The Casualties

“Sorry, I’m late.”

I turn around. It is my guide, the good doctor Kandwal. His cheerfulness is at odds with the morbid atmosphere we are surrounded by in the Casualty. When a doctor sees 50 patients every hour that he sits in the Casualty, emotions are as scarce as a fresh pair of surgical gloves. India knows how to turn humans into automatons.

I glance at the wall opposite and am distracted by yet another poster, this one on the subject of spitting.

“Come, let me introduce you to my friends”, says Dr Kandwal.

As we walk towards the row of sitting doctors, I notice a few patients returning from the desks crestfallen. Their verdict has been announced.

“This is Dr Abhishek. Ortho.”

Dr Abhishek grabs my hand and shakes it. Truth be told, he is a little relieved with the diversion. It’s approaching noon and he’s had a full day already. The patients look at us searchingly. Some of them clearly have their bones broken. The gauze arm sling has yellowed and is grimy, as though scrubbed in dirt. These patients have come from afar, from towns that are a mile and a world away from Delhi.

“All departments are represented here”, says Dr Kandwal. “There’s surgery – Dr Sachin. That’s Paediatrics…”

The crowd is enormous, and building up all the time. I’m certain more than half of it will be turned away – asked to go home. There simply isn’t enough room or the resources to treat so many patients. Safdarjung, as Dr Kandwal confirms to me later, is the last port. A patient can be referred to Safdarjung from any hospital in India, but by law Safdarjung cannot refer a patient to any other hospital – they have to treat him or tell him he is quite alright and should best be heading home.

A father approaches, carrying his little son in his arms. The mother walks alongside holding a bottle of drip high up in the air, making sure that the thin tube that connects the bottle to her son’s arm doesn’t kink. The family comes to a stop near us.

“There”, says Dr Kandwal, pointing the father to his friend who’s taken position behind the Paediatrics desk.

Not a single person is overweight. Not one.

“Once the patients requiring further treatment are selected”, says Dr Kandwal. “They are shifted to the many Units. Come, I’ll show you a few.”

As we leave the Casualty and walk along the corridor, I notice large colourful arrows, each pointing to the various departments and facilities. X-ray Department is black, Ortho is red, Cardiology blue.

“Most patients who come to us cannot read or write”, says Dr Kandwal. “We have instructed the nurses at the Casualty to ask the patients to follow the colour codes. It works.”

“But easy for a harried patient or a relative to forget the colour for a particular department, no?”

“On the contrary. There is a heightened sense of awareness in an emergency. When they are told: ‘Follow the yellow arrow’ – which is for Paediatrics – they remember it like the name of their child.”

Dr Kandwal is taking me to the Neurosurgery Unit. As we climb the flight of stairs, he is constantly accosted by patients who try and weave around him to get to a vantage. “Sir, please can you have a quick look?” “Doctorsaab, just one minute – my bleeding son isn’t being seen to.” “Sir, what does it say in the prescription here?” “Doctorsaab, I beg of you.”

Dr Kandwal is polite, but firm, in directing the relatives and patients to the various departments. “This is not for the faint-hearted”, he says.

“Do you run out of medicine frequently?”

“Sometimes, yes. But remember, everything here is free of cost. Down to the last bandage.”

The Neurosurgery ward is a spacious hall with a high ceiling and large windows. All the beds are occupied. Relatives sit on wooden stools placed next to each bed. They are struck by the sight of a doctor and a few make preparations to get up from their stools. I, on the other hand, am struck by the beautiful herringbone wooden flooring, a marked departure from the corridor linoleum that had peeled and curled up dangerously at places.

“This is to prevent the patients from slipping. Head injuries are bad enough.”

We emerge from the Neurosurgery ward to observe in the corridor – empty a few moments earlier – a patient lying unresponsive on a canary yellow metal stretcher even as a distraught woman fans him with her dupatta. His leg is swollen to double the normal size and is leaking puss.

“He’ll need an operation. He should have come weeks earlier”, says Dr Kandwal. “No matter what, we have to treat him. Free of cost, of course. But it’s not easy. If you think the doctors here are stretched, spare a thought for the nurses and the ward boys. We have no option but to teach the relatives to do the dressing and help patients with their ablutions. At first they are repelled, but then they get over it.”

We walk out of the Unit and my eyes fall on a notice that warns patients and doctors of Tuberculosis. It’s a rough scrawl, written in a hurry, and is being overlooked by everyone.

“How rampant is Tuberculosis here?”, I ask Dr Kandwal.

