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Sunday, 30 June 2013

IT'S NOT ABOUT MOURNING .........written by Dr. Brijeshwar Singh

इस लेख को पोस्ट करने का कारण

सोशल मीडिया पर मैं हमेशा मौजूद रहता हूं। एक सनक की हद तक। सोशल मीडिया पर अच्छे लोग भी मौजूद हैं और बुरे लोग भी। अच्छे कम। बुरे ज्यादा। अक्सर मेरे साथ फेसबुक पर वे लोग अवतरित होते हैं, दो-चार महीने में,जिन्हें अपनी कोई तस्वीर अच्छी लगे। वो तस्वीर वे मुझे भी जबरिया दिखाने की ठान लेते हैं। और आ जाते हैं, अपनी तस्वीर मुझे दिखाने, मेरी फेसबुक वॉल के माध्यम से। 30 जून 2013 की शाम करीब 6 बजे मैंने बड़े भाई, पूज्यनीय डॉ. बृजेश्वर सिंह का अर्टिकल पढ़ा। अर्टिकल का पहला शब्द है...She....और आखिरी शब्द हैंकहने का मतलब यह कि, पूरा अर्टिकल पढ़ने के बाद ही रुका। मुझे लगा कि कम-से-कम 30 जून 2013 की तारीख में तो मेरी फेसबुक फ्रेंडलिस्ट में किसी ने इतना वजनदार और सरोकारपूर्ण व धरातल से जुड़ा अर्टिकल नहीं लिखा या पोस्ट किया है। सो CRIME WARRIOR के माध्यम से आप सब तक भी पहुंचाने की उम्मीद में पोस्ट कर रहा हूं। एक अस्थि-रोग विशेषज्ञ के हाथों लिखा अर्टिकल नहीं है यह। अगर ऐसा होता तो ये अर्टिकल शायद कभी भी कम से कम CRIME WARRIOR पर तो पोस्ट नहीं होता। यह अर्टिकल लिखा है, एक इंसानियतवर इंसान ने। इंसान की नज़र से... इंसान की सोच से.....बिना किसी ताम-झाम के। इस अर्टिकल में कहीं भी किसी फिल्मी स्टाइल की पटकथा लिखने वाले लेखक या फिर किसी उपन्यासकार की आपको सोच दूर-दूर तक अगर नज़र आये, तो आपकी शिकायत का भार crime warrior के कंधे उठाने को तैयार हैं।
-crime warrior-

Dr. Brijeshwar Singh
She left my chamber with tears welling up in her eyes. I wish I could understand her at that very moment, perhaps I didn't realise .,,,,as I was preoccupied with a cram full out patient clinic, but later in the evening when I saw Sachin mishra .........a head injury patient in neuro ICU .........his condition was even worse than before....I could make out why she was so worried for Sachin .
She is my cousin. She is working for my hospital as an ICU supervisor. 
She is popular as NEERU didi. 
Sachin was on ventilator for last one week...., he had severeBrain trauma with fractures ......result of a ......macabre road side accident leaving two severely injured and one dying on the spot, attributed to a deadly combination of alcohol and headlong driving .......Sachin's cousin suffered poly trauma and underwent a Number of surgeries by me and general surgeon though he too was serious initially .....but we finally SAVED him ...... 
What could be the BEST was done by the striving Neuro surgeon for Sachin , whose initial chances of survival were remote .............,the neuro made an urgent tracheostomy And kept him on Ventilator , Mandatory to save or prolong his life .. Simultaneously he clearly explained poor chances of Sachin survival to his parents and relatives, yet they were hopeful for any miracle to happen .

That day Neeru came quite early for ICU rounds around 5 in the morning , and was baffled on the sight .......with blood oozing from the tracheostomy site of sachin,as well as the sleeping ICCU staff ...since how long were you guys sleeping , she roared , didn't you notice his bleeding, “You have to get lost before you can be found.”in a mean time the oozing and gasping Sachin was resuscitated by the duty doctor and team , "............but she relegated both the duty staff..

What a wilful stupidity,she let out a big sigh..and extremely furious,when she found those two guys were again on the same duty, next day.
how dare you come on duties, she hit the ceiling, when they were called in the duty room..
and without letting them to say any thing she called the administrator instantly,
No way I cannot digest such an ignorant staff, Mr chauhan ......... if you have a shortage of staff , why didn't you tell me two days earlier and she banged the phone...

