Resuscitation

RESUSCITATION

SUDHA

“Perfect, her house is perfect,” I thought as I walked into my best friend Roopa’s house. The best friend I had not seen or talked to for twenty two years. The one who married the man I was in love with.

And here was Prakash, Roopa’s husband after all those years, the same easy lopsided grin, the same enviable tall, athletic build, enveloping my husband Krish in his big bear hug. “Good to see you da!” Turning to me, a quick embrace, and we walked into the beautiful mansion Roopa and Prakash have built. It felt so natural, just like the first day of internship, the day we had bonded, the day we developed the friendship which I thought would last forever. We were so young, so idealistic, wanting to change the world, but barely managing to survive the year and save ourselves.

We had all reported on the first day of the surgical rotation to Ward 48, Male ward in Madras General Hospital. The long years of poring over thick, dusty textbooks and memorizing esoteric facts were behind us. We were now real doctors who wore our white coats with pride and slung our stethoscopes around our necks like badges of honor. The ward was narrow, and dank. Antiquated ceiling fans rotated lethargically managing to not stir the tepid air at all, and fluorescent light bulbs cast a gloomy shadow. The metal beds were peeling white and covered with inch thick mattresses. On every bed and sometimes on the floor lay the patients, frail, emaciated, and hopeful. The team was making rounds with a senior consultant, Dr. Veluswamy, and we were getting a lot of attention as the new interns.

“Welcome, welcome,“ said Dr. Velu, and I could not tell if he was smiling or grimacing at the thought of yet another group of untrained doctors. He glanced at Roopa, and then he was definitely smiling, visibly uplifted by her extraordinary beauty. I often wondered why a woman with eyes that looked liked emeralds, such flawless, creamy golden skin, and abundantly shiny hair would bother with the rigors of being a doctor.

“She should be a model or actress,” I thought a little sourly as all pairs of male eyes were riveted momentarily by the brilliant smile she had just flashed. Rounds proceeded with the usual tedium we were used to from medical school days, but we were now expected to accomplish an endless list of tasks; cross, match and transfuse two pints for Cancer stomach in bed 18, coagulation profile for hematoma in bed 24, suture removals beds 2, 15 and 18, intravenous antibiotics for 12, 6, 18,17, 19, 24, indent for drugs, that is write prescription orders for all 40 patients in triplicate with carbon paper between the sheets. I was losing track of the tasks and was hoping that my co-interns Krish, Roopa and Pakash were writing more diligently than I was. I was overwhelmed by the list and new responsibilities. At the end of rounds the Chief Resident Armugam turned and said with a smirk,”Oh yes, do not forget dressing change for Mr. Thiru.”

The day passed in a blur. We divided the tasks among us, drawing blood, hanging IVs, giving intramuscular injections, fumbling with lack of expertise. The sterilizer for instruments, syringes and needles wasn’t working and there were only about 3 glass syringes to give fifteen injections. We were dipping them in the tepid water in between injections and praying no one had a communicable disease. At one point the plastic bag with the blood for bed 24’s transfusion ripped apart when Krish was trying to hang it leaving a pool of precious AB + blood on the floor. Krish was almost in tears, and we were aghast. There was no way we would find another pint for the transfusion. We had a secret weapon though…Roopa. She worked her unique magic on the blood bank manager and managed to get us a reserve pint.

We forgot lunch and finally broke for tea in the grimy hospital canteen. We held the hot glass tumblers of over sweetened milky tea and bit gloomily into the crispy pakoras.

“Is that it? Did we get everything done?” Prakash was asking looking at our note cards.

“ No, still got to do dressing change for Mr. Thiru,” Roopa said. We groaned in unison and fatigue.

“Let’s all go do it together. It cannot take more than ten minutes,” said Krish. We agreed and trooped back to the ward

Mr. Thiru, in bed 40 was a seventy year old who had had a stripping procedure for varicose veins. He looked ill, and smelled bad. As we helped him up we saw that his bandages had been soaked with pus. He held up shaking, folded hands to us in a tremulous Namaste of thanks, telling us that no one had wanted to change his dressing in more than a week. We were gagging but the idealism of being new doctors still burned strong in us. We unwound his bandages and I had to turn away and stop myself from retching. The long wound down the side of his leg was oozing pus and over-run with maggots.

“Myiasis and extensive wound necrosis,” Roopa said. This wound would need a lot more work. “We have to take him to the theater and debride this”, Krish said. We looked at each other and our minds were made up without speaking. Krish and Prakash wheeled Thiru to the theater and we did what we could do for his wound, cutting, snipping and pouring antiseptic liberally. We started an IV, and hung some antibiotics. It was six before we were done.

“We did it,” Prakash said quietly, and then he turned and grinned at me. My heart did a long, slow flip, as I noticed for the first time how good looking he was. He was on call that first night but the on-call rooms were full so he stretched out on the wooden bench at the end of the ward and was asleep before we had even finished handing over to him the list of evening duties, injections, and IVs, he had to accomplish on his own later that night.

