir, you are like a god to us,’ the parents said. Dr Karmaker was wary of the word. There is a very thin line between god and dog in our country. But he decided to go along with the happy moment. ‘We want Barun to be a doctor like you when he grows up. He is a good student,’ added the father.
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Dr Karmaker wondered if he still enjoyed being a doctor. He enjoyed the fight against disease and the adrenalin surge of combat. But he hated the emotional and economic baggage he had to carry on his shoulders. He knew that the reactions would have been very different if the child had not pulled through.
Bibhas and Priya had both left. He had met them briefly at Tolly Club for a drink but his mind had been elsewhere. They both commented on how old and haggard he had become.
He watched Barun walking with the physiotherapist. He would be going home soon. He looked back to his own life. His own daughter was about the same age and he rarely had time for her. What would he have done if this had been his child? Yes, he had taken the right decision and become a paediatrician. Someone needed to fight for these kids.
He sat down in his clinic and called in the first patient. His assistant put a cup of coffee in front of him. Even the coffee tasted better today. He savoured the slightly bitter taste on his tongue.
They wheeled in a sickly girl of seven. The child was pale, emaciated and had scraggly hair. Her legs were spindly and the skin looked mottled. There was something seriously wrong with her.
He explained everything patiently to the father. She needed to be admitted immediately and have some tests done. Something sinister would probably emerge like a childhood malignancy. He did not use the word cancer but hinted at it broadly choosing his words carefully.
‘Doctor-saab, there is nothing to fear then, right?’
Dr Karmaker bowed his weary head in exhaustion. He wondered if he could get a direct flight to the South Pacific from Dumdum Airport.