Could you spare 5 mt , want to have a word with you bhai, she inrushed in my jam packed chamber.
Relax!! I ll manage, could you please wait for a few mts, we will talk after these two patients .
Ok bhai she softened,and sat amidst the patients.

Nothing had yet been done about this ICU , waved off my suggestion .Brother , he is just 23 and the only son ,what will happen to his poor parents , if some mishap would occur .she reeled off the long list of complains of patients ...attendants against many staff, we need to chuk them out immediately otherwise ..
Sorry, you'll just have to tough it out, see we don't get trained staff so easily ,we will certainly punish them for their negligence, but expulsion is not the only solution.i tried my best to convince her .
..she had tears in her eyes .. I assured her for a meeting ,but she wasn't satisfied,and left my chamber..
She was pretty tenacious in terms of getting something , and NEVER settled for what' was 'practical' , since her childhood ,but late in the evening when I saw Sachins condition , I realised , these kind of patients need a very meticulous nursing care, and even a slight ignorance could change the outcome.Though he was serious when he arrived but definitively his health had detoriated after the oozing episodes..
She swore , never to be silent on even a bit of ignorance from the hospital staff, doctor or management , the day she joined the hospital , as she had herself suffered appallingly in the same hospital .
May be instead of her..........................her husband would have been working for the hospital today... Surely she cannot forget that very long and awful night of ICCU when her husband Nearly lost his battle of life .

Even today it does not seem a talk of yesteryears though it's more than 7 years..........................the happily married Neeru and bobby lived in a joint family......bobby was a great help to my hospital....... as well as me..
My mother believed that there was no point in raising and educating a girl child in the remote village,as she remained uneducated in spite of her sumptuous she adopted Neeru from my real uncle for her brighter future.. 
Like us she got good education,values,and freedom of thoughts, though she married by a choice of her own...................,as bobby hadn't any govtt service background , as my parents wanted so we were a little reluctant initially but later bobby proved to a Amazingly simple ,Intelligent and humble with his god gifted charming personality, and he became more of a friend than relative,as soon as this hospital was made...he was the first person who took over as the PR of hospital and soon he was our strength in managing the whole system.
Everything was going alright till dec 2005....... they had two lovely kids,and a happy family , bobby was working for the hospital apart from managing his own school, 
Extraordinarily a person like bobby was rare, amid all our relatives and friends..
It was dec 2005 , Sentient bobby had some issues with management and ,didn't come to hospital for three, four days, ..........then this issue was brought to me , perhaps being extremely busy in my clinical work I didn't envisage on the hoof.. So some how due to my ignorance ,I couldn't intervene .... And a week later on a chilling evening I received a SMS 
Dearest bhai,
Ive been used, abused, and taken for granted.
I have been hurt by the ones Ive loved, and rejected by the people I called my friends. 
And don't tell me you don't know.
Bhai !! you believe I am yours, I'm your Bobby...
It was quite a strange for me , you must be joking bobby I thought .
Ohh , it's Saturday night , you are drunk go home. I wrote.....
I'll come back if you tell me that you'll , never leave me till I die . 
What a crap he is writing I thought ......what happened to this guy but I avoided to call as well reply .. Though ,it appeared a fraught with some danger ..but again I ignored it ...
Same night my mother asked about bobbys matter and insisted me , to mull it over... Then and there..I told my mom ,that he is drunk right now , any other day I ll see..
Before I could leave the hospital that day around 3 am in the night, what a perturbing emergency I received ,Bobby and his friend as an injured...they met with an accident at NH 24 two hrs back and were brought by police to the hospital ..
Bobbys condition disquieted me like hell!!! And at the same time i had the guilt of not taking bobby seriously too.
, he had. multiple bruises all over the body with a few fractures With sever pain in his abdomen , ultrasound showed a mild collection of blood .
. While looking at him it was needless to ask how it had happened .he him self felt ashamed , ..........we were up fuddling all evening, and after that I didn't remember how it bechanced. Sheepishly he said sorry bhaiya , 
and one more thing , please don't tell any thing to Neeru about this inebriety .
ok I promised ..
and before I could anticipate Neeru was there with her inlaws and in no time there was almost all members of family were there, and all thanked the almighty for saving his life...
bobby didn't require any surgery and was merely kept under observation. But he was not getting relief of his pain in abdomen , but doctors including me didn't take this complain seriously, as all his investigation were with in normal limits.
For us our General surgeon 's words were like a complete assurance that he is out of danger,so we could only wheedle him despite his intractable pain. Bobby still had dull ache when he was sent home with repeat almost normal Ultrasound. 
With in a few days of stay at home he was not able to eat properly , and lost weight drastically. As We were all very much disquieted about his health, his parents took another opinion for his abdominal pain . Dr Dutt is a one of prominent amidst the very good surgeons of the town and good friend of mine. He felt sorry for the delay in ct scan as he could detect the severity of adhesions in ct scan," Now I am not sure Whether we can set it straight or not" With open surgery ..alas !! It's delayed... Dr Dutt didn't look happy for bobby , we too puzzled with the situation, and planning to go back to the drawing board. I touched base with Our GS again regarding bobby condition on the same evening, he admitted that CT should have been done earlier,but still no harm we will operate ,we had witness many miraculous surgeries of GS .so I had planned Bobbys surgery ,without a shadow of a doubt.
Two days later bobby under went bloodcurdling surgery , most of intestine was rotten and adhered, that had to be removed , first time I saw our GS struggling on the table as a sweating cobs ,.........,I made a big mistake , Never put your faith in a Prince. When you require a miracle, trust in a Witch.” remorsefully I thought, I couldn't stay just left the operating room merely god dependent ,"not everything that meets the eye is as it appears". I dismayingly whispered . 

