Pandemic and Pandemonium: A Doctor on India’s Kafkaesque Medical Reality

Manish Tripathi* is quite unaware of the impact that the novel coronavirus is going to have on his life. Late in February, the signs start creeping in, little by little in small increments at first, and finally culminating in the madness, chaos, mayhem, rank stupidity, ineptitude and gross incompetence which characterise any large-scale venture in India.

Kafkaesque doesn’t even begin to describe the situation that he witnesses.

At his hospital, early in March, the administration suspends the biometric method of attendance. Large signs are taped over the machines stating that due to the risk of contracting COVID-19, attendance shall now be marked with new face recognition technology machines.

“F***ing far out and futuristic,” Manish thinks, although he notices that he still needs to use his hands to open the gazillion doors in every corridor, toilet and department at the hospital – which sort of undermines the whole exercise. But never mind.

The IT chaps make him pose in a variety of ways to capture his facial characteristics for the machine, exhorting him with, “Please sir, profile pic first, small smile, thank you very much sir. Don’t frown sir, please show forehead sir,” all of which have the feel of posing for a ’90s amateur modelling shoot.

The next day, he walks up to the machine and starts grimacing and bobbing his head up and down in front of it, but to no apparent effect. A security guard notices and offers some sage advice.

“Sir, you need to touch the screen before it can capture your face.”

“Oh, thanks mate. So are you telling me that the machine which has been specifically installed to prevent us from touching surfaces needs to be touched in order to turn it on?”

“Yes sir, touch the screen, then only pose in front of the camera.”

Cool story. Manish happily complies, secure in the validation that this latest development only proves what he’s felt all his life – the world is insane, India especially so, and the only way to survive is to go with the flow and join all the madness.

The next day, administration requests that all doctors in the hospital attend a conference where they will discuss the hospital’s strategy to deal with the pandemic, and to address any concerns of the staff. A slightly frazzled looking professor takes the stage and starts lecturing the highly trained medical workers on the characteristics of SARS-CoV2.

“So you know why it’s called coronavirus? It’s because corona is Spanish for crown (actually it’s Latin, Manish thinks, but never mind), and this virus has a crown. Do you know crown? Crown, na, like mukut, which kings and queens used to wear?”

This exposition is accompanied by a PowerPoint slide depicting a badly drawn cartoon of a medieval ruler with a crown. Fearing that this vital point has not been communicated properly enough, the lecturer then mimes the shape of the crown over his own head. This goes on for several minutes.

The professor then starts talking about the origin of SARS-CoV2. “It is believed that it came from Chinese people eating bat soup. You know these Chinese, they eat everything. Ha ha ha.”

The audience also sycophantically laughs, while the PowerPoint slide now shows a racist depiction of a Chinese person hovering over a cartoon bat in a bowl.

You got to hand it to this guy, Manish thinks, did his kindergarten children draw these cartoons on MS Paint on short notice, or did he just upload stock images from

After several such gems, the Q&A session is thrown open to the audience. Predictably, half the mics don’t work, so a lot of pertinent queries are unheard, or garbled beyond understanding. When they are heard though, the professor responds by attacking the questioner, screaming at them, or evading the question (especially those on a shortage of Personal Protective Equipment – PPEs), or deflecting responsibility to some poor chump in Procurement or Engineering.

Some bold fool stands up and asks, “Just suppose I, or any other healthcare worker, get sick – not just infected, but sick with the disease in the course of our duties, and need hospitalisation and maybe a ventilator, will we be treated here? And if so, does my insurance cover that treatment? And if we won’t be treated here, will my insurance cover treatment at a private hospital?”

The professor is incensed at this frivolous question.

“Well firstly, why would you think you’ll get sick? You are so young and healthy, ha ha ha. Look at me, I’m pushing 60, and I’m not worried about all this. Listen, you youngsters are always trying to get out of responsibility. In my time, we would stay awake for four days straight and still have the energy to go home and beat our wives ha ha ha. Anyway, jokes aside, if you get sick, you’ll of course be thrown out of here because we can’t risk you infecting others, and sent to a government hospital (he names the hospital which Manish used to earlier work in and of which he has terrible memories). So now there’s no question of insurance and all, is there? It’s free treatment at the government hospital, and of course, maybe sometimes you’re crowded three deep in a single bed with tuberculosis patients, and sure, maybe now and then, they give you the wrong medicine because all the nurses are overworked, and maybe they use the same needle and syringe on multiple patients, but that’s just the life of a tough soldier like you, no? I used to be in the army (officer class, of course), and we never used to complain about petty things like this, you millennials are just used to having things handed on a spoon for you. We’re in a war, dear boy, like those soldiers standing at Siachen glacier etc etc! And we need all you to pull together and act as a team instead of moaning about lack of protective gear and whatnot.”

