by Aman Sethi
The first five minutes of every interview at RBTB are consumed by a review of the evidence: the patient and the family must prove that they have exhausted all other means of medical redress before they appear before the panel; without a referral slip, it is impossible for the doctors to even interview the patients—it’s against the rules. Prescriptions, X-rays, referral letters, and test results must be marshalled in a convincing manner before the doctors come to their decision. Most patients are too ill to move unattended; they sit back on the bench as a family member coaxes, pleads, and harangues the doctors into admitting their relation.
The doctors rarely ask any questions. As one doctor later told me, ‘The problem is that everyone who comes to RBTB has already been told to say that they regularly cough up blood in their sputum…’ and a lot of them do. They sit silently, inscrutable in their masks, wincing to themselves as relatives and patients talk of how far they have come and the difficulties they have overcome in their quest to reach RBTB. With the hospital running at full capacity, every patient admitted means another booted from his or her bed and declared fit to go home.
Patients are allowed about ten minutes to plead their case. The lucky ones are put onto stretchers and bundled off into one of the hospital’s many wards; the rest are asked to return when their condition worsens.
‘But, Doctor saab, we have travelled two hours by bus to get here; we cannot take him back…’
The doctor shakes his head with sincere regret.
‘Next.’
In the waiting room, I’m picking up pointers on how to convince the doctors. Everyone present has a theory. The crowd is undecided on the profile of a likely ‘admit case’. The fifty-five-year-old carpenter from Tilak Nagar is of the opinion that doctors prefer younger, ‘softer’ cases. ‘It makes sense to treat those who have a good chance of recovery and a whole life ahead of them. What’s the point of wasting medicines on someone who might die in the next few years anyway? You have a good chance: the old must make way for the young.’
But the thirty-year-old seamstress from Dilshad Gardens thinks that the doctors prefer ‘urgent cases’, ‘because the others can come another time when there are more beds’.
‘The doctors prefer poor patients because if the sarkar doesn’t take care of the poor, then who will?’
‘No, they prefer rich cases, because all the doctors are actually looking for bribes.’
‘You should come with your family because those with relatives get priority. The hospital doesn’t have enough staff to look after everyone.’
‘If you come with too many people, the doctors will send you home because they will assume you will be well looked after.’
‘If one of you can cry, it might help your case.’
‘Only with a male doctor; with a female doctor it could be tricky. If her husband doesn’t listen when she cries, why should she listen when you cry?’
‘Next!’
‘Number 35!’
‘Wake up, Satish, that’s you!’ I give him a shake and half carry him in. We take our seats on a long wooden bench facing the long table of four masked doctors.
The first question is directed at me.
‘Are you a social worker?’
‘No sir, I am a journalist.’
‘Are you writing a story on this man?’
‘No sir. I am trying to help him.’
‘The press is always criticizing. Never any helpful suggestions. Just point fingers.’
The panel speaks as one mind, the masks making it difficult to pinpoint the source of any one remark.
‘The press does not determine the facts. The press does not consider the limitations.’
‘Yes sir.’
A pause. The masks seem disappointed; I have surrendered so easily.
‘How do you know this man?’
The attendant outside has warned me of this question. ‘Do not say you know him. If you do, you will have to stay with him in the hospital. Say you found him lying on the road, and they will put him in the lawaris category and assign him someone from the ward.’
‘Sir, I saw him lying on the road.’
‘And you brought him?’
‘Yes sir.’
‘Journalism is the wrong profession for you. You should be a social worker. Does he have a referral letter?’
‘Yes sir, and an X-ray from Bara Hindu Rao.’
‘Fill out this form. Patient admitted. Next!’
To
The Medical Superintendent
Rajan Babu Tuberculosis Hospital
Dear Sir,
This is to state that I, Satish Kumar, s/o Lallan Singh, am a pavement dweller and lawaris case (without kin). Due to my illness, I am without work and am poor, destitute, and helpless. It is requested that my meals be provided free of cost for the duration of treatment at this hospital.
