One of my long tiring days

"Doctor.... doctor... he is vomiting blood..!" an anxious wife complained me about her husband.

Busily stuck in my never ending routine ward jobs, I cast my eye in the direction she ran from and realised who the patient was. I told her not to worry and that I will be with him in a minute. I was n't very keen to jump to the scene as I just left him after a long chat about all irrelevent topics he brought out inspite of my revealingly deliberate attempts to cut the discussion at every stage. He was the most stable patient I have on the ward and I still have a few other unwell patients to sort. On top of that I am on-call that evening.

His retching sounds dragged me towards him. With a doubt in my mind if his anti depressant has pushed him into euphoria, I decided to divert him from his usual topics to his current condition. Last time he spoke to me about british policies in world politics. So I started designing a strategy to counter the next most possible topic 'american politics in world economics'. As I entered through the curtains I saw a petrified face alarmed by the sight of his blood in the vomit. It wasn't the same jolly face I have been seeing. The couple were undoubtedly terrified. I saw the bowl in his shivering hand filled with blood stained fluid. I wanted to assure him that this is neither unusual nor too dangerous as it is just a tinge. So I told him that I would n't be too worried to see this little bleeding in people with oesophageal (food pipe) cancer and that he is already put on some gastro protective capsules. I have shown my reluctance deliberately to subdue their anxiety. My efforts probably made some affect before I left to my desk.

Not long after I left, she came with another bowl full of blood. This time I got worried as it was frank blood. He could not have produced that much of blood in so less a time unless he is bleeding actively. Did the tumour erode an artery? - that was the question for which I dont know the answer. I ran towards him trying to hide my anxiety, only to see that he was deathly pale and sweating. I felt his hands to feel the pulse and gosh they were cold!

"This seems to be a bit more severe than what we thought. So I am going to do some blood tests and restrict you to eat or drink anything until we find out the reason why you are vomiting blood" I said. "I might end up giving you some blood as well. But dont worry too much as you are in a hospital."

'I want you to be worried about me as I dont feel too good. I had this cancer for atleast a couple of months by now but I never brought out blood.' he said quickly before I left. While I was asking the nurse to check his blood pressure, I saw him collapse back onto his bed with his eyes rolled up. My heart skipped a few beats. Did I take a few grave signs too easy or did I take it granted that he is my most stable patient and so act a bit late? These were the questions running in my mind while I was groping for his pulse. I quickly pulled the emergency button and in less than 10 seconds atleast 3 nurses and a couple of health care support workers came to the scene. Curtains quickly got closed around all patients of that bay. Mean while I could feel his pulse very feebly and thank God he became conscious. Neither me nor his wife were in a mood to accept his statements of fearlessness to death.

On a war footing we laid him flat with his head down, secured a better and broader venous access, collected necessary bloods and checked his blood pressure. It was as expected. 70/50. I ordered nurses to pump colloids into him and spoke to lab. Although nurses usually are very particular about signed documentation, every thing was just a verbal order from me. They did not dare to bother me at that busy time while I was negotiating with surgeons, ITU registrar & haematology lab and ofcourse they realised the seriousness of the situation. I got blood and we started infusing it through the warmer while he continued to vomit it out. I used all my brains and authority to influence every one in the hospital to see that he comes out of this acute phase as I did not want to feel guilty of my prejudiced act.

While I was a little settled to know that his BP came up to 110/70, my bleep reminded me that my oncall commitment has already started and I ought to be else where. I did not want to leave him in that critical stage. So I convinced my registrar that I will swap my role with who ever is supposed to attend this patient from now onwards. And I continued to resuscitate him. We pumped around 10 units of blood and 3 units of fresh frozen plasma but the bleeding never stopped. The more aggressive I was in resuscitating him, the more unstable he became. The more I comforted him, more agitated he became. More the puzzles I solved, more the challenges he posed. While the process was going on under my leadership, I did not want to loose although that is what seemed inevitable. I spoke to thoracic surgeons at Nottingham city hospital and they had a go at me for referring such an unstable patient. But with the help of my registrar, we convinced them for the blue light transfer. Now the burden of transferring such an unstable patient to nottingham is on us.

Through those anxious moments time ran without a clue for us and the night team came at 9pm to take over. I did not want to leave him for obvious reasons although my duty timings are over. Every one including me had a strong feeling that we were not winning. Some of the new team members started expressing their concerns that all this appears to be going futile. I just came out of the chamber slowly with a lost mind and faced his wife right in front. That was the moment I could never forget in my life. Her face had many questions for which I had no answers. Her reddened eyes were blurred with tears. I could not escape this anticipated embarrassment inspite of my best efforts.I approached her to explain what was going on there. I dont know how much she took on board at that time, but she appeared to have understood that this is the end. We gave him diamorphine to allevite his newly developed severe tummy pain.

It was half past ten in the night and I decided to go home because I knew what was happening. I just did not want to certify his death. I went straight to his wife again.

"I am very sorry. Really very sorry for what has happened. I tried my best but...." I could not say any further and held her hand.

She hugged me and said "Its OK. No one can see what's happening inside. dont worry."