Perhaps Crestfallen me , just couldn't utter a word in front of bobbys relatives, wanted to spent few moment in a lonely place,but had to go for waiting outdoor But the big question of course remained on my mind , .what would happen to this boy ?? .....

Surgery was being done with resection of almost half of intestine, and anastomoses , I made the best of a bad situation , he is out of OT , GS informed me on phone. Thank you sir , let's hope for the best... I greeted him .
Two days later bobby was shifted to the private room, and he was almost alright apart from few minor complains, I was bit relaxed with the situation and next morning I came to Lucknow, for some work, same afternoon Neru called me up , bhaiya he is not comfortable , so please talk to some doctor, I assured her for everything , and same evening I returned back , and went straightaway to hospital to see bobby, till that time his condition ameliorated, and we had a peaceful sleep.
Next day bobby had abdominal distension and difficulty in breathing, so he was shifted again to surgical ICU, due to abdominal problem , i called my doc friend dr harsh deep sahani who could diagnose it is a case of ARDS , and advise urgent support of Ventilator . Even being blighted, we had no choice, but to put him on ventilator, but again the question was for how long,and is it safe to rely on our other doc who were there only for a make shift In place of our own renowned intensivist alas ! who was out of town... Bobby was induced and kept on ventilator , two days passed on vent, and his chest also improved a bit....
The minute you think you've got it made, disaster is just around the corner.. How true!!!
it was almost 3am in the morning , in surgical ICU When bobby on ventilator became awake for a while ( as the effect of drug was washed ) and he started struggling for removal of his ventilator tube, just to make him relaxed on ventilator he was repeated the paralytic doses of relaxant , perhaps bobby fought , and removed his tube simultaneously , while he was been given relaxant...... Without tube if you give relaxant what would happen?? Only DISASTER!! 
Due to accidental removal of tube ,he was off oxygen for more then three minutes.sister and ICU staff called out for intensivist dr somesh mehrotra ,unfortunately he was out of town for conference substitution anaesthetic on duty called upon ,please come immediately .sister yelled on phone..
within no time I rushed to ICU. Bobby 's Condition on the monitors tore me apart,I became very nervous and giddy , never felt such helpless.
what went wrong, alas,he was pushed from one disaster to fall into worse.
Bobby was dying beyond all means. Both the anaesthetist rushed to Surgical ICU .
We were all struck dumb while resuscitation was going on , intubation was difficult due to lot of frothing ,lot of IV drugs infused, intra cardiac adrenalin , no response... Then defibrillator was used .once , twice, . Slight cardiac activity appeared, still BP was not recordable ,while looking at ICU monitors ,an animation appeared , so there was hope,......a little hope 
we could read the Fresh calm countenance of anaesthetist who was struggling and sweating initially.
With the Persistent efforts of both the anaesthetist, what seemed hopeless , turned to infuse life in bobbys body .His cardiac activity appeared, respiration was regained but seriously comatose eyes not responding to any stimuli , that mean Brain activity still not appeared, would brain be functional again couldn't say!! 
Probably brain was grossly affected due to cutoff of oxygen for a pretty longer period ,and we were not informed by the SICU staff.
It was an immense heartbreak for our family ..
And I'll never live down the fact that untill now all vicarious responsibility was mine ,
And unless we embrace a new strategic approach, it would be a hard pushed to save bobbys life .
Being so much miffed with myself ,Just didn't want to take more responsibilities .
And started taking opinion, regarding his prognosis , famous neurologist dr vinays gloomy prediction, so downhearted me that I gave up all hope .." Diffuse axonal injury" due to lack of blood supply and oxygen to his brain,its a pity brijeshwar he has become almost vegetative now!! Dr Vinay said it, ...dispiritedly 
Oh my I felt really bad inside,just want to break out in tears,just wanted to release my feelings of disappointment , my plans didn't turn out the way, I thought they would . Bobby was shifted to Delhi, in ventilator ambulance , my wife Garima along with Neeru accompanied Bobby, almost the whole family except me went along , I was so exhausted and agonised, I couldn't have enough courage to move to Delhi . 
Sick Bobby who had yet to reach Gangaram hospital developed severe hypotension near Gaziabad and he had to be admitted in fortis hospital Noida where emergency resuscitation saved an almost a dead bobby but docs were not hopeful even for his life..
I remained in Bareilly and was in constant touch with constantly blubbering Neeru and Garima for news of bobbys health at regular interval .

