An ambulance wails in the distance as I hurry into the building. Like every other intern in the ER, that noise strikes fear into my heart. It is 8.01 am and the hospital corridors are deceptively empty. Inside the trauma ward, doctors and nurses sit with bated breath, anxiously awaiting the onslaught of patients.
A lone cleaner is feverishly mopping the floors. She shoots me a scathing look as I inadvertently walk over her efforts. I hurriedly get out the way before she ‘accidentally’ whacks me with the mop.
“Dean rounds today”, the Trauma nurse warns me, casting a disdainful look at my crumpled and not-so-white-anymore coat.
As I round the corner, I spot the Casualty Medical Officer (CMO) ambling towards the Triage desk, where my co-interns are already seated. Oops! Doing my best to be unobtrusive, I speed up my pace. The CMO pauses to chat with one of the nurses.
Without missing a beat, I sprint across the hallway and stumble into the swivel chair. The rickety chair tips dangerously to one side as I grab at the table for balance. Not a pretty sight. But mission accomplished. The CMO distractedly glances our way and looks satisfied at the presence of all three day-duty interns.
The ER is a particularly memorable time in the life of an intern. Between triaging patients in Casualty and treating them in Trauma, it is our first opportunity to feel like fully-fledged doctors. While the medicine intern is forever in the pursuit of missing lab reports, and the surgery intern is doomed to the operating theatre, hanging on to a retractor for dear life, the ER intern struts around with a self-important air, occasionally pausing to peer knowingly at X-rays and ECGs.
My reverie is cut short by the sound of a siren, which abruptly stops as the first ambulance pulls up in front of the Casualty entrance. Doors slam and a flurry of activity begins outside. My fellow interns and I trade apprehensive glances. There’s no telling what will come through those doors.
Barely 15 minutes later, we are in the midst of a maelstrom of broken bones, bleeding noses and chest pains. We scrutinise the horde for the sickest ones, so that we can get to them first, then document and diagnose the rest. The CMO drifts in and out, making sure we don’t bungle anything too badly.
There is a brief uproar when it turns out that a snake-bite victim has brought along his assailant (dead, thankfully) in a plastic bag – for identification and diagnostic purposes. We all take turns inspecting the snake, not that we have any clue how to determine what kind it is. The bite wound, however, is bad enough that we promptly dispatch him to the ICU for antivenin.
After that bizarre incident, the day descends into a dull monotony. Turns out people do the same stupid things day after day. They crack their skulls open in motorcycle accidents, ingest everything from yellow dye to rat poison, stick all manner of things up their nose, and assault each other with pressure cooker handles, apparently.
As the crowd begins to thin, I duck behind a crash cart for a momentary respite. Something nags at the back of my mind. I poke my head out and catch the nurse’s eye. “Hey, wasn’t the Dean supposed to come for rounds today?”
She gives me a funny look. “He came and went a long time ago, doctor.”
The time is 2.17 pm. No wonder I feel ready to drop. I pull out my phone and open the Swiggy app. Just as I finish paying for my paneer tikka rice bowl, I notice the CMO talking into the phone, looking grim. That typically means only one thing – a VSP (Very Sick Patient) is headed our way. What will it be today? Head injury? Amputation? Plague? I get the feeling I won’t be eating lunch anytime soon.
My prediction comes true 45 minutes later when the arrival of the Swiggy delivery guy coincides with the arrival of the VSP.
The 17-year-old is unconscious on arrival, with yellowed skin and a breathing tube in-situ. I read the referral letter over the CMO’s shoulder. Paracetamol poisoning, it says in capital letters. Non-accidental ingestion of 50 tablets of paracetamol 22 hours prior to referral.
As hasty phone calls are made to the ICU to set up a ventilator, I sneak a peek at his lab reports. From the dangerously high numbers, it is clear that his liver is failing. Rapidly. Should medical intervention fail – and it most likely will – his only chance of survival will be a liver transplant.
Unfortunately, getting a healthy liver for transplant is nowhere as easy as buying a strip of paracetamol in a pharmacy. Nearly 5 lakh Indians need an organ transplant of some kind, but only 2-3% of that demand is met. Had that 17-year-old boy even fully understood the consequences of what he was doing? Too late to wonder.
I watch as they wheel him away.
Sowmya Kruttiventi is a newly minted doctor trying to do her bit to contribute to the Sisyphean task of public health education in India. You can sign up here for an organ donation pledge card.
Featured image credit: Pariplab Chakraborty