A tear...for Priyanka

Priyanka might not mean anything to anybody. She might not mean much to me too if and when I am seeing more patients, if and when I am more busy. She might be among the many we see, manage, talk to briefly, touch and get touched by, chat nonsense with , palpate spleens and lymph nodes of...say how one is rubbery and the other hard,poke needles into, draw blood from, administer a whole load of tablets to and follow just up to they are gone. Away from our lives. We away from theirs.And they might remember us more than we might remember them.
But Priyanka died. She died unseen in a crowded medicine ward at 2 am..when all were asleep. She died an orphan..all of 14 years.. of HIV/AIDS...or that is what we suppose. No one dies of HIV really. They die of complications associated with HIV. We could never figure out how she died. When my junior resident got a call at 2 am, she was motionless, no pulse, no BP, no heart sounds. He dutifully entered these in his death notes and went back to his room to catch some sleep. The only one who shed a tear then was her grandmother who doted on her grandchild. She had shown us photos of Priyanka when she was prettier and healthier...a mere 6 months back. Dressed in pressed and pretty navy blue school uniform with hair oiled and smile on her face. " Kashi hoti.....kashi jhaali!" ..she chokingly exclaimed to us as she pointed to a wiry girl with scraggly hair with herpetic lesions over forehead, cheeks and neck. I could imagine her making a trip from her village with luggage bundled into a potli, a sick Priyanka to console, traveling a few hundred kilometers to make her grandchild better.In hope she would be able to attend school again, healthy and cured.

Final diagnosis at death: disseminated herpes simplex infection with bullous impetigo,abdominal tuberculosis,AIDS.Immediate cause of death: we don't know.

I first got a call from skin dept on my Sunday emergency at 10 PM about a patient with disseminated herpes with "poor GC" for transfer to medical wards. My resident was reluctant to take her. " Sir, woh skin ke patients bahut gande lesions lekar aate hain....mat lo transfer", he said. I was in two minds really when I went to see the patient. But then she didn't have extensive skin lesions. She was looking sick when I saw her, lymph nodes everywhere, abdomen distended, coughing.I decided to take her to our side.When I learnt her story...orphaned with only a grandmother to care for her, and really not 'unsalvageable' I wanted to send her home healthy.She wasn't poor GC for gossakes.And everything was goin well. She wanted to go to school. Her favorite subject was 'ingraji'...so we talked to her in ingraji....and she would smile knowing she wasnt game to this type of ingraji.

So when my CR told me over lunch that " woh to gayi"...I felt a paw dig into my throat, words escaped me and I could just whisper nothings ...for a moment my mind was blank. How? When? Why? I could probably some time get answers to the first two interrogatives. But Why? I had no answers to that.Cmon...what was I arguing against. She had pulled on for 14 years...thats good for childhood HIV/AIDS. Statistical true lies stared against my hope to get her going.She had to die. Sometime now or later. That was fated for her....not her decision to make but something that her parents had slapped her with when she was born.Given her a death sentence at birth.
I thought there might be hundreds of Priyankas that I might not see, never hear who might even not come to a Sassoon and die uncared for febrile and consumed by pestilence and cytokines.

We are taught that a physician needs to be affectively neutral. He cant be sentimental and needs an emotional distance from the sorrows and mania of his/her patients.That will not cloud his judgment, his rational/analytical thought and diagnostication.But what does that make us? Wooden emperors with scepters to mete and dole diagnoses gloomy or good, mechanistic, stoic,comforting, omnipotent almost. But are we so? Who made us so from normal carbon based homosapiens that look and think the same as those we treat? Should doctors not cry? They do.So says a book compiled by a sensitive thinking resident from AIIMS.But who proclaims they shouldnt?
Why shouldnt a Dr Bawaskar shed a tear when he sees a mother die while feeding her newborn child who innocently suckles at her breast while she gasps for breath from left ventricular failure...as the sun dawns , and dies despite the doctor toiling the night trying to salvage her with the limited resources he has at hand. What could be more poignant!!

There are so many instances where lack of time and more pressing problems have stopped us from getting more attached to our patients.There are many more stories that will ever haunt me.I can remember three more. I do want to chronicle that...so that later I may feel what I felt then...so that I dont become that affectively neutral 'ideal physician'.I admit one will become emotionally drained if one sheds a tear for all the sad stories that people who sit and cry outside a hospital MICU will have to tell you.But should that deter one from feeling closer to the ones we care for?
But till then we move on, there are more people who will come sick and dying.There will be more stories of how people sold their houses for chemo,Dickensian stories of how daily wage earners lifted loads in the daytime and brought all their wages and gave them to you in the evening to buy that darned acyclovir, ate vada pav afternoon, evening and night because 50 rupees was all they had,travelled ticketless and were arrested and policemen played good samaritan bringing them to the hospital, died waiting for anaesthetic fitness, camped outside hospitals after discharge because they couldn't travel home and come back for the scheduled DSA appointment a week later,begged at a helpless resident to do what they could to save their kin, watched husbands die a couple of beds away, admitted with the same illness...so many more.



The shortest verse in the Bible is : " Jesus wept"