Friday 15 June 2012

Diary of a young doctor (part 2)

(published in The Friday Times, on 15th June, 2012)

here was a frantic knock on the door of the doctors' room. A half-asleep lady came in abruptly. It was 2 o'clock in the morning and there was absolute silence in the rest of the ward. The lady gasped and said, "Dr Sahib, the condition of my patient is serious, can you please come and check her?" I had no option but to get up from the couch I was lying on, get my stethoscope and accompany her to the bed of that patient. As it turned out, the lady was a patient of liver failure and was having pain in the abdomen. After a brief checkup, I wrote down a simple ant-acid and asked the patient to take some water. Problem Solved. Sleep be damned.

The above-mentioned scenario is one of the many that we have to endure during our 28-30 hour long ward duties, also known as "long calls". After a regular day at work, the whole ward becomes the responsibility of 4-5 doctors who are said to be "on call" while the rest of the doctors go home. This duty has to be done once a week and at a weekend once a month. The regular tasks that we are required to perform during our calls include noting down blood sugar levels of diabetic patients, monitoring blood pressures of any serious patients, doing a routine checkup of patients in the ward, dealing with occasional complaints (like the one mentioned above) and lastly, to oversee casualties that occur on our watch. We are required to be present in the ward at all times during duty hours, and it basically means little rest and little to no sleep. After every 5-10 minutes, there are knocks on the doctors' room and one attendant after another barges in to get the required "attention" for their patients. In many cases, the condition of the patient is "irretrievable" and it is difficult for both the doctor and the attendant to see the patient suffer. Most of the patients admitted in medicine wards are suffering from either chronic liver disease (due to very high prevalence of hepatitis in our population), tuberculosis in its various forms, stroke (known as 'brain hemorrhage' in popular culture), kidney failure, meningitis (infection of the coverings of brain), chronic pulmonary disease (due to long-term smoking) and fever due to infections. Patients are checked twice daily, once in the morning and once in the evening.In a country with so many health-related issues, negligible amounts of money are being spent on patient care in public hospitals. A lot of patients can be saved by provision of simple ventilators but the number of ventilators across hospitals in Lahore is no more than 100-150! Similarly, dialysis units and liver transplant facilities, which are considered routine in developed countries, are not easily available in most tertiary care hospitals in our country. The human aspect of being a doctor can be seen during ward duties, as doctors give their best efforts and energies to save the patient without having any relation with the patient. In many cases, young doctors work out of their comfort zones to treat the patient as well as is humanly possible.
Young doctors are the wheels upon which the health care system is working
The culture of attendants in our country is not only cumbersome but also problematic at times. Due to socio-cultural beliefs, more people are willing to stay with the patient than is necessary. The problem arises when doctors are inconvenienced by attendants craving attention, leading to neglect of other patients. Even when forced to leave the ward during rounds, the attendants are back as soon as the restriction is over. Last year, a team of doctors were visiting from the United Kingdom for a project and they were surprised to see so many attendants in our wards. They recounted that in the UK, attendants are allowed to visit the patients only during scheduled hours and even at those times, so many attendants were not allowed to visit the ward, ultimately avoiding the mess that we have to face. At this juncture, I would also like to point out that the running of emergencies and the wards is primarily done by the young doctors and they are the wheels upon which the healthcare system is working, despite all glitches. It is an unfortunate reality that most doctors working in public sector hospitals are not even paid for their jobs, making their work more worthwhile than it already is. As I wrote earlier, there is acute shortage of bed space in public sector hospitals. Last year, during the dengue outbreak, when the Chief Minister visited many hospitals including the one I work at, he was appalled to note that two and in certain cases three patients were present on one bed. Based on his instructions, patients were adjusted but it was a short-term measure and the situation remains the same. I personally have had to discharge patients at times because of acute shortage of space. I felt extremely bad doing that but the patients themselves wanted to go home and be comfortable. The toughest aspect of ward duty I found was the time of casualties. The usual scenario goes like this. Doctors are mostly aware of the patients who are having a really bad time and they try to counsel the relatives beforehand. When a distraught attendant comes running in, calling for attention, the concerned doctor rushes to assess the patient. When the patient is critical, the doctor calls his batch mates for help and combined efforts are done to resuscitate the patient. If the patient can't be revived, the protocols are followed and the attendants are informed about their patient's demise. The response of the attendants to the news depends on various factors including the age of the patient, disease of the patient and the quality of counseling done previously. In case of young patients, the reaction of the relatives is quite severe and I have seen my colleague's collars ripped off by an angry relative. Due to their inability to cope with grief, many attendants blame the doctors for the casualty of their patient, without acknowledging the work done by the same doctors when that patient was alive.
At the end of the day, it is not a fair world and a doctor can do only as much.   

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