Who was he?

Every evening, I would get to see him. He sat beneath the old tree by the entrance of our college, staring vacantly at the ground, mumbling to himself.
His features were rugged, his clothes were torn, and his body was tanned, more perhaps from long years of adversity than from the sun. Our shrill voices would interrupt his reverie and he would look up. His eyes were blood shot and his teeth were stained with nicotine. He would stare at us until we passed him. I would look at him from the corner of my eyes and feel a strange repulsion. He hadn’t bathed for years and the stench of his body odour was repulsive. At times, I glanced at him. He would stare back, his eyes and smile mocking the repulsion on my face. He seemed to mock my inability to confront the horrors of his world, even from a distance. I was almost scared of him…scared of the facet of life I saw through him.
Occasionally, we saw him pick up his possessions and walk away. There wasn’t much- only a sheet he spread out on the ground to sleep on, and a bag that held a few clothes. The subsequent morning, I would look out for him, almost expecting the place to be vacant. But he always returned. In the mornings, we would find him fast asleep on the ground. Sometimes, I couldn’t tell if he was asleep or unconscious.
At times, we saw him at his meal. The meal was in all probability a discard he had picked from some rubbish heap. But it didn’t matter to him. He ate hungrily, licking the bones.
There was always a bottle of alcohol by his side. Occasionally, we saw him drinking from it. Even as he slept, the bottle was by his side. Perhaps it was the alcohol that numbed his senses enough to give him the courage to confront a destiny that had thrust him into the periphery of life. A life denied of dignity.
Meanwhile, summer gave way to monsoons. I wondered where he slept. In the mornings, I continued to see him at his usual abode, fast asleep. The rains picked up. It was impossible to sleep beneath the tree. The man disappeared. Days passed and there were no signs of him. Gradually, he disappeared from my thoughts.
Several months later, I was taking an evening stroll, brooding at the storms and torments in my life. I felt lonely and empty as I gauged my circumstances. The sharp barking of dogs broke my reverie. I turned to see the man sitting by a makeshift hotel, holding a bowl of food. Three stray dogs sat by his side and they barked as he held up a piece of meat, testing their patience. He finally threw it and the dogs chased the food, and then ran back to him. He laughed aloud. He then put out most of his food for them to eat, hungrily devouring what remained of it. At the end of all that food and play, he packed up and walked off, taking quick steps. The dogs faithfully followed him, wagging their tails and smacking their lips as the man conversed with them. He paused, looked at one of the dogs, and screamed, ” They are fools. All of them. But with fools, one shouldn’t argue. One should just let them win. What do you say?” The dog wagged its tail. The man laughed aloud, repeating his words, and walked on.
A little ahead, he stopped and spread out his sheet. Perhaps this was his new abode. He lay down and the dogs lay down by his side. He put his arm around one of them and went to sleep.
It was then that the loneliness and poverty of my world stared back at me. In my mind, I heard his laughter- the laughter that had always mocked my life.

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The Power of Passion

I sat in my cabin, watching the rain outside. I love my cabin. Partly because this is the first time I am not sharing my work space with other people. And largely because I have carved it into a space that mirrors my mind. I have put up photographs that I love, cards that have been gifted to me, magazine clippings that I have been attracted to, posters with quotes that have inspired me the most. On my desk, I have stationary of all kinds. I have always loved stationary. Perhaps because I am a writer? And then I have a coffee mug and some books. I love the feel of that place.