Although the next morning with a Series of doctors we consulted reports of bobby in Bareilly , Lucknow,Delhi. "Nonetheless heart didn't want to give up until any miracle happens"..whenever my mind said ..."give up, heart whispered one more try"
Hereafter many astrologer had been consulted on the same night , myself went to several small narrow alleys,did donations to mendicants and paupers ,orphanage, tantra mantra every thing we tried, finally somebody suggested to Balajee darbar in Bareilly ,I went there , they issued a decree to go to Main Balajee darbar in Salasar Rajasthan .and I prepared my self to go to that place after seeing bobby in Delhi ..
Just Wanted to go Balajee , for the sake of bobby ,and merely putting his life in the hand of lord hanuman , at his disposition , what else apart from prayer from the depth of our heart, starve and fast with full sanctity ,I could do...

finally bobby was shifted to Ganga ram hospital ,and with the help of cardiologist friend Dr kandpal , he also got the bed in ICCU .No assurance was given from the team of highly experts doctors, still after 48 hrs of admission in ICCU his condition was not stable ,every information of any significant fluctuation in vitals tend to stir us every time, and we start praying for bobby As a last resort,and pray for NEERU as well to give her strength to endure this difficult time. 
Two days later I reached Delhi, with the help of my cardiac friend , visited ICCU at an odd hour Of non visiting time .. Last three days of ICCU made bobby ineffably emaciated, 
I couldn't hold my tears, it just rolled down on my cheek.
I was deeply moved, to see Neeru who was waiting out side the ICCU, sobbing inconsolably, I hugged her and cried together , sister don't cry , we have to stand the pain ...Please take care , finally I made tearful entreaty ,please take ultimate care of bobby ,to Dr kandpal , and left for Balajee Rajasthan to beg life for bobby ..
As Bobby was advised he underwent surgery for leak in his abdomen , famous GI surgeon performed it,and that part was well controlled , but he remained inICCU for another two weeks for his other medical problems, later he was shifted to semi private category . Neeru had to look after her two pitiable kids so she returned to Bareilly , parents of bobby were there for care of bobby..bobby was gradually improving as far as vitals were concerned but he was almost moribund.still everybody including Neeru was hopeful. 
Time was creeping, with bobby's parents Taking care in Gangaram hospital, Neeru and our family juggling between Delhi and Bareilly, hoping someday, some way, someone will make things right for bobby , on the contrary "Someday perhaps change will occur, or Someday change will be accepted as life itself". I thought .
Even after lot more persistence,lot more efforts and exorbitant expenses of hospital , bobbys seemed no where to recovery in near future. Now it was difficult to cope up with routine expenses of Ganga ram hospital , as their school which was the only source of income ,was locked, parents were retired , elder brother was separated long ago after his marriage, though everybody related to bobby including me contributed according to their capacity... But virtually they were at the verge of losing there house apart from lock, stock and barrel in this treatment ..
Bobby was brought to Bareilly in the same moribund state,no body in the family was mentally prepared to accept his approaching death ,both the parents , Neeru and a sister from Kerala were their for his all nursing care . Sister and Neru started 12 hour duties for bobby , and soon Neeru was equally trained in all nursing. In few months Neeru became cachetic due to her restless schedule, but Most pivotal was Neru's sanity, she maintained it Even in the horrible period of bobbys insanity ..
For the sake of her kids, she has to live for them With the occasional thought of impending death of bobby .it was all together quite wearying , but she was doing it . Lately in spite of her total dedication towards bobby her in laws were not completely satisfied and they never ignored even any short coming of Neeru and always pointed in rough tone . once I was there at bobbys place , her mother in law scolded her like any thing. For a trivial matter 
"I call a spade a spade , when I see she is ignoring something important in his care"... Mother in law straight away said in front of me...
it went quite low down in front of me ,Neeru was in tears and i couldn't stay any more , went out forthwith.
Due to shortage of funds Kerala nurse was relieved, so Neru was left alone for care of vegetative bobby.. 
Time drifted slowly , bobby remained same, it was almost two years ,nothing gud befell in bobbys family , sombreness couldn't be replaced by any means. It had been the longest period of melancholy in any family ,in any house ,I could see in my life.