The audience is suitably chastised and humbled by this tirade, the questioner meekly bows his head and sits down. The professor glowers at everyone, daring someone to ask any further questions. Thankfully, nobody is stupid enough to do so. The lecturer then gives everyone a respite, smiles, and throws the medical staff a bone.

“I also have great news for all of you. Thanks to the tireless efforts of our government and our hospital in particular, we have obtained the drug hydroxychloroquine which we will provide to every single employee here, free of cost…”

At this point, the manager in charge of Procurement steps up to the dais and whispers urgently in his ear.

“Okay, maybe not free of cost, but the point is we have got it! And you all can get it easily, you lucky, lucky fellows.”

At this point, Manish is extremely grateful at the magnanimity of the hospital administration. “What a benevolent institution I work at,” he thinks, “Of course they are deeply concerned about the well being of all of us.”

He decides to gloss over the fact that hydroxychloroquine is a completely unproven drug, and that it might actually be harmful to treat COVID-19 with it.

A few days later, it is announced that the long awaited N-95 masks are now available for the medical staff “who actually require the use of one”. Since Manish sees patients daily, any number of which could be potentially infected, he lines up in the long queue to be allotted one. They hand him what he first thinks is a napkin. He’s a bit nonplussed.

“Excuse me, is this actually a N-95 mask?”

“Of course it is. See, it’s printed N-95 on the mask itself. Why would you ask?”

“I’m sorry, it’s just that it appears more to be a paper thin rag with underwear straps. See, it even has those frilly elastic bands which are used in cheap lingerie. Also, I’ve never seen an N-95 mask which has N-95 printed in extremely large letters across it. I also happened to notice that it has some rather large holes over the part that’s supposed to be covering and protecting my mouth and nose, so you can understand my doubts.”

“Look, the holes are there so that you can breathe (but wouldn’t I end up breathing in the virus, Manish wonders), and the masks are issued by the Government of India itself. Are you saying you don’t trust the Government of India to give you legitimate masks? This same selfless government which cares so much about you that it made all its citizens bang pots and pans and light firecrackers in your honour? Is that what you’re saying?”

“God, no. I love my government and nothing they do can be wrong. Please give me my underwear mask so I can go out fully protected like a good soldier in this great war.”

Manish feels like a bit of an idiot after he puts the mask on. The edges are poorly fitting and leave huge gaps between his cheeks. And although the holes are supposed to let him breathe freely, they somehow don’t work very well, and his breath fogs up his glasses and vision constantly. This becomes a problem that night, when he’s on duty in the Emergency Room and has to intubate (insert a breathing tube into the windpipe) of a patient who is suspected to have COVID-19.

According to WHO guidelines, intubation is one of the most hazardous “aerosol-generating procedures” which carries the highest risk of infecting others in the room, especially those who are doing the procedure itself. Manish should be equipped with a proper face mask, face shield, and covered head to toe in a hazmat-like suit.

Instead he’s wearing a hole-filled tissue paper, his lab coat, and that’s pretty much it. Thankfully, help is on the way.

A nurse walks in carrying what looks to be a plastic version of a medieval soldier’s shield. She places it in front of Manish and instructs him to put his arms through the two holes thoughtfully provided in the shield and then proceed with the intubation. The moment Manish touches the shield, it promptly collapses like a broken umbrella.

“Look the sides are still open, and I’m taller than this shield, so it’s not really protecting my face which I believe is the route of infection. Can’t we get like those decent respirator masks like the ones on the TV shows?”

“Ha ha sir. There’s only two of those masks in the hospital, and those are only to be used in the ICU. Look, I’ll hold up the shield and you can intubate the patient.”

It probably should be mentioned that all this is happening while the patient is gasping for breath and in dire respiratory distress.

“I still can’t see anything because my glasses are fogged up. I might put the tube in completely wrong and then this guy will choke to death.”

Another doctor is hustled in to help Manish and to be his eyes. To avoid infection, since the shield doesn’t ‘protect’ this doctor, he is wearing swimming goggles, and a bandana.