Sincerely,
Signed
Signature/Imprint of Right Thumb of the Patient
A doctor dictates the letter, I write it out, and we force Satish’s thumbprint on it. ‘We will take it from here,’ says the ward boy, and Satish is carried off on a stretcher.
3
‘See, see. Right here.’
‘A bullet wound?’
‘No, no.’ Bhagwan Das tries to shake his head but is constricted by his shirt which he has pulled up over his head to give me a better view of his large and completely hairless stomach. We are discussing the genesis of the neat, circular scar just above his right hip.
‘The pipe, the pipe.’
‘What pipe, Bhagwan Das?’
‘Arre, the plastic pipe I pissed from! After the accident, the doctors put in a pipe and I pissed out of my hip for the next three years. When the minivan ran me over, my bladder burst like a water balloon. So they had to give me a pipe to pee from.’
‘So then?’
‘For three years, I walked around with the pipe and a bottle. For three years I couldn’t piss.’
‘And now?’
‘Now I can piss—it’s all God’s grace. That’s when I decided to stop driving an autorickshaw and picked up my father’s old tools. The pipe is gone now. I piss… I piss normally now. But the scar is there. Three years without pissing, can you imagine?’
Honestly, I can’t imagine. I believe him when he says it was horrible, I don’t need to see the scar. But this is RBTB Hospital—all everyone does is trade stories about illness and accidents; and each story is presented, picture book-like, with accompanying scars or stitches.
We are sitting in a dingy staff room on the third floor of one of the male wards. Bhagwan Das is in the midst of telling me why he came to RBTB.
Bhagwan Das is a man who, of his own volition, spends more time with the patients than anyone else in the hospital. He isn’t the ward boy who ferries patients between wards and clinics, he isn’t the nurse who makes them take their medicines, he isn’t the doctor who checks on them every now and then: he is the barber who wipes flecks of dried blood from their lips, lathers their cheeks, and spends the day shaving them, his face a few inches from their mouths. Their mouths!
There are no gaping wounds at RBTB, no shattered bodies covered in bloodied bandages—at RBTB Hospital it’s the mouth. The mouth is the festering sore, the suppurating lesion, the source of contagion.
But Bhagwan Das has no fear of the disease; he has survived the foul air of RBTB for more than seven years without once succumbing to the common cold. Not a cough, not a hint of a fever, not a day missed due to illness. He looks patients in the face when he addresses them; he doesn’t cringe when he touches them; his grip is as steady as his razor is sure.
He sauntered into Satish’s ward one afternoon, just as I was leaving, and shouted out what I subsequently learnt was his trademark greeting. ‘Main hoon Bhagwan Das nayi, aaj kis kis ne nahin banayi?’
He came up with the greeting a few years ago, ‘I am Bhagwan Das, the barber, who hasn’t shaved today?’ Of course, it sounds better in Hindi, it has a ri
ng to it. The patients like it. It cheers them up, gives them something to look forward to. Without that, a TB hospital can be a pretty depressing place.
It’s a strange place to set up shop. It’s one thing to be assigned to a TB ward; it’s another to choose to come there of your own accord.
Bhagwan Das comes from a line of barbers. His father ran ‘Punjab Hairdressers’, a successful salon in Shahdara. ‘But I never wanted to be a barber,’ he says. ‘Instead I became an auto driver.’ And then he had the accident with the minivan.
‘After the accident, it was a year before I could walk again. A man can do a lot of thinking in that time.’
When I hear stories that involve a patient lying flat on his back for six months I often wonder how the patient ever emerged from the episode with his mind intact. It happened to a friend of mine who dislocated his hip in a motorcycle accident and spent three months in a hospital; but then he was in love and spent his time writing letters to his girlfriend who eventually married him, so I suppose it all ended well.
For Bhagwan Das, the first two months, when his body still possessed a memory of mobility, were the worst. But in three months he had transformed into another creature; the soles of his feet no longer missed the unyielding texture of floor and the skin on his back—initially prone to rashes and bedsores brought on by his prone posture—adapted to the task of bearing his weight.