.. One morning when Neeru was taking a shower , bobby breathed his last at around 8 am.. Per chance , no body was there in bobbys room when her mother in law, arrived , she found bobby is Dead ..she cried out at the top of her voice, where are you Neeru Why have you deceived me? Bobby is dead,my son is dead, this is what you wanted, you killed him, you removed his oxygen, Neeru came in the room ,struck dumb, she started sobbing over bobbys chest ..
“Don't cry because it's over, smile because it happened.” Her mother in law, roared,Neeru was perpetually ,taken a back....
When we entered in their house , pitiful wails could be heard,from out side ..
Finally this was the end of all hopes, .Hope actually is the worst of all darkness because it prolongs the torments of a loved one, and today the clearly visible catastrophe brings the end of all bobbys bedevilment, and of course of Neeru too..
The death of Neru 's husband brought no emotional support or financial help from her in laws family, she was merely allowed to stay in the house with her kids. 
Though this young death impacted many , but most affected were the kids ,suddenly they became sort of destitute,temporarily cushioned from our family and neighbourhood friends in the form of donated dinners, and a bit of attention, and moral support ..but how long it would have worked, I too observed subtle impatience of Neeru in her family, but any how she got her separate unit with our intervention .
As I watched her grief slowly fade over time, she began to find herself experiencing not that much of restless nights, i often thought about how lonesome it must have felt being in her position. Upon his death, reality only set in further, and shook me to my core.
Don't know how 5 year slipped away from her in raising and bolstering her family, amid that period my mother was the only true supporter for almost everything of her, ...many a times she helped her,...from the money she took for herself. 
With soaring routine expenses , she wouldn't have survived , with the amount she was getting to run a family ,so she had to figure out ,what to do with her life when her world has been turned upside down in last seven years..
I know you love him, and of course you too had waited long enough And you can’t care about what other people think. You just have to get on with your life the best way you can.” I said this many a times to convince her, before she agreed to work .
Finally she wanted to work in the hospital , didn't know that time ,Why she chose same ICU , where her beloved wheeled live and became vegetative . Today I have an answer for that ."she knows the suffering of icu patients ,she wanted to work and share in the mourning of those who day and night live in death fear". 

Almost two wk ago, my neuro called me, sir your patient sachin is stable and his gcs has improved so you can operate his fractures now , there are fair chances of survival ,so please go ahead .
What a bliss!!! I congratulated my neuro for his hard work..and thought about Neeru she must be on cloud sachin was saved..
Oh!, I was going to call you only ,I was surprised to see Neeru in my chamber, Before I could congratulate her about Sachin , she shared another issue.. Bhai today morning icu 9 expired ,we were providing all the treatments for the last three days as he came as a destitute , his attendant came just now , so please call some authority so that his postmortem shouldn't be delayed,as his BODY has to be transported to Bihar. I was just watching her, how she was concerned even with the final journey of a person who was very short lived in our ICU , putting aside all hospital benefits .. I remember her words ,she has told me ..on a death of some patient...
"Still I am learning so much about living and being from these short lived persons who have let me be a part of their lives as they bid farewell to this life."

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