“At any given point, two of my post-graduate students are being treated for TB. At any given point”, he says. “Many times they treat their TB patients while on anti-TB drugs themselves.”

The Tuberculosis Unit is two flights up from where we are standing. I look at Dr Kandwal.

“Perhaps some other time”, he says. “Let’s go to the ward that is under my supervision – Oncology.”

As we emerge from the building and enter a long damp corridor that connects the Casualty and Neurosurgery Unit to the Oncology ward, the reality that is the Indian healthcare is in evidence everywhere. If Casualty was forbidding, this is something else altogether. A sea of bobbing heads weaving through patients and their relatives lying supine on bed sheets they have brought from home. Their pose is not reactionary but pensive, heads resting over crooked arms, legs crossed at shins.

The corridor has multiple arches that run along one side, while the other end is daubed with fresh lime that has a bluish tinge. The passage is tomblike.

“When I visited Safdarjung last”, I tell Dr. Kandwal, “I saw a doctor writing a prescription wearing gloves that had blood on them.”

“It’s common”, says Dr Kandwal. “What do you expect? You have seen the rush. And besides, how many gloves will one change after every inspection? In the OPD, I sometimes end up seeing 160 patients in three hours. What does one do? It’s the over-population.”

“Is it? But there are countries that have a similar population density to India’s. Japan, for example.”

“Yes.”

“Perhaps if there were 10 Safdarjungs…”

“Not in my lifetime.”

“This is the famous Burns ward”, says Dr Kandwal, as we take a minor detour to explore the campus further.

Safdarjung is known throughout India primarily for its Burns ward. The ward is isolated from the main hospital and housed in a two-storey building of red brick.

We enter. The OT door is ajar and I peep in. Cement sacks are stacked on one side; a few have been ripped open. The air is heavy with dust. A stray exits quickly.

“Under renovation”, says Dr Kandwal. “Let me show you the ICU.”

The ICU is well-maintained. But it’s a terrible sight, and what is not visible is at once imagined, heightening the shock. The beds are crowned with little nylon camping tents that drop down like awnings at the shorter ends.

“These are patients with 80-90% burns. Many are bride-burning cases.”

The imagining is petrifying. I cannot see the living, breathing bride under that tent, but I can picture what horror she must have endured. A young and cheerful woman, newly married, showing off the multi-coloured choora bangles that fall over each other and hide her hennaed arms and tell the world that she is now a wife, a wife looking forward to the joyful days and years that lie ahead of her, and then, as she is taken by surprise and pinned to the kitchen floor someone empties a can of petrol over her…

“These tent-beds with ventilators are few and constantly in use”, says Dr Kandwal. “Now to my Oncology ward.”

As soon as Dr Kandwal enters his ward, a hush descends, as though the librarian has returned to his seat after lunch. The post-graduate students stand to attention, the nurses have a spring in their step and the patients perk up their ears for Dr Kandwal’s approaching footsteps.

“There are two sisters for the whole ward”, he says. “We ask the patient’s relative to collect the urine. This also helps the patient when he is back home.”

“This young boy”, says Dr Kandwal, “is recovering from RTA.”

“RTA?”

“Road traffic accident. He lost control of his motorcycle and it hit an oncoming car. His spleen is ruptured. He’s been in the ICU for a week and was shifted here yesterday. He’s from Mathura.”

The boy attempts a smile but it ends in a grimace. He cranes his neck as a compromise – a mark of gratitude for his saviour.

The patient on the adjoining bed is from Sonipat. The moment he sees Dr Kandwal, he tries to get up. A task that is excruciatingly painful for him. He collapses back on the bed but manages to join his trembling hands in a namaste.

“Gangrene of the intestine”, says Dr Kandwal. “We had to remove four of the five metres. He’ll live.”

“This girl’s from Nepal. Stomach cancer. We can’t operate because she won’t be able to survive anaesthesia.”

“This is Salim. RTA.”

Salim’s parents, old and forlorn, beseech Dr Kandwal with their eyes.

“What work do you do, sir?”, I ask Salim’s father.

“I pull a hand-cart”, he says. Tears start to well-up in his eyes. Salim’s mother is sobbing.

“We showed him to a doctor in Faridabad”, she says, wiping her brow with her dupatta. “We have no money left.”

“Yes”, nods Dr Kandwal, moving on. “Most times the patient’s condition is worsened because of quacks or a botched-up procedure. You must understand: they don’t just decide on Safdarjung. This is their last call. Their very last call.”

A second year post-graduate, Rahul, joins us.