The pain changed pitch as well: from a white hot agony radiating outwards from his shattered hip to a dull, gnawing, and persistent ache that moved along his spine, spread outwards along his ribcage, and then upwards to his shoulder blades.
But would he ever walk again?
In the first month, the doctors were non-committal at best. ‘You should walk again, but then you never know about these things.’ On other days they adopted a more cheery, and paradoxically more depressing, demeanour. ‘I am sure you will walk again. Never underestimate the miraculous healing powers of the human body.’ They also told him to be happy: ‘Happy people heal faster.’
They were more optimistic in the second month, and by the third, had assured him that he would almost certainly walk again. As the terror of paralysis receded, he found his thoughts turning to the future. He knew he would never drive an autorickshaw again, but the only other thing he had ever done was help out at his father’s barbershop in Shahdara.
And then he met Ram Babu. When he stepped out of hospital a year later, Bhagwan Das often wondered if Ram Babu had existed at all, or if he was a figment of his sedative-influenced imagination. The nurses and doctors had changed since he was admitted, and so did not know of the man who had occupied the bed adjacent to Bhagwan Das’s for just one week. Das remembers little of that time except that he and Ram Babu had long, profound discussions on the meaning of this life and the path of the virtuous man.
He just had to close his eyes to recall Ram Babu’s serene bearded face, with those twinkling playful eyes. ‘I was once admitted in RBTB Hospital,’ Ram Babu would say. ‘There you will find patients suffering. Why not devote yourself to easing their pain?’
‘But the patients at RBTB need a doctor; I am just a barber-turned-auto driver,’ Bhagwan Das would reply.
‘They suffer not from their illness, but from their abandonment. You wonder how a mere barber can ease suffering? Do you have the courage to shave the needy? Do you have the strength to give them company, maybe for just five minutes as you shave them? To make them feel like someone cares and isn’t scared off by their illness?’ It was on Ram Babu’s directions that he changed his name from Bhagwan Singh to Bhagwan Das, literally, servant of god.
‘Did you ever meet Ram Babu again, Bhagwan Das?’ I asked.
‘No, never. I never found out who he was, or what he did. But our conversations in the hospital stay with me to this day.’
On 17 November 2001, Bhagwan Das picked up his old shaving kit and scissors and stepped into RBTB Hospital with a prayer on his lips and a handkerchief tied tightly about his face. The first day at work was terrifying; he had never seen such ill people before. But every time he wavered, he thought of Ram Babu’s beatific face and resolved to continue at RBTB.
Initially, he spent the mornings working at the hospital and the evenings at his father’s shop in Shahdara. But once word spread that he was shaving patients in a TB hospital, his evening practice dwindled to a few regulars, who insisted on bringing their own scissors, towels, and razors. After a few unsuccessful attempts at reviving his evening business, Bhagwan Das embraced the path shown to him by Ram Babu and threw in his lot with the patients at RBTB.
Twelve wards, at least thirty patients per ward, between eighty and a hundred paying customers a day, approximately ten rupees per customer, and no competition for their business. No rents, no bribes, no overheads, no staff salaries. A risk of illness and possibly death—but certainly safer than driving an autorickshaw.
‘One must accept that living is itself a risky business,’ explains Bhagwan Das. ‘To live is to risk death. Some risks, like the risk of an accident, are shared equally; other risks, like TB, can be minimized.’
Pulmonary tuberculosis, as an intern once explained to Bhagwan Das, is spread primarily through airborne germs exhaled by those afflicted by the disease. Once in the lungs, the infection results in scarring of the lung tissue leading to shortness of breath and wracking blood-laced coughs. In a hospital scenario, or even elsewhere, it is impossible to avoid these germs altogether; the only solution is to boost the body’s natural defences to ensure that the bacilli are swiftly eliminated when they enter the body.
