Thoughts and insights from medical students
Baptism by Fire
There’s a place in my hospital. A godforsaken place, where only the sturdiest of interns dare to tread. It’s a place that’ll give you nightmares, and leave you dreading your next visit. Deep in the bowels of the hospital, like a dungeon of sorts, the Burns ward. Almost a rite of passage, and, forgive the pun, a baptism by fire, for interns as they pass through their surgery posting!
Situated, for reasons of antisepsis, at the polar extreme end of the hospital, the daily trip to the burns ward as a surgery intern was something to dread, a reason to stay in bed when you got up in the morning. Of course, as with all undesirable human experiences, we battled the experience with humour- humour and a failsafe numerical system that made sure you only went once in two days.
As the name suggests, all burns patients were shifted to the burns ward, and the unit on emergency duty that night would take that patient on. As emergency interns, we would run around the ward changing gooey, pus soaked dressings, and “debriding” ( a euphemism for cutting off dead flesh until you hit live tissue...uh, you know, live tissue with live nerves that cause live shrieks...). Every time the phone would ring in the ward, we stopped what we were doing, breaths bated, listening for the tell- tale signs, the furrowed look on our residents face, the resigned expression as he put the phone down; we all knew what it meant. I’ve seen some hard-as-nails residents in my time as an intern, but honestly, no one was immune to the sense of pending doom that a trip to the burns ward implied.
It was the monsoon (the Indian monsoon, believe me, is another story for another day...), and burns patients always, without fail, came in the night. So the call would come, and off I’d go through the dark, damp and desolate corridors of the hospital, transformed from the familiarity of day. We had a shortcut, of course, a cross country venture through the bushes and thickets in the lesser-trod areas of our hospital. Unfortunately, I had once spotted a giant black cobra crossing not four feet ahead of me using the same shortcut ( I was glad we had running electricity and working lamp posts that night!). One would think that a cobra would be enough to dissuade us from that particular route, but sometimes, I swear those five hundred meters of walking we saved were worth a bite!
I admit, sometimes, my imagination runs wild, but with the burns ward, I wasn’t the only one. As we entered that final corridor, we all felt something amiss in the air. There have been, over the years, a lot of deaths in the burns ward, and the tension in the air was real. There would be two nurses on duty at all times, and they would add to the sense of horror with their stories of giant pythons found hanging from the corners of the only exit door.
Of course, the first time round, the residents would accompany us and give the basic life saving orders, fluid calculations, vascular access, etc. But trust them to leave the dirty labour to us interns! From that point on, it was our duty to change the dressings, every twenty four hours. It was an experience that took a toll on us, and dragged us to the limits of our sensibilities.
Try imagining it... a dank, drippy hall with dull tube lights flickering, a room to the side for bathing, another for dressing, and then the smallish wards on the other side of the hall. There were never more than 3 or 4 patients at a given time, and it was never hard to locate them... just follow the moans. Now imagine the plight of these poor patients- not drifting in and out of consciousness, but horrifically lucid, in tune, traumatised since the incident that brought them here, unable to make sense of anything other than their pain. And believe me, when you see a burns patient, you know pain... you can feel their pain enough to never wish such suffering on even your worst enemy. And then, over the course of a few days, you see them slip slowly down that slippery slope... barely able to sit up, hardened skin over their trunks, neck and back, shivering because of the constant loss of fluid and temperature, drooling and mumbling incoherently... it’s our lot in life, our duty, to try our best to heal these poor souls in agony, to bring them a semblance of solace, and sometimes, it gets frustrating watching them slip away. Because with burns patients, you can never tell, a patient with forty-plus percent burns and horrendous tissue loss, can go on for weeks, fighting, hoping for a miracle (and I’ve seen some miracles, too.) and then sometimes a comparatively trivial 10 percent burns case, coherent one day, slips into sepsis or respiratory failure and passes on, right in front of you.
Treating burns patients was a test of our developing skills, too. Searching a charred surface, for a patent vein, performing the odd femoral puncture, these were the little things that felt like small but significant victories against a barrage of daily depressions. Gowning up from head to toe, with double gloves, trying to remove the old soaked dressings and quickly debriding and coating with sulfadiazine, and then wrapping the patients up, quickly, efficiently, all while trying to minimise the pain we were causing...once I got over the initial horror of the burns ward, it was truly one of my most challenging learning experiences as an intern. Of course, by the time I was finished, I would be drenched in sweat, and aching all over!
The burns ward had a profound, sobering effect on us as interns. This may sound silly now, but many of my colleagues have recounted stories of seeing visions of their burns patients, hearing them moan in the night, as they tried to catch some sleep in the duty room or in the hostel. Once, a friend of mine dressed a patient in the middle of the night and sneaked off for a nap, later on, only to be haunted by the poor girl’s face in his sleep. What made it worse was that we found out the patient had indeed passed away that night.
But the burns ward experience was not just about the physical burns... in India, burns patients come with some intricate overtones. Many, many of the burns patients tended to be young, newly wed girls, with tragic stories. Of course, they all came with “accidental burns” from cooking oil, or spilled kerosene (it was uncanny how many times people expected us to believe the kerosene had just spilled). But the sad, undeniable truth was that many of these cases were actually done very much on purpose, by uneducated, uncouth, and inexcusable in laws, or husbands, as punishment for a variety of “crimes” the poor bride was blamed for, ranging from not bringing enough dowry, to giving birth to the wrong sex of child. Imagine the emotions in the air, when the girl’s parents would bring their poor daughter in, imagine the paranoia when sometimes, it was the in laws who brought these patients in, acting ever so normal.
There are things that happen in my country, that still go on today, that make me sad and ashamed. But along with the sadness and frustration of the poor relatives as they watched their daughters and sisters slip away at the hands of the people she called family, along with our own frustration at these archaic, barbaric practices, there was the small consolation, almost gratification, as our residents and doctors played a pivotal role in bringing those foul players to justice. Sometimes it felt like such an anachronism, to be working on the cutting edge of medical science on the one hand, but then having to face the realities of working in a society that simply refuses to move into the modern age.
It wasn’t all tears and anger though. We witnessed the odd miracle too. I remember once, a young baby of not more than 6 months, who accidentally fell into hot water. I remember his family, crowding around him, consoling him, trying to ease his pain, cajoling him, looking on in silent reverie, as we tried our best to save him. I remember the nurses, and even the “cold hearted” residents, melting away at the young boy’s plight, talking about him in the wards, thinking of him in free moments. When that boy was in the burns ward, you could feel the prayers of well wishers in the air. And when he pulled through, and news of his impending discharge percolated through to the ward, I remember the atmosphere of raw celebration that filled the normally drab wards that day!
Like pretty much every other part of my internship, the burns ward taught me, taught us all, invaluable life lessons. The kind you only get to learn when you are over worked, with your back against the wall and surrounded by despair. And yet, there we were, battling it out every day, taking it one day at a time, trying, in our way, to bring about the rarest of miracles that happened every now and then, and it was the hope of those miracles that kept us all going.