If Only...

Lessons from life

Looking through the rear mirror, Sanjay reverses his Maruti to the right side and deftly manoeuvres it in the last slot available at the parking lot of the Central Park. As he pulls out the ignition keys, everything gets quiet. The nip in the fresh morning air sweeps his lethargy away, clearing the smell of the petrol fumes spewing from his car. His car is long overdue for it’s service.

Getting onto the winding walkway, he tries to step beyond the inertia of the first few hundred metres after which, his body would naturally fall into the well-accustomed groove. Though it’s almost a fortnight that he has returned to his favourite track.

The compulsions of his private practice are eating into the exuberance which he has been known for. Working hard to attract increasing number of patients to his clinic, then squeezing time to attend to all of them, solving the nitty gritty of his double-storey clinic in the congested by-lanes of the walled city and then attending to late night parties with the fellow private doctors leave him exhausted at the end of the day. He knows he can draw upon the reserves of his active sporting life of his medical college days. But how long?

The freshly painted milepost with 250 metre mark has just passed by as he is consumed by the perfumes of the park which usually prepare him for the fumes of the coming day. But today he is bothered by an unpleasant salivation building up from his food pipe since last couple of minutes. This is not dissimilar to the feeling he has after an alcoholic binge with lot of salty snacks thrown in. But the last such party was three days ago, he reasons with himself.

“Hello Doc Saheb,” a group of morning walkers greet him,” seeing you after a long time.”

They are gone without bothering to listen to his answer.

He is back with his morning walk with its passing pageant of tentative greening and monsoon lushness.

A few birds have descended on the clumsily scattered remains of the bread crumbs which have escaped the attention of the squirrels flitting around nearby. His train of thoughts gets severed by the uncomfortable blowing of the horn of a Roadways bus. As he takes a turn at the bend, the moss-laden walls of the SMS Hospital building peep through the thick cover of neem trees scattered around the Tonk Road.

And with it the memories of his numerous visits to the Goverdhan’s shack, across the road for endless cups of sweetened tea and rounds of omelettes during his student days at the medical college jostle for a space in his weary mind. He is surprised that even the thought of the smell of chilly and onion studded omelette is sending him into an unexplainable nauseating spell today.

The name of the DGP inscribed on his bungalow is not visible clearly as a tall climber has come up on the railings of the park. Save for an occasional two wheeler or an ambulance, the main arterial road of the city is relatively quiet at this time of the day.

The discomfort all along his front of chest which has been lurking till now claws back to noticeable severity for a few minutes. Sanjay dismisses it as a spasm of the food pipe because of the pan masala he consumes so frequently. He carries on, but slows down. He has to.

A few steps more and the pain gets more intense. It’s only a kilometre he has come and another three remain to be covered.

The phantom scent of Raat ki Rani by the side lingers like post-coital languor. The pink and peach blanket of the bougainvillea shrouds the track till the far end of the view.

Another lap of 250 metres sends funny sensation to Sanjay’s jawline. He realises he can’t carry on any more. He decides to return and rest for the day. After all, the last few days have been very hectic when he had to do the running around for setting up of a new equipment providing a battery of new blood tests. The application engineer, who is here from Delhi, can always wait.

A few auto rickshaws are plying on the road outside. Should he call them and go to the SMS emergency? After all it is the largest public hospital of the area. He is not sure whether he will find somebody known to him there. Most of his batch mates have already travelled far and wide and settled in other cities. Recalling his own residency days, he fears the ER(emergency) may not be well-equipped.

The bright morning appears to be hazier now and a strong taste of bile regurgitates in his mouth. He tries to shove it back into his system. Suddenly, the pink of the eastern sky appears dirty as Sanjay’s spright leaves him. The rustling of the leaves and the squawking of the parrots on their sojourn for the day suddenly appear distant as the palpitations tend to drown him into a momentary lapse of concentration.

And now it’s his shoulders which are bothering Sanjay. The dull ache, when he used to be serving overhead during his tennis days, seems to returning, strangely though. Sanjay is quite unable to make out the variety of new feelings he is getting today-from jaws, to shoulders, to his upper chest and the sense of abdominal uneasiness. He doesn’t remember any clinical syndrome except the gastric reflux, which can explain his present predicament.

All that he has been holding back for last half an hour is released in a projectile trajectory as he vomits out just near his car. He feels embarrassed and helpless. But he is relieved too. A final lurch to his car, a loud bang at the door and a quick awkward take off finds him on the road to his house just two kilometres away. The thought, which has been nibbling at him, rears up once again as he crosses the SMS hospital. Should he enter the hospital ? Should he avoid the centre which used to be his dream when he had entered the medical school?

Bothered by similar episodes of pain and burning in the chest in the past, he has even had his ECG done which had always been normal. How can a fit person like him be that sick to enter the hospital as a patient? He has been conditioned to be in the hospital in his customary apron and never in a patient’s gown. Faced with the first death of an alcoholic in his ward, Sanjay had been woken up at nights thereafter drenched in cold sweat and dreaming of the patient’s ashen face imploring him to save his life. But after that, the idea of mortality and disease afflicting himself had never disturbed him. Books and lectures during his medical school days delved into fixing of health issues, hardly about death. Never about death of a colleague.

Dismissing the idea of going inside the hospital, he courses along the road. The morning breeze is cool. Only that his palms are sweating and he seems to be losing control on his steering.