Bhagwan Das wakes up at six o’clock each morning and follows a routine that has the rigidity of a ritual. Three rotis with vegetables, curd, and a quarter chakki of butter. Then he dons his work clothes: one of three identical pairs of plain white shirts and trousers that are washed every day in a solution of Dettol and detergent. At work, he is careful to avoid any contact with blood or saliva, and at the end of his shift he washes his hands with two separate soaps—an antiseptic one and a neem one—kept especially for this purpose. The dirty clothes are stuffed into a plastic bag and dropped into their antiseptic solution on returning home.
‘I am very disciplined. No meat, no alcohol, no paan, no gutka, and no beedis.’ Except on Tuesdays when, like all barbers, he takes his weekly holiday and sits out in his small veranda in his house in Shahdara, and pours himself a stiff whisky and lights a cigarette. ‘A quarter bottle of whisky and three cigarettes—that’s all I allow myself.
‘On Tuesdays I think about how so many people lose everything and die in a hospital—sad, sick, and lonely. It’s important to think about these things: Where are you going? Where are you coming from? What could happen if this happens? What will happen then? I am healthy now. My wife loves me; my son is working in a call centre. But I could fall ill tomorrow. What if my wife deserts me? What if my children disown me?’
‘What will you do then, Bhagwan Das?’
‘I’ll lie down on one of these beds, safe in the knowledge that the ward boys will look after me and the doctors will heal me.’
‘But who will shave the barber?’
‘That is a good question. Who will shave the barber?’
•
I’m travelling in Aligarh when my phone rings.
‘Mister Sethi?’
‘Yes.’
‘I am calling from RBTB Hospital. Please speak to Mr Satish.’
Satish is not doing well at all and has demanded to speak to me. A doctor has agreed to make the call; unfortunately, it is of little use. I bellow down the phone, but get surprisingly little response.
‘Yes, you are right,’ the doctor admits, having taken back the phone. ‘He is quite deaf.’
‘So how am I supposed to speak to him?’
‘Well, I thought he could at least speak to you! Don’t worry, it’s just an allergic reaction to streptomycin. He will be fine.’
‘Well, he doesn’t sound fine.’ In the background I can he
ar Satish mumbling incoherently.
‘Everything is under control. Please come as soon as you can.’
I make a hurried phone call to my sister. She agrees to go down to the hospital with a friend of hers. She calls back triumphant.
‘It’s fine. We’ve fixed everything. He just needed a change of underwear. They hadn’t bathed him since he was admitted a month ago.’ They bought a fresh set of clothes, two sets of underwear, a mug, a bucket, and some soap. She said he seemed much happier.
4
Satish Kumar, Bed Number 53, Rajan Babu Tuberculosis Hospital, is dead.
He was discharged on 11 July. They said his TB was in recession, they said he would make it. But then he got worse. Finally, a social worker from the Sewa Ashram took him away to spend his last days in peace. He died on 13 July 2006 at Sewa Ashram, Narela. A nurse at the Ashram told me that the last rites were performed at the electric crematorium at Rajghat.
No one at the mandi even knew when it happened. They still don’t know. I have found out today. I am preparing myself to tell them.
I found out when I went to the hospital and saw someone else in his bed. Singh Sahib, right across in Bed 56, told me that the bed had been reassigned to another patient. He told me that several people had been discharged in the same week. Singh Sahib is an emaciated shell—TB has hollowed him out. Satish is only one of the many he has seen die around him. He has been in Ward M 13 for almost four months without dying or being discharged—a record of sorts. He spends most of his time lying flat on his back, alternately calling up his ‘Chandigarh walle sardarji’, who doesn’t pick up his calls, and castigating his family via telephone for not visiting him. It used to be a running joke in the ward that no one who walked in with a cellphone could walk out without having dialled a number for Singh Sahib. But now there is no one left to laugh any more.
Everyone has gone: Manoj the electrician in the yellow shorts who used to fill Satish’s water bottles; Krishna the aspiring social worker who used to run down to the STD to make calls for Satish; Pratap Singh, Satish’s self-appointed caretaker, and former colleague at Choona Mandi; and even Ammi and her son Salil. Ammi, who used to stay up nights nursing Satish’s cough with glucose solution.