As I watched the rain outside, two men knocked on the door. They were from Elsevier Publishers. I had met one of them before, and he had taken my opinion on the South Asian edition of Guyton’s textbook of Physiology. I had given him my opinion in brief. This time, they had a more detailed discussion. I was very pleased because I have never been in favour of substituting Guyton, and I haven’t been very happy with the restructuring of the book either. I found myself getting passionate as I spoke my mind, explaining why the original version of the textbook was immensely appealing. I stressed on the fact that the editing had cut the flow in many segments, and there was a general drift towards a more factual tone, as opposed to the original version, which bears a strong emotional appeal. The passion element was missing in many places. We discussed on how the faculty had played an important role in encouraging students to switch from Guyton to ‘apparently simple’ books, and how it was actually our moral responsibility to promote textbooks like Guyton, which taught fundamentals and concepts. I didn’t wish to be a part of this deterioration. The passage of time does not alter the fundamentals. So I am in favour of retaining and protecting Guyton, because it has no substitute. I would be happy to review the South Asian edition and work on maintaining the essence, flow and beauty of the original version. The discussion was so heartening because we were all on the same page here.

In those few minutes of exchange of thoughts and perspectives, we had all evolved a trifle. All of us felt the excitement of contributing meaningfully to the world. As they bid goodbye, I couldn’t help thinking that passion is perhaps the most powerful tool to change the world. When you are deeply passionate about something, it instills power into the words you speak and the things you do. It attracts people to your perspective. They want to listen to you. They start to believe in you. And they start to believe it will work, no matter how impossible it may actually sound. Passion is infectious. It can set up a revolution.

An ICU Story

I took slow steps to the ICU. I wasn’t feeling up to work. Until yesterday, my life had been brimming with happiness. But it had only taken a moment to fall off that pedestal of happiness and injure myself beyond imagination. The truth was that I felt lost and devoid of all hope. I wanted to die. Like a zombie, I stepped into the ICU. The same picture greeted me- eight cubicles spread out before me, the beeping sounds of the ECG monitor and the ventilator, wires coiled around the patients, and the nurse busy with her routine chores.

I sat at my desk. I saw the nurse trying to get an I.V. line into one of the patients. I went up to her and offered to make an attempt. The patient was in coma and it was a tough job finding a vein and getting in the line. I finally succeeded. I looked at the patient. He hadn’t stirred through that entire manoeuvre. The ICU was different from the rest of the hospital. There was a certain hopelessness about this place. The feel of defeat, wherein disease had gained the upper hand and silenced the spirit of the human being. There was the smell of death here.
I looked at the patients. For the first time, I saw their faces. Somehow, in my two weeks of ICU posting, I had looked past their faces. I couldn’t have recognized them if I had seen them elsewhere. Some were in coma, some in sepsis, and yet others were on ventilator. In any case, they were too ill to respond or react or express. And that had made me look past them. I had failed to see them as human beings. Until that point, their identity was in their bed numbers or their ailments. ‘The OP poisoning’ was on his way to recovery. ‘Bed number 5’ had visitors today. I neither knew their names nor did I recognize them by their faces.

Today, the sight of those eight beds offered me a strange comfort in my misery and loneliness. An unspoken companionship that stemmed from a mutual need. I walked to the first bed and watched the nurse suctioning and clearing the secretions from the patient’s trachea. This man had attempted suicide by consuming some pesticide and he was now on a ventilator. I sat by his side. I saw a tear roll down his face and I wiped it with cotton. ‘Does it hurt?’, I asked him softly, pointing to the suction. More tears rolled down his eyes. For the first time, I thought about how agonizing it must be to be bedridden for weeks, with the body sore from the posture and immobility, the mouth sore with ulcers, the throat sore with the tracheostomy tube, the mind frustrated with the inability to communicate anything at all, and endure this predicament day after day, uncertain of when it would end. This was a far worse predicament than death. I felt terribly guilty of being comfortable and pain-free while this man suffered in silence. I sat by his side for a long time and was relieved when he finally went off to sleep under the influence of sedatives.

I went to the second bed. This patient had been in coma for a long time and death was only a matter of time. He was a fairly young chap who had bled into the brain, and been brought unconscious to the hospital. I wondered what kind of life he had lived until that point in time. I wondered if he had left behind a lot of memories. I wondered if he had been happy.

