Over the last few days, I’ve started observing at one of India’s most advanced, most crowded and most over-utilized and understaffed hospitals. I’m starting in the Orthopaedics department, so in the last two days I’ve seen things clinics, outpatient departments and a couple of surgeries- including two spinal fusions (or spondylosyndesis- for the technically minded) as well as the beginning of a surgery involving a severely cut hand which was spurting blood from a severed radial artery branch.
It’s a different world in this hospital- there are patients in all directions, waiting in hallways, on floors, in every situation imaginable. The patients are waiting patiently, waiting for a doctor to come through quietly enduring whatever they’re suffering. As the doctors come through with a bevy of senior and junior residents on rounds they spend barely a minute talking about a patient. They don’t talk to the patient, nor do they attempt to explain anything. They discuss it amongst themselves, reaching a decision on how to treat the patient, with a look at the diagnostic imaging, a glance at the wound, and a few words from the resident who looks after the patient. The first few patient interactions, I was shocked- how could one responsibly be doing this, I wondered? Then, I saw the number of patients. Day one, we rounded on over a hundred patients in a little over an hour. After that, each resident had to run to get to doing all they had to do- be it treating, testing, surgery or whatever. As they do so, they speak to their patients, telling them what decision has been reached, how they will be treated and an estimation of when.
These residents and attendings are treated by patients and patients families with a reverence that is amazing to see. The paternalistic philosophy of medicine is very much alive and well here- the patients are not consulted about their decisions, they are simply told. Decisions are made and communicated to the patients, and for a vast majority of them, they seem to like it. The physicians act and are treated like rockstars, with admiring glances and awe in their wake. It’s a heady combination this, and I can admit to getting swept up in it as I go along. But, for one, I feel like a bit of a fraud in that white coat- I’m a second year med student, not a practicing orthopaedist and I still have a little trouble reading CT scans. So each time a patient comes up to me, with a look on their face that grants me that same level of awe, I feel not yet worthy.
Day two, as we rounded, I saw a woman badly injured, lying on a gurney unconscious. We didn’t speak about her or discuss her, nor did we even acknowledge her presence. But as I walked by and looked her mother and sister in the eye, I felt this sudden urge to speak to them- not for the minimal medical advice I could have given, but to perhaps offer comfort in a difficult time. I understand why it can’t be done in the restrictions one works under in this type of system. Yet it makes me wonder if doing so for years will make one detached and cold to the people one came into medicine to treat.
Each day more patients requiring an OR come in than can be treated by the staff and resources available. So, the backlog grows day by day. The numbers of patients who need closed reduction grows in such leaps and bounds, that they require a day in the hospital but stay a week.
That being said, I’ve seen some of the faculty do amazing work- surgeries with a cleanness and economy of time, energy and resources that speaks of their comfort and competence. At the same time, as you walk the floors of the wards, you see what they’re up against- the sheer numbers that could overwhelm their prodigious skill, and the constant fear in such overwhelmed hospitals- infection. I can only imagine how they must feel, their pride in a perfect spine repair or reduction being reduced to bitterness when their patient dies from an infection acquired due to too many people in too small a space.
I will try to post regularly as I go along, but that’s assuming time permits.