by Anirban Bose
Only Rajeev hummed a tune while eating.
EIGHTEEN
For the next few days, Isha’s work in the wards and Adi’s spirited defense of her position dominated the discussion in their class. Even though he hadn’t gone to the wards, Adi was, for all practical purposes, guilty by association. He found himself haemorrhaging friends at a rate directly proportional to the time Isha spent in the hospital defying the strike. Helpless to stop the defection, Adi fretted and fussed, bemoaning the potential fallout, while Isha remained completely unruffled by the feathers she had ruffled. Now, the class representative’s position was not even in contention: Adi was left fighting for a friendly face. Conversations with the same guys with whom he had spent hours babbling about the most irrelevant topics on earth turned uncomfortable and stilted. And if Rajeev, Pheru or Harsha were in the room, they would quietly leave when he entered. The feeling that he had wronged Harsha and betrayed Pheru was on everybody’s mind, even though it never formed on anyone’s lips. Suddenly, the atmosphere in the hostel stifled him and Adi realized that unless he could convince Isha to join the strike, solitude would be his only steady companion.
He grappled desperately for a good plan, scribbling his options on a piece of paper and crossing them out because of their impotence in assuring a favourable outcome. Instead of useful ideas, these brainstorming sessions left him with monstrous headaches. Finding a persuasive argument proved as hopelessly arduous as his efforts to corner Isha and talk some sense into her. The watchman at the ladies’ hostel always came back to inform him that there was nobody in her room, and Adi never managed to find a private moment to talk to her during the few lectures that were still on. He wanted to avoid following her to Cama – the act of asking her to join the strike within the hospital’s premises seemed particularly unconscionable.
After a few days, desperation seized hold of Adi. He realized he had no choice but to confront her at work. Everything was at stake: his position, his popularity, his friendships, as well as any prospects of a future with her, rested in this do or die effort.
Unprepared and unsure, Adi could feel an emptiness gnawing at his insides as he entered the hospital. He spotted Payal sitting next to a patient a few feet from the entrance to the ward. Lurking behind the dark green curtains at the entrance, he whispered loudly, ‘Hi, Payal…do you know where Isha is? I need to talk to her.’
Before Payal could reply, the sound of hurried footsteps distracted Adi as a young man rushed past him. Trailing him with an unsteady somewhat soporific gait was a young woman. Their clothes were cheap, and the dark blotches a few days of perspiration paints, accentuated the tawdriness. From his hand dangled a worn out cardboard suitcase that held on to its contents thanks to the tenacity of a single latch. She walked barefoot, the soles of her feet hard and callused, while the comparative luxury of his battered sandals flapped loudly on the cement floor. As he sat her down on the floor of the ward a few feet from the doorway, Adi realized that she was pregnant. She looked tired and was noticeably jaundiced. Her eyes had trouble focusing, and she held on to her husband’s hand tightly, as though looking for a reassuring link to life and sanity.
The young man turned toward Adi, folded his hands and cried, ‘Please, doctor sahib…please help us…please.’
Caught unawares, Adi tried to evade him, but the attention the young man drew towards Adi with his impassioned pleas, made him say, ‘okay, calm down, calm down…tell me what is going on.’
Dr Choksi, having heard the commotion, came running out of the delivery room. He smiled upon seeing Adi. ‘Dr Bhatt…thank you for coming. God knows we need help around here. Can you do the history and examination and tell me about it later? I’m needed in the delivery room.’
With that, he turned around and returned in the direction he had come from.
Adi felt trapped by Dr Choksi’s expectations. He smiled nervously to allay the curious stares of the other patients and nurses, trying hard to prevent the discomfort from showing on his face. He decided to get the history for Dr Choksi and then leave as quickly as possible. He turned to examine the young girl.
The glow of impending motherhood, although heavily stained with bile, was discernible on her youthful face. Demure and groggy, she held on to her husband’s hand, answering Adi’s questions somewhat haltingly. Her husband prodded her through it, grateful for Adi’s interest, peppering her story with small snippets of whatever he thought was relevant.