“Are you sure you can see better than me? I don’t think swimming goggles are really good for visibility outside water.”

“Yeah man, I can see just fine. My depth perception might be a little off though, so just factor that into your process.”

After a bit of trial and error, Manish manages to successfully intubate the patient. However, the delay in doing so has dropped the patient’s blood oxygen levels precipitously, and his chances of irreversible brain damage and permanent disability are quite high. But never mind. That only means that he will be on the ventilator for longer, and his family will have to pay the exorbitant ICU rates for longer, and as a consequence the hospital will make a tidy profit.

Although, as a humble employee, Manish won’t receive any share in these profits (those will be distributed among the administrators and senior professors), he is rightly proud of his contribution to the great war and the system which enables such misfortunes to occur. For how else will we fight the pandemic, he reasons, without sufficient funds to do so?

Speaking of funds, Manish is astounded to discover that nearly Rs 5,000 have been “temporarily and voluntarily deducted” from his latest salary, for contribution to the newly established PM-CARES fund. If the PM cares that much, Manish reasons, he can bloody well pay for it out of his own pockets, which are considerably deeper than Manish’s own. Incensed, he storms off to Finance.

“Look, it says that this is a voluntary donation, but I didn’t volunteer, did I? As it is, you leeches hack out a considerable chunk of my pay as taxes every month. I’d like a full refund immediately.”

The Finance Manager sighs, removes his glasses, and starts polishing them with his tie. His whole posture seems to convey a deep and weary disappointment with the selfishness and greed that Manish is displaying. It’s never a good sign when a banker starts fiddling with his glasses.

“See here, we gave you a notice that we were going to deduct this amount.” He points out a badly cyclostyled illegible piece of paper which is pinned up in a dark corner of the room. “It’s voluntary because you didn’t object, did you? However, if you really want to make an issue out of it, please write a written application stating your reasons for refusing to donate.”

“Reasons? It’s my money, I’m a healthcare worker, and nobody asked me, how’s that for a reason? I’ll write out your damned application right now.”

“Also, please attach a copy of your Aadhaar card, PAN card, bank account number, proof of residence, proof of citizenship, and passport number to the application,” adds the manager with a smirk.

This stops Manish in his tracks, as it’s no doubt meant to. Oh shit, he thinks, I’m going to end up on a government blacklist after this. On the other hand, it’s 5,000 bucks. I could buy six bottles of decent whiskey with that money. His outrage re-ignited at the thought of this gross injustice, Manish happily provides the documents and is told that the money will shortly be credited to his account.

It never is.

Lockdown woes

Since the lockdown caught Manish unprepared, he’s been in a mild panic because his booze and cigarettes are running out. Thankfully help is on the way, in the form of one of his patients.

“So, all your tests show that you’ve completely wrecked your pancreas and liver because of your drinking. You’ve got to stop with the alcohol, otherwise you’re not going to live out the year. I’m going to refer you to a de-addiction clinic, and prescribe you some medicines to recover.”

“Doctor sahab, I can’t help myself,” his patient wails. “I run a theka and I always have easy access to liquor. I can’t give up my livelihood so what am I supposed to do when I’m surrounded by so much temptation.”

Manish’s ears prick up at this. He asks the family to leave the consultation room because he needs to “discuss delicate issues of addiction with the patient in privacy”.

“Listen, you run a theka? Do you have some jugaad to get me some booze? Now, you shouldn’t be drinking,” he hastily adds, “but I am perfectly healthy, and maybe if I took some of that liquor off your hands, you won’t be so tempted to drink in the future.”

It’s almost an act of philanthropy, he justifies to himself.

The patient contemptuously smirks at Manish and says, yeah sure, he knows a guy who can provide booze from his warehouse, provided that doctor sahab is willing to drive out to the boondocks. Of course doctor sahab is willing and phone numbers are quickly exchanged. Manish writes out a prescription, and assures his patient that he’s prescribed only the best and most affordable of medicines for him.

The whole purchase is conducted in a manner similar to that of some shady drug deal in a back alley.  The contact who meets Manish is a shifty-eyed mustachioed goon and keeps exhorting him to “keep his eyes peeled for cops”. He sneaks the bottles into Manish’s car and tucks the cash into his underpants, then disappears in his car in a cloud of dust.

Later, after he’s driving back home with a trunk full of illicit alcohol, the shame hits him. I’m an amoral piece of scum and I should be thrown out of my profession. I’ve indirectly encouraged and validated a patient’s addiction. And similar self-castigating thoughts.