People must be up and about by the time he reaches home. The schools have already reopened and Pratul, his son, has been going through his grind for the high school boards. From the soft sound of the popping of the gas flame, to the clinking as the Acquaguard releases its first drops in the steel container, to the incessant rattling of the cutlery, to the impatient calls from the bathroom by Pratul and to the last minute rush for packing Pratul’s lunch for the school- the morning is always a disorganised mess and Sanjay is always happy to be away from all this into the calm environs of the morning walk. They all would be surprised to see him return so early.

The car lunges in the drive way, as his grip lets go the steering. Some disorderly pounding in his chest suddenly degenerates into a weakening rhythm and he slumps like a log on the hard floor. “Call Doctor uncle,” the panicked call by Pratul fades away as Sanjay falls into deep unconsciousness.

Hearing the babel of the shouts and cries, Ashok, a physician living next door, arrives and gets working on Sanjay’s chest for an effective and aggressive cardiac massage instantly. Sanjay responds. The staccato breathing gives way to a more organised pattern. A sharp stabbing pain in his lower ribs has replaced his previous central pain. He complains.

“It’s the cardiac massage which I just gave, " Ashok talks to himself as he is himself breathless and petrified at the sudden turn of events in the morning.

“Where are we headed to?” Sanjay mumbles and goes quiet. Ashok ignores. His thoughts are racing faster than the car which Pratul is driving. Sanjay threatens to go into an episode of stiffening of his limbs with some frothing from the angle of his mouth. Before Ashok could act, he quietens. Ashok feels his pulse. It is weak and thready.

Soon the car has to slow down near the SMS hospital. The road is congested. Attendants are out there to fetch some medicines scribbled at the last minute by the house surgeon before their patient is taken up for surgery or to get their flasks filled with freshly prepared tea from numerous shabby shanties lining up the road. A crowd has spilled around a temple by the side. Most of the devotees are attendants who throng the place and pray for their patients inside the hospital. Plying impatiently through them, the car surges further, past another small cardiac centre, and heads to the far end of the city, where stands the Regency hospital, the latest addition to the cardiac facilities in the region. Ashok is assured that things would be easy once they reach there.

Regency Hospital

Few minutes and many more ominous grunts later, the car swerves in the glass-cladded hospital porch and Sanjay is immediately wheeled in the adjacent emergency room. The space is well-lit and smelling of freshly mopped floors and spirit. With the predefined protocol for resuscitation thrown into action by the duty doctor and the businesslike nurse, Sanjay stabilises and seems to be breathing at ease now. It’s only that he is drowsy and on blood pressure augmenters. After analysing Sanjay’s ECG, which shows a mild attack, the cardiologist suggests for an emergency angiogram. Soon enough, the procedure is through. It reveals no massive blockages in the blood supply to the heart except for a small piece of clot hanging in one of the branches.

“It means no angioplasty and only blood thinners,” says the cardiologist.

“But my father is not coherent.”

“It’s probably because of the time his heart and brain had been in hypoxia or lack of oxygen, while he had collapsed and was being shifted to the hospital.”

This was the moment when Sanjay’s family stepped through the looking glass and embarked on their own confrontation with the reality of morbidity and mortality.

What followed was days and days of waiting endlessly outside the swanky ICU, for the briefs from doctors and then hoping that things might turn around. Starting with a sole cardiologist, the army of treating doctors kept on increasing with an ICU expert, pulmonologist, nephrologist and a neurologist joining the bandwagon. The catastrophic onset, characterised by a precipitous fall of blood pressure and oxygen for a few moments, decayed into an unstoppable downhill descent with progressive organ failure.

Groups after WhatsApp groups of doctors and his batch mates were full of description about Sanjay’s unfortunate turn of events and discussed the course of management to length. Friends from his medical school dropped by, went inside the ICU and came back saddened after seeing Sanjay drugged to oblivion and tubed in most of his natural orifices and some artificial ones.

Hooked to the ventilator, a swollen Sanjay lay in that borrowed, fluorescent place. Death was certain, only the timing wasn’t.

“He may respond,” one would tentatively tell his son.

“There may not be any long term consequences,” other would talk to his wife.

Words like respond and long term provided a false and reassuring gloss on a dire reality. Surely, they themselves never wanted to go like this, where technology sustained the organs until the patient is well past the point of awareness and coherence. The end would come with no chance for Sanjay to have said good bye or “it’s okay.”

But the question which kept following all of them till they walked outside and to the dark basement parking of the magnificent hospital structure was, “Could Sanjay have been saved?”

If only, he had not ignored his “gastric symptoms.”

If only, the medical aid had been there a few minutes earlier, when the blood supply to his heart got blocked by an ugly clot sending his heart into a storm of disorganised beats and the ensuing unconsciousness.

If only he had turned his car inside SMS, during those initial crucial moments when his heart muscles were crying for air and all it needed was to be entrained into a cadence of normal rhythm and some respiratory support. The clot had struck, and struck hard but had cleared on its own as was seen in the angiography which followed.

Many times, ‘shelter from the storm’ is the ‘hope’ of not perishing in the storm. SMS, the humble SMS, the innocent SMS still stands there as a hope for thousands of sufferers of the region to weather their storms.

Based on a true incident. The names have been changed to respect their privacy.