I walked to the third bed and realized that the patient was awake. He seemed to be in pain for his face was crumpled into a frown. I went close to him and asked him if he was in pain. He put his hand to his forehead, indicating a headache. He was already on analgesics. I put my hand on his forehead. ‘You just had a shot of a pain-killer. We’ll wait for some time and if the pain doesn’t go, we’ll give you another shot.’, I said to him. He held my hand tight as he felt the throbbing in his head. I gently pressed his forehead and let my hand rest there. In a little while, he went off to sleep. I was spellbound by the power of disease. It transformed you into a child. I suddenly saw my own self in each of these patients. They were all so lonely in their suffering. And so was I. I derived a strange comfort from their companionship. Despite the fact that they were incapable of communicating. And there, within the confines of the four walls of the ICU, I perhaps learnt my first lesson on empathy. My own pain had suddenly sensitized me to the pain of fellow human beings.

I came back to my desk and vowed that I would be a better human being henceforth. I felt strange that I had been blind to the suffering of these human beings all these days….blind to that little ounce of life they clung on to. I felt ashamed of my lack of reverence for life.
The next morning, when I walked out of ICU, I was a transformed soul.  Within my heart, I carried a bit of each of my patients in the ICU. They had suddenly made me appreciate the abundance in my life. It still hurt to think about the events that had shattered my dreams, but I suddenly felt richer. And more importantly, I felt a reverence for life and for the human mind.

For the first time, I took an interest in reading the case history of these patients. I looked up the names on the case sheet and felt ashamed that I had never felt the need for that until then. Bed No. 3 was Ravinder. Bed No. 1 was Channappa. I wondered what had prompted him towards suicide. That evening, when his family came to visit him, I learnt that Channappa was a poor farmer who had run into debts over the last couple of years. As the debts mounted and the income from agriculture dwindled, he had resorted to suicide at some desperate moment. And accumulated more debt as the hospitalization expenses ran to several thousands. I was too young and naive to talk to Channappa about life. But I would talk to him every evening in the hope that I was restoring his faith in life and in humanity. He could not talk to me, but I had learnt to understand the non verbal language that often conveys more than words do. I could read his facial expressions and the emotions in his eyes. I was deeply impressed by the nurse who could tell when he wanted to be turned around or when he was uncomfortable with the secretions and needed suctioning. I realized that she was more in touch with his needs than the doctor who was treating him.

The anaesthetist meanwhile, was trying to wean him off the ventilator. He was improving remarkably and his family was hopeful. At this hour, the debt and the piling expenses were secondary. His life was all that mattered. The tracheostomy tube was eventually removed and it made me very happy to see him gradually sit up and make attempts to talk. When asked if he would ever resort to suicide again, he cried uncontrollably and expressed his regret over the act.

One afternoon, as I sat down to have lunch, I was called back at the ICU. When I arrived, it was to see all the doctors gathered around Channappa, the anaesthetist frantically trying to breathe life into Channappa. Channappa had collapsed without warning and the anaesthetist had rushed in. But the efforts were futile. It only took a few more minutes to pronounce him dead and document the details. I looked at his lifeless body. A few hours back, we had tried to cheer him up, playfully making fun of him as the nurse was changing his posture. He had smiled. The anaesthetist and the nurse were devastated. They had worked hard to bring him back to life, and those initial moments of hopelessness and uncertainty had been replaced by hope and optimism.

In the other cubicle, Ravinder was being moved to the ward. He had recovered completely and as he left, he thanked me for my empathetic gesture. A few minutes later, Channappa’s family arrived and I did not have the courage to confront them. My shift was coming to an end and as I walked out, I carried two images in my heart. Channappa’s lifeless body being wheeled out of the ICU and Ravinder’s beaming face as he was being shifted to the ward. The irony being that both had made their entry into the ICU in a similar state, bordering between life and death. It brought me to the realization that as doctors, we have a huge responsibility on our shoulders. Our patients entrust their body and mind to our care. Our personal sorrows are often belittled by the ocean of sorrow and suffering we deal with, as part of our profession. And so, we have aptly been called ‘wounded healers’.