The couple had just arrived from a small village in Bihar. They had fled their village, escaping the wrath of the upper-caste Thakurs when, as Dalits, their crime of solemnizing their wedding in the upper caste temple and having a drink from the upper caste wells had spawned a murderous attack. His odd jobs as a labourer, laundry-worker and dishwasher had saved him just about enough money to buy two train tickets to Bombay. He had heard that Bombay was where all the jobs were and, in this amazing city, being from another caste was not a reason to kill one another.
His eighteen-year-old bride was six months pregnant and had developed a fever while on the train. He couldn’t say how high, but she had felt very hot. She had complained that her stomach hurt while pointing to the area over the liver. The previous night she had thrown up whatever she had eaten, and the yellowish tinge on her skin had progressively deepened. Simultaneously, her urine had turned dark and so, as soon as their train stopped at the station, they had walked out to the nearest hospital they could find.
She allowed Adi to examine her hesitantly, clinging tenaciously to her husband’s hand at the touch of another man. Although his knowledge of medicine was quite rudimentary, Adi was fairly certain that she had hepatitis. He donned a pair of gloves and sent off some blood tests while waiting for Dr Choksi to re-emerge from the delivery room.
An hour later, Dr Choksi walked in just as the results of her blood tests arrived. He presented her story to Dr Choksi who grew visibly upset. ‘She should be getting her care from the medicine people, but now they will send anybody who is pregnant to the ob-gyn floors. This is terrible…terrible!’
Adi showed him the results of the blood tests. Her liver enzymes and bilirubin were high, confirming Adi’s suspicion.
‘She either has severe viral hepatitis or fatty liver of pregnancy… I hope nothing else,’ said Dr Choksi. ‘Either way, this does not look good. She is a little groggy too. I hope she is not going into fulminant hepatic failure. What is her PT– Prothrombin Time?’
‘Normal,’ said Adi, adding, ‘the hepatitis serologies will take a few days to come back.’
Dr Choksi nodded to acknowledge the report, ordered a low-protein, fat-free diet and some general symptomatic relief measures. Then, smiling appreciatively, he put one hand on Adi’s shoulder and said, ‘Dr Bhatt, what you are doing shows that you are a doctor already. You don’t need to pass any exams or get any degrees. You care, which is the most important quality a doctor can have. This caring is not learnt by reading big books…it comes from within. I thank you from the bottom of my heart and you should be very proud of yourself.’
Adi nodded diffidently and looked away.
Dr Choksi’s smile faltered at Adi’s hesitant response. For a moment, his eyes teetered on the brink of a question. But he held back. Instead, he smiled affably and patted Adi’s shoulder before walking away, leaving Adi with a huge dose of guilt.
Adi arranged his bag slowly as he deliberated his next move. A strange doubt began to creep into his thoughts; a doubt that he felt scared to confront. He tried to reassure himself that he had gone above and beyond his duty – even Dr Choksi had said so. Yet, instead of a sense of accomplishment, he felt inordinately delinquent. He decided to leave the building immediately, hoping that his rapid exit would somehow douse his doubts.
As he stepped outside, the young girl’s husband came running out to meet him. His face had curled into an expectant smile. ‘She will be okay, doctor sahib? She will, right?’ he asked.
‘She is very sick,’ said Adi, finding it ha
rd to convey an accurate prognosis without feeling a twinge of guilt.
‘But you are taking care of her, doctor sahib. I trust you, sahib. The rest is the will of the one above…none of us can do anything about His will. But I trust you… I do.’
Adi sighed. ‘Can’t you take her somewhere else…like a private hospital?’
‘Why doctor sahib? I trust you and the old doctor…I know you will do your best for my Neelmani.’
‘It is not a matter of trusting us… In the government hospital, many doctors are on strike, so it’s not good here.’
‘But you are not on strike, sahib!’
‘I’m not now…but I will be. I am not coming tomorrow.’
The young man’s face fell. An uncertain smile stayed on his lips while his eyes flitted between incomprehension and bafflement.