“People like Rahul are the life blood of this place”, says Dr Kandwal patting Rahul on the shoulder.

We move to the next bed, and the next, and the next…

“This boy is from Behjoi in UP. Cancer of the gall bladder and tuberculosis of the intestine.”

And so it continues. Every bed, every patient, every relative has a gut-wrenching story to tell. Not a single patient is from Delhi. There cannot be a worse indictment of our public health system than this. Meerut, Moradabad, Agra, Rohtak, Bhatinda, Bhopal, Behjoi, Kanpur – and only one Safdarjung to treat them all.

It is approaching lunchtime. We journey – a word chosen carefully – we journey through the OPD hall on our way to the Resident’s hostel and canteen.

“Look at this”, says Dr. Kandwal, pointing at the mass of patients and their relatives.

Strays run about unchallenged. There are no waiting chairs that I can spot. Everyone is down on the tiled floor, either squatting or stretched out.

“It is impossible for us to see so many patients. They arrive as early as four in the morning – gates open only at eight or thereabouts.”

There is a giant digital information board at the entrance, just like at the railway stations.

“But so many can’t read”, I ask.

“They get by. Someone always knows how to read.”

The Resident’s hostel is a disaster zone. The building is filthy and crumbling.

“The Residents went on a strike a month ago”, says Dr Kandwal. “Just see all this. Is this the way to treat the doctors who work day and night for a pittance?”

But the kitchen and its surrounding area are worse. The familiar sight of a stray sniffing around giant woks is still palatable compared to the open sewer at the back of the kitchen, where we have presently ended up for a smoke. We are joined by one of Dr Kandwal’s team members.

“Meet Dr Shail. He is part of my team.”

The talk turns to the condition of doctors at Safdarjung.

“You like horror stories?”, Dr Shail asks me, straight-faced. “What do you want to know – that there are only 80 rooms and 1000 Residents who want accommodation? That we work on average 30 to 36 hours at a stretch every week in the Emergency? That we have asthma and Tuberculosis?”

Dr Kandwal is smiling. He knows I’ve touched a raw nerve.

“I’ve been in Safdarjung for 12 years now. Twelve years”, says Dr Shail. “My bank balance is Rs 26,000. Try and start a family on that.”

“Why would any doctor want to stay here?”, says Dr Kandwal. “Is he mad? No one respects you here. No one cares whether you work 30 hours or 36 hours at a stretch in Emergency. This country is dead. It does not care for its living. It does not care for those who help save lives. Most of my friends are now abroad. You should see the respect they get, from authorities, from their peers, from patients, from the society.”

“Can I ask you, Dr Kandwal…”

“I know what you are going to ask me. Yes, I am leaving Safdarjung in a few months. There’s only so much a man can take.”

But what the brilliant Dr Kandwal doesn’t know is that India can stand to lose a thousand Kandwals without batting an eyelid. Her eye might be bloodshot but it is open, has been since time began. The eye sees the miserable conditions of the patients and the doctors. And the eye sees the lack of beds and the overcrowding and the pathetic doctor-patient ratio and the exhausted nurses and the shattered ward boys. And the eye sees that 5 out of the 18 ventilators for children are non-functional. And yet, the eye doesn’t blink.

The System is sacrosanct, the System can do no wrong – it is always the doctors who are at fault. Who do they think they are, brooding little runts – complaining of the ghastly conditions, of the absence of drinking water, of clean toilets, of a decent canteen…are they not Indian? Why, then, are they complaining?

We, through thousands of years of practice, have somehow made our people believe in Karma, in Aatma, in Avatar, in Bhagya, in Punarjanam, in all those elusive concepts that wow and tempt man into believing that come what may, life goes on, nations move on, the world ticks. Whatever happened, happened for the good. Whatever is happening, is happening for the good. Whatever that will happen, will happen for the good.

That 830 million of us live on as little as 30 cents a day is happening for the good. That in the near future they’ll live on 20 cents a day will also happen for the good. The state of our people no longer shocks us. Roll up the windows, the lights have turned green.

Objects in the mirror are closer than they appear but we don’t care. We never have.

Two kilometres away from the sordid hovel that is Safdarjung Hospital, is the Safdarjung tomb, where – as I write – visitors gawk in awe at our architecture, at our concepts of design and space utilisation. They do not know of the Kandwals or the Shails or a thousand others who write prescriptions wearing gloves that have blood on them.

The doctors are innocent – they only have blood on their gloves. It is we, the people, who have blood on our hands.

This article first appeared in newslaundry on Aug. 29, 2013.