Thankfully, after the third drink of that evening hits him, Manish has laid his self-doubts to rest. He knows he’s as much of an addict as that patient of his; and if fellow addicts, brothers-in-arms, won’t help each other out, then who will? Besides, he’s paying his dues to this damn society every single day, giving up his sweat and blood and happiness, and toiling near-selflessly to save their asses.

There’s a line he remembers from a book he read once – “Take what you want, and pay for it”. Who can say that he hasn’t paid in full, and then some?

Drunk that night, he decides to go on a drive and enjoy the empty roads of the city. As he’s nearing one police checkpoint, he sees a cow majestically lying in front of it, gazing around with that air of supreme entitlement that only Indian cows can muster. Manish decides to cut through the red tape and bureaucracy, if you will, and go straight to the top.

“Sir, or ma’am, I’m a doctor and here is my ID and my white coat which proves that I am one. Kindly allow me to pass,” he waves his badge in the cow’s face and entreats it.

The cow continues to chew cud contentedly, but offers no objections. Manish takes this as assent, and drives breezily past the checkpoint, while the nonplussed police officers on duty stare silently at him, but otherwise make no demurral.

The next day, Manish is told by his boss that he’s been assigned to supervise the COVID-19 testing lab in the hospital. The f*** do I know about virological testing or supervision, he thinks, but doesn’t say out loud. What he ends up seeing there, however, surpasses all his previous experiences.

The laboratory

The first thing he notices walking in, is that the doors to the lab are always open, allowing all manner of insects and contaminants to breeze in. Mosquitoes and beetles crawl lovingly over the Styrofoam boxes which house hundreds of highly contagious SARS-CoV2 specimens of patients from across the city. These boxes in turn, are ‘sealed’ with cello tape.

“Look, can we close these doors? Apart from all the risk of contamination to the outside world from these samples, we’re also absolutely swamped with a billion biting insects and I’m finding it a bit hard to work with that particular distraction.”

“Well, sir, we didn’t want any conventional doors in place because manually opening and closing them with our hands increases the risk of infection. So we installed automatic doors.”

Manish glowers at the lab technician. “So, why don’t they close then?”

“Ah, so the problem is that the sensors don’t work. Ergo, they’re either always fully closed or fully open. Better to leave them open so that we can at least escape if we spill a sample, no? Ha ha ha.”

“This is ridiculous. Call Engineering and get them to fix the sensors.”

“Well, we did do that sir,” the tech placidly answers, “but unfortunately, there are no spare parts available, what with the lockdown and everything. It’s okay though, look Pest Control is here.”

He points out a flamethrower wielding persona who’s just jogged into the lab, and who then proceeds to spray the entire area (including the sensitive COVID 19 sample boxes) with nauseating and highly corrosive disinfectants. There’s a rush as everyone scrambles to escape the pungent fumes, and testing is halted for a few hours till the air inside assumes a less Martian-like atmosphere. For the first time, Manish is glad for his N-95 mask, because even if it might not prevent him from getting infected with SARS-CoV2, at least he’s not able to smell the chemical fumes. Poring over the sample forms, he immediately notices another snag.

“It says we received 400 samples from this particular hospital, but there are only 390 patient detail forms attached to the same.”

“Ah sir,” the wise tech, who has now assumed role as Manish’s mentor, advises him. “This happens quite often. Sometimes we get more forms than samples, and sometimes it’s the other way round. What is critical though, sir, is that we assign the proper lab number to each sample and form, and we note the details in our trusty little register right here”, he indicates a Navneet brand school notebook in which these particulars have been painstakingly filled in by hand.

“But that’s insane. How do we know which sample belongs to which patient if the numbers received don’t match up?”

“Sir, are you familiar with eenie-meenie-mynie-moe? Yes? I think a bright young doctor such as yourself will have no trouble whatsoever applying that maxim to this situation.”

Thus encouraged, Manish begins to randomly allocate the samples to patients that he has never seen. His enthusiasm refuses to fade, even after he notices more than half the forms are illegible, and that names, addresses, age, or gender are all malleable to his whims and skills of deciphering illegible doctor scrawls.

Undeterred, he fearlessly assigns impossible names such as “Hnnnan” or “Mrra” to these people. The same names, of course, will be uploaded to the ICMR site to be used for quarantining, contact tracing and isolation of the positive cases.