‘There was a fight between the doctors and the dean…the hospital’s chief,’ explained Adi. ‘The doctors are doing this to improve the conditions in the hospital. They want to see that people like you get better care. They are doing all this all for you…for your good.’
The young man stood there with his mouth open, staring at Adi with vacant eyes.
‘Do you understand what I’m saying?’ asked Adi.
‘But she will die! Neelmani will die, doctor sahib. If you don’t come back, my Neelmani and our baby will die!’
‘But if we don’t do this, things will never get better!’ replied Adi, trying hard to force conviction into his words. ‘The resident doctors have to do this to protect more lives…to help more people like you and your Neelmani. Don’t you see? Sometimes we have to make these tough choices. It is for everybody’s good.’
The young man kept staring at Adi uncertainly, his apologetic face berating his inability to grasp the important principle at stake – a principle that was worth the lives of his wife and unborn child. Then, shaking his head ruefully, he said, ‘You know, doctor sahib, when we were running away from the Thakur’s men and hiding in the forest for five days without anything to eat or drink, my stomach would burn with hunger and I would wonder…why is our life worth so little? Neelmani would tell me we are achoots, we clean everyone’s toilets and that is what we are worth. Then we learned that in this big city, nobody cares if you are achoots… Here everyone is the same…everyone’s life is worth more than the toilet he cleans. But now, when my heart burns with the same question, I realize that we are not achoots any more doctor sahib, but we are poor. We are very poor – and I don’t know which is worse.’
Then, clutching Adi’s hand with both of his, he hung his head and began to cry.
Adi returned to the hostel late that night without getting to meet Isha. He didn’t turn on the lights upon entering his room. He opened the windows, tidied his bed, swept the floor and arranged his clothes, trying to lose the events of the afternoon in the small inconsequential things he usually did out of habit. His troubled mind kept wandering back to the young girl struggling for life and her husband pleading for her care. He wondered how to tell the other guys in the hostel that he had failed to convince Isha and Payal to join the strike.
His thoughts became noisier and an irritating heaviness hung inside his chest, doggedly perseverant despite all his manoeuvers. He arranged his bag for the third time, hoping for some sort of a panacea in all this activity. Finally, frustrated with himself, he looked out of the window and stared into the vast calmness of the night.
A full moon smiled back at him benevolently. A light wind brought in the cool night air along with the beautiful scent of the jasmine flowers blooming outside. The leaves on the trees rustled playfully in the breeze. In the distance, the backwaters of the Arabian Sea shimmered like diamonds under the clear starry sky. Other than the occasional chirp of a cricket, silence hung heavy in the air.
Adi wondered how everything could look so deceptively peaceful, so starkly paradoxical to the malevolence in his heart.
His eyes wandered to the Textbook of Medicine sitting upright on the bookshelf. He gazed at the cover, feeling a strange calm materialize out of nowhere. He reached over and pulled out the book, the peaceful feeling now slowly gaining strength. As he opened the table of contents and thumbed through the list, the sensation coursed through his veins and buzzed down his spine. Suddenly, the questions in his head started to evaporate and the turmoil in his heart began to recede. He leafed through the pages with slow deliberation, savouring the steady percolation of serenity. By the time he opened the chapter on Acute Viral Hepatitis, the heaviness in his chest had completely disappeared.
Adi felt tears of relief well up in his eyes. He wiped his face with his hands and was about to begin reading the chapter on Acute Viral Hepatitis, when his eyes fell on the name taped on his bag. ADITYAMAN BHATT, CR it said. He smiled and pulled it off, then rolled it into a small ball and tossed it out of the window.
The next morning when Adi showed up in the wards, he was shocked to find the young girl tied to the bed with cords fashioned from long reams of gauze. He could hardly recognize her as she twisted and turned, screaming obscenities at everyone during her intermittent moments of consciousness. Her jaundice looked markedly worse and she didn’t make any sense as she thrashed around in bed like a woman possessed, tugging at the cords till they dug into her wrists. The shy, demure girl who had held onto her husband’s hand in the presence of another man, was now oblivious to how her sari had ridden up her legs, exposing her thighs and buttocks. Her husband stood next to her, weeping at the sight of his sick wife whose condition was deteriorating so rapidly in front of his eyes.
