IMCU: A real life story

This is a real life story from my past, one that is so personal that so long I have hesitated to share it publicly. I have been cherishing a dream of publishing a book, a collection of real life short stories based on doctor patient relationship, something that is very disturbingly turning very hostile these days. I hope to inspire my doctor friends and also the non medical community to write and share stories that one again start weaving us together as part of the same.

IMCU

Amongst the mostly uneducated dumb poorest of the poor patients in the government hospital of Chennai where I completed my MBBS internship, she was one of the smartest and most intelligent young lady. With simple features her bright eyes and occasional smile stands out in my memory. 

I met her at the IMCU (intensive medical care unit) during my 2 week long posting. Just 2 months into my internship, I was still relatively fresh as an intern. We were the junior most doctors, the first contact of the patients whose responsibility was to provide all basic care starting from giving daily injections, intravenous fluids, maintaining the iv lines, monitoring the patients, take notes of new complaints from patients and their attendants, counsel and explain therapy etc to them, communicate to the post graduate students and senior doctors etc. 

The first thing that hits the mind thinking of IMCU is the continuous loud beeping of the life support systems amidst a disturbing silence. The moment you step through the glass door it seemed like another world far away from the cacophonous  world outside. The air conditioned super clean space accommodating about 30 beds arranged along the four walls, each separated by curtains, with a central station for nurses and doctors failed to provide an welcome change from the super hot relatively dirty crowded hospital wards outside.  The beeping sound seemed like a constant reminder of lives hanging by a thread. I also remember a distinctly different smell, perhaps a concoction of high end antibiotics, life saving infusions and disinfectants mixed with the air conditioned air. The ventilators and monitors running constantly at each unit may have added to the smell. 

Most beds were occupied by seriously ill elderly or middle aged patients, many of whom were partially conscious or in coma. The patient attendants were grave, less noisy and more obedient compared to other wards. 

Amidst this cold death reminding space there was this young couple who radiated a daft of warmth, joy and hopefulness every time I passed by them. The wife was suffering from aspiration pneumonia, a fatal condition that fills the lungs  with fluid and makes breathing difficult. She was intubated and put on ventilator to help her breathe. Because of the tube passing through her mouth she couldn't speak though she was conscious and very alert. She would communicate with her husband and the staff with hand gestures. The husband was good at understanding her. During visiting hours every morning and evening he was always next to her bed. A man of tiny stature, docile looking and quiet, he was a doting husband, something that was a not so common sight among the lower socioeconomic strata that they represented. During his visits he would take shopping lists from her that she would write. I remember Horlicks was one of the things she had listed in one such list which she was handing over to him one day as I came by to give her regular injections. 

I could say she was quite a talkative person. Everyday she would eagerly wait for me to come by her bed for the busy nurses and other duty doctors didn't show her enough patience to try to understand her hand gestures. She would ask about her progress or try to convey some complaints. I would go on guessing her gestures and replying her, giving her hope, while she would nod her head to indicate if I was guessing right. She wouldn't budge till she got her answer. The most touching thing about her was that she was pregnant carrying their first baby. She was quite worried about the baby. One day she had her ultrasound check with a portable USG machine brought next to her bed. I saw the tiny head, arms and legs as the Sonologist did the scan. After she left giving the report I reassured her that the baby was doing well. She was slowly recovering and we were expecting soon she wouldn't need the ventilator anymore. 

One early morning when I came by the bed she complained of irritation at her throat and some chest discomfort. When the post grads came for their morning rounds they decided the bronchial tube needed a change as there seemed to be partial block due to secretions. There were two of them and they seemed confident. First they called the anesthetist on duty to do it but after waiting for awhile when he didn't show up they decided to try it themselves. They warned her she would have discomfort in breathing on removal of the tube but they would have another tube inserted pretty soon. They removed the tube easily. She was quite cooperative. They moved on to insert a new tube. Sometime passed and it seemed the postgrad doc who was trying was having some difficulty so the other doc took over. Some more time passed and they were still struggling. She was gasping for breath by now and her fists were clenched. The doctors were trying very hard. At this point the anaesthetist appeared and joined them. I couldn't stand by her bed constantly though I wanted to, as I was called to attend another patient. I followed what was going on from a distance. A sister pulled the curtain across her bed so that I could only guess. When the defibrillator was brought in, I knew where this was heading. She had gone for cardiac arrest. I rushed to assist in injecting adrenaline and atropine while the seniors frantically tried resuscitating her with the defibrillator. I had to move away again. After many minutes the doctors came out from her unit. They were talking to themselves and left the IMCU soon. I think it was one of the nurses who confirmed that she was no more. I distinctly remember that moment. It was like time had stopped for a few seconds as I saw her lay lifeless on her bed. Just few minutes earlier I had talked with her and had reassured her that everything would be alright. It was completely unacceptable, she had a baby in her! I started wondering if the bronchial tube wasn't changed she might still be alive. Wondering if it was the right decision, if the post grads were competent enough or was it just fate. I cringed at the thought of her husband who wasn't there yet. 

I had to go on about my duty caring for the other patients while my mind was constantly going back to the curtain drawn across her bed. While returning from my breakfast break later that day as I reached the IMCU entrance my eyes fell on him. Far away across the corridor on my left there he sat on the floor, stooped against the wall, his head drooping and eyes fixed to the floor. He was calm, motionless like a stone. What a contrast against the storm that must be raging within! I felt like reaching out to him and giving him a tight hug, didn't know what to say. Instead I found myself pushing the glass door and proceeding on with the last few hours of my IMCU duty. I was very disturbed and prayed to God to give him strength. It was the last shift of my posting. That was also the last time I saw him and I knew that image would stay permanently etched in my mind.