I dont know what it really means but that was the most helpless I ever felt. I left the ward quickly to avoid anyone watching the water that is overtly filling my eyes. I reached my room very tired but did not feel like eating. I felt lethargic to do anything. I could not sleep inspite of changing my decubitus repeatedly. At about half past one in the night I rang ward and asked about that patient. I got the answer what I was expecting. He passed away about an hour after I left.

I knew later that he died because of Aorto-oesophageal fistula (the locally infiltrating oesophageal tumour has eroded the great big descending artery) He would have died anyway with such a big threat breaking open, where ever he was and who ever was there managing him how ever early acting upon. It soothed me a little, but that night was terrible and unforgettable. It filled me with a sense of guilt. I became very apprehensive to manage any bleeder then after. I was worried to have to manage such impossibly seeming and doomily case that too in a disguise. He was in his mid fifties and used to tell me the various holidays he planned with his wife after he would have had his tumour resected. He was hopeful that his cancer would be cured completely after the surgery because there was no distant spread.

Having slept quite late that night, I woke up late and reached my ward just in time. In the lift I was wondering how dangerous these adenocarcinomas I have been looking after without realising how bad they can turn. I consoled myself that they dont come that often to be embarrassed again.

Trying to deviate nurses who were asking me if I was Ok, I looked at that bed which took away a patient the before night. There was a middle aged lady on the bed reading a book with a drip running into her arm. I opened her case notes and started reading about her.
She was 53 and got admitted early this morning to have her chemotherapy and alas, for her oesophageal adenocarcinoma...!!! (the same cancer which killed the earlier man on that bed)

భక్తి Bhakti

కలడంబోధి కలండు గాలి కలడాకాశంబునన్ కుంభినిన్
కలడగ్నిన్ దిశలం బగళ్ళ నిశలన్ ఖద్యోత చంద్రాత్మలన్
కలడోంకారమునం త్రిమూర్తుల త్రిలింగవ్యక్తులందంతటన్
కలడీశుండు గలండు తండ్రీ వెదకంగానేల యీ యా యెడన్

In the above canto, Prahlaada tells his father Hiranyakasipa that God is omnipresent. He is there in abstract and materialistic, living and non-living objects, sedentary to mobile and from an atom to universe. one who believes this fact undoubtedly to the bottom of his heart will take much less time to realise such omnipresent god not just in himself but also in other humans and living beings. The depth of this belief will extend his ability to feel the omniscient in non-living and abstract things as well. A stage should come when you can see none other than your God in every human being no matter what their religion/belief is. None other than that supreme power in every animal, bird and insect. This very basic thought will make you 'love all and serve all' irrespective of who they are and what they did to you. This is the idea behind being vegans in some and being kind to animals in others. Various adages like "Ahimso paramo dharmah" prop out.

Good and bad work like magnets. Nearer you are, stronger the force and farther you are, weaker will be the force of attraction. Having known this fact it is upto us to decide which way we take our first step. It is your own deed that decides how close God should be to you. whether you invite him into you by doing those he likes or drive him away by doing otherwise is our choice. Once you bring him in with utmost hospitality and thoroughly enjoy his presence within you, he will be loyal not to leave his devotee. Your hospitality will make him your servant. He then, being so loyal a servant can protect you from slipping into filth at all times.
Think that God is there within you at this moment while you start any work and see if you could do bad. See if you procrastinate anything. See if you could do it with partial effort. See if you ever fear while doing that work and check if you ever fail. This thought that God exists within you will impart divinity by giving the ability to forgive like him. It brings tolerance to other religions, castes and creeds. This thought when sown into your mind will reap those actions which bring him closer to you. Such persisted action of doing good to every one will then become a habit and then your nature. Once your character has changed into the one who always does good to others, they can then start seeing God in you (Not just you imagining his presence in you even if that was how you started). This is when you reassure yourself that he is still within you. There will be no foes on the surface of this planet. It also gives a few other benefits like health & hygeine (as you would know how to keep his residence kempt), peace & courage (as he knows to protect his true residence), strength & valour (as you believe that what all you are doing is actually done by him through you) and self-esteem(as you would respect the God within you). This is what exactly that little boy Prahlaada believed and proved his father. Neither the king's servants nor the snakes and elephants could do anything to Prahlaada as they all witnessed their God with in him. He protected him from poisons, fire and oceans. He was never afraid of anything as he believed God, his presence and his abilities so strong. Unlike the current generation youngsters he did not bother to think of the science behind the way he does his job. His belief (bhakti) reached the summit where one would realise that the rules of science are made by him. Once you think of a possible explanation for those deeds in your own way and try to convince others of his greatness, it only tells that you are actually believing science more than God and that is the reason you started believing him only after you had that so called scientific reasoning. One can never convince an atheist about the existence or greatness of God by science as a born blind can never appreciate colour. Also it may risk downgrading God to mere scientific level. One who realises that it is God's job to convince people of his existence will not force them either with scientific or monetary explanations! He will find no difference between the various forms of that interconvertible energy.

Thus it all starts with that thought. For those who are still uncertain Prahlaada reassures them.....

ఇందు గలడందు లేడని సందేహము వలదు చక్రి సర్వోపగతుం
డెందెందు వెదకి చూచిన అందందే కలడు దానవాగ్రణి వింటే