Dr Choksi and Isha stood beside the bed. As Adi approached them, Dr Choksi turned to him and said, ‘This is what I was afraid of: fulminant hepatic failure. She has Encephalopathy.’
Adi was horrified. He remembered having read the previous night about Hepatic Encephalopathy. It carried a terrible prognosis, especially among pregnant women, with abysmal survival rates even in the best centres in the world. This was Cama hospital, the ob-gyn floor, with a skeletal staff and no support services. It was a death sentence.
‘I’ve put her on a zero-protein diet and started her on lactulose enemas,’ said Dr Choksi. ‘Her prothrombin time was normal yesterday, right?’
‘Y…yes,’ said Adi, his voice cracking up with emotion.
‘Repeat it today. It should be very high and she’ll need vitamin K injections. This time, get it done from Bombay hospital…I don’t trust the lab here. Also… Dr Bhatt, her husband keeps asking me, but I cannot explain it to him. Maybe you can tell him that I’m not too hopeful for her… I don’t think she is going to live. He says both of you are from the same state…is that right?’
Adi nodded. ‘Yes, we are. I… I’ll talk to him.’
Adi stared at the young husband helplessly, unsure how to begin explaining the inexplicability of her death. His heart felt heavy and a lump in his throat hurt every time he tried to talk. He had seen death many times before but had never known it could be so difficult to confront dying. Death at eighteen, an age that was supposed to be bursting with life’s promise, a promise that was growing in her belly. A promise that was going to die.
He prepared to collect her blood. Isha helped steady her arm. As the dark red blood began to fill the syringe, he heard Isha whisper, ‘Adi, I’m so proud of you.’
He looked up at her and smiled.
He carried the blood to Bombay Hospital. It wasn’t far from Cama – a brisk walk of five minutes was all it took to get him there. Yet it may as well have been a world away. The grand atrium he stepped into was lined with dark wooden panels and recessed halogen lights, reminding him of a five-star hotel. Soft classical music wafted from the tiny speakers on the walls, as people in business suits and long white coats walked about, looking important. The air was cool from the central air conditioning, and some pretty ladies sat below a big sign that said ‘Reception’, staring into computer monitors and answering telephones with polished accents.
The ladies directed
him to the clinical laboratories. He paid the forty rupees it would cost to run the Prothrombin Time and waited for the results.
In the cool comfort of the air-conditioned lab, Adi’s mind wandered over to the meaning of life and the difference he had seen in its scope amongst the rich and the poor. He remembered pitying the beggar he had seen on the streets, the one whose torso, devoid of all appendage, would loll about aimlessly when trying to reach the comfort of a tree’s shade. For the first time, Adi understood his miserable existence.
It was miserable, but it was existence. An existence enshrined by the innate and universal addiction to live. And it surprised him to think that this necessity to exist, so quintessential of life, was a privilege, not a right.
The cool air was such a refreshing change from the damp heat outside that Adi started to doze off. An hour later, the lady in the lab woke him and handed him the envelope containing the results of the test. Adi thanked her groggily and started making his way back to Cama. Halfway there, he realized he hadn’t even checked the results. He opened the envelope to see that the PT was reported as twelve seconds. Normal.
Adi stopped dead in his tracks. It couldn’t be…with fulminant hepatic failure the PT should have been markedly elevated. He was furious with himself. He had spent so much time on a test of dubious value, and was now carrying back a fallacious result. On top of that, he was forty rupees poorer.
When he reached Cama, Dr Choksi studied the result with astonishment. ‘This was her blood, right?’ he asked.
‘Yes, sir,’ replied Adi. ‘I drew it and took it to Bombay Hospital personally.’
‘If her PT is normal, then she is not in fulminant hepatic failure. It just cannot be. We are missing something… Let me call Dr Pershovan.’
Dr Choksi ambled to the end of the ward and dialled some numbers on the telephone. Then, with his eyes focused on a spot on the floor, he started talking rapidly to his old friend and internist, Dr Pershovan.