In that moment, Manish’s imagination and understanding of the Indian system exponentially expands. In his mind’s eye, he sees waves of chaos and incompetence spread out like ripples in a pond, propagating throughout the city and all its inhabitants. He imagines teams of barely literate policemen being handed out incomprehensible names to hunt down and quarantine. He visualises how perfectly healthy and uninfected individuals are mistakenly assumed as positive – then ostracised, isolated from their families, and needlessly tested again and again; all the while the truly infected continue to roam freely and spread the deadly virus.

He understands the comical futility in trying to definitively identify and isolate a single person in a city of nearly 10 million. Half of these people tested have no fixed address – years of economic slowdown and unemployment have seen to that. The Byzantine State which is trying to regulate precisely the location and identity of its citizens, is immediately foiled in this task by its own labyrinthine networks of ineptitude and corruption.

When an ICMR official comes for an inspection of the lab a few days later, Manish tries to point out the myriad problems afflicting them, mostly stemming from the point of collection of the samples.

“Hmm, yes. Perhaps if we develop an app to enter in the details of these people when we take their samples for testing, you could resolve a lot of these issues. I’ll ask someone to get in touch with the Ministry of Electronics and Information Technology and work on it right away,” the mandarin beams, secure that this hurdle has been successfully crossed. Look, his smile seems to say, we in the government are totally hip to entrepreneurship and the latest technology, and we’re absolutely 21st century about everything, yo.

“An app? What’s wrong with a plain old computer? It’s quicker to use and far cheaper and we can start earli…” At this point a hospital administrator interrupts Manish in his tirade, puts his arm around him, and draws him away.

“Listen, Manish, you’re doing great work here, and thanks to you, the lab is absolutely humming along. Only problem is that some of the virologists are complaining and the pace of work seems to be slowing down these past couple of days. Why don’t you have a chat with them and see if you can figure out their problem.”

Manish willingly obliges. The problem appears to be that a box of shoe covers – which had been stored in the lab – has gone unaccountably missing. For the last two days, the entire staff of the lab including the doctors and technicians, has been hunting down this box – to no apparent success.

“Why don’t you just order some new shoe covers?” Manish offers.

The senior most virologist is not impressed with his simple-minded solution to a most complex problem.

“The point is, doctor sahab, we cannot ignore these kind of mishaps and just gloss over them. Why,” he adds with a little sneering laugh, “today it is a box of shoe covers, tomorrow it might be the samples themselves! What will you do then?”

Manish concedes that he wouldn’t know what to do then.

“Whether it’s theft or simple misplacement, we must resolve this issue and punish the miscreants involved! I kept this box personally in my own office, and yet it was stolen in broad daylight, FROM MY OWN OFFICE,” the virologist is screaming at this point, spraying specks of spittle in every direction. This isn’t probably the best COVID-19 prevention protocol, Manish thinks, while ducking to avoid getting spat upon, but never mind.

Manish is afforded a respite when a junior doctor approaches him with a pressing question.

“If I get dengue or malaria from being bitten all day by these mosquitoes here, will I be eligible for the Rs 50 lakh insurance cover provided by the government?”

Manish is stumped, so they both pull out their phones and Google the new Pradhan Mantri Garib Kalyan Package: Insurance Scheme for Health Workers Fighting COVID-19.

“Hmm, it appears that only applies if you die because of COVID-19 directly or indirectly. In which case, your family has to file an application with at least nine forms attached and probably a hundred in triplicate to support the same.”

“Yes, but if I die due to dengue fever, wouldn’t that be an accidental death due to COVID-19 related duty?”  she counters.

“I don’t know. But look,” Manish points out, “it says here that in the case of accidental death, there has to be an FIR filed with the police. Whom are they gonna file an FIR against, the Aedes mosquito?”

Ultimately they decide that the matter is too convoluted to be adjudicated by simple low-level doctors such as themselves. The junior doctor resolves to pose this question to the professors and administrators for clarification. Her contract with the hospital is terminated for “inciting disorder and creating disturbance within the medical fraternity” and for “being critical of the security measures taken by the Government and the hospital to ensure the safety of its employees”.

After that, Manish stays silent and carries Odomos and All-Out with him every time he visits the lab. He’s barely been bitten since.

The author is a doctor whose constant fight against authority and the establishment have left him prematurely bald and grey.

All illustrations by: Pariplab Chakraborty