The next day came and the one after, endless with tasks, jobs, lists of things to get done. However, after the horrors of the first day, the spilled blood, the leaking IVs, the non- sterilized needles, and Mr. Thiru’s wound, things seemed to slowly get better. And everything seemed better when Prakash was working by my side. I never noticed the dirt, the stench, the tragedies and he helped me find courage when he would calmly look at me, or us, and say “It can be done, we will find a way.”

A few days later Mr. Thiru died and his body was wheeled away to the dissection hall in Anatomy as no one claimed him. My first patient, my first death, unmourned, uncared for. We sat somberly in the canteen with a plate of oily pakoras and felt a collective twinge of guilt. Had we hastened his death?

“His prognosis was really poor. Diabetic, septicemia, multi-organ failure. We gave him dignity and treated him as a patient should be,” Prakash said. I looked at him and felt renewed courage. I would need it every day to stare down death, to believe in my decisions, those split second calls that could determine if someone would live or die.

Twice a week we would go to the Operating Theater, the whole purpose of a surgical rotation. Most days we would scrub endlessly, gown and mask and spend four hours holding a retractor and pinching the ends of bleeders with the forceps. It seemed that this where Prakash and Krish found their true calling. Their skills became quickly apparent and they were allowed to do the simple hernia repairs and hydrocele surgeries.

“Come on pretty girl, give us a smile,” Prakash said one morning to the curmudgeonly and frightening head nurse of the OR. She stood there in her too tight white uniform and white stockings adjusting her starched white cap which was fastened to her oiled hair with black bobby pins, smiling for Prakash’s camera. She screamed at everyone, even the Chief Resident, but had fallen under Prakash’s spell. By default his friend Krish was included in her circle of grace, and soon she was bullying the Chief to assign more and more surgeries to them.

“She hates me,” I mourned in the canteen after I had spent 2 hours holding a retractor again in the OR, while they had both been actively involved in an exciting bowel resection.

“Bring her a present or something,” Krish offered.

“Like what?” I could not imagine anything that might soften her heart. I knew she could see I was not passionate about surgery and although I wanted to learn, I never was going to be a surgeon. I fumbled when I held the forceps, dropped stitches, or did not pull them tight enough. She once rapped my gloved fingers hard because I snipped off the suture material too far from the base, wasting it. All remnants from this surgery would be sterilized and re-used and the martinet would not have any wastage on her watch. Roopa had her respect though. She would “close up” at the end of surgery with painstakingly tiny, neat stitches, perfect work, but lacking the flamboyance and brilliance with which Krish and Prakash would wield the scalpel.

The unusual thing about the friendship between Krish and Prakash was the absence of rivalry in an OR rife with complicated jealousies and conflicts. They thrived in each other’s success and they bonded like true brothers.

I was looking at them now, the years had treated them well. My husband Krish, still with his bookish look, and unkempt hair which was graying gently and, my first love, Prakash. They were laughing, their mutual admiration so apparent, both cardiac surgeons, though on different continents.

“I love your house,” I said awkwardly to Prakash. “Oh it is all Roopa’s ideas , her plan to move out of Cambridge to Newton. Though it’s a nice city, still close enough to Boston….,” his voice tailed off.

Roopa. Roopa and I had a much more complicated relationship than these two men. We spent many long hours together, nights even, bleary eyed by a patient’s bedside. I thought I knew her really well and she did tell me things I am sure she had not shared with anyone, the difficulties of her childhood, the hardships of her single mother, and even what she considered the burden of being judged for her looks.

“Come on, you are complaining about being stunning?” I would laugh.

“You don’t understand, most people do not see who I am,” she once told me. “With us, our little group, it is different. You understand I am strong and have value.” She did have value, she was smart, and always got what she wanted. She was loyal and carried me through when I was defeated or fatigued, helping me complete the tasks which could overwhelm me, the menial jobs of an intern’s daily life, protecting me from the sarcasm of Chiefs and Residents who could live to torture interns. Roopa could see my hesitation We were like sisters but when things went wrong between us, we had become the bitterest of enemies so rapidly I wondered often about our friendship. Had it all been a sham?

“Where is Roopa?” I wondered, looking out of the big bay windows at the leafy neighbourhood.

ROOPA

I could hear them downstairs laughing and talking. The camaraderie of old friends, who had bonded, over the worst of circumstances. How we survived that pathetic General Hospital, and its abysmal conditions, I would never know. And to think that Prakash wanted to stay behind and do his Residency there. Something about wanting to “serve the people”, while I could not wait to pack my bags and fly to America as soon as internship ended. Today’s reunion was one of his worst ideas, and this time I did not have my usual power to dissuade him. It must be the mid life crisis and Ananya going away to college. This empty nest syndrome which suddenly makes him want to reach out to people we have not been in contact with for over two decades.

I will have to talk to Sudha after so long. I wonder if she is still diffident as ever. I remember her moaning and moaning over Prakash, and how much she loved him. “I will die for him,” she had said dramatically on one occasion. “Tell him then,” I told her several times. She never did though. And most likely still blames me for marrying the man she had crush on.

Sudha probably looks back fondly at our General Hospital days when we were so young and idealistic, while those memories make me cringe. Especially those of that one fetid day, long ago, the day the long dormant volcanic despair in me exploded. The day when my best friend, the one I considered my sister, humiliated me. As I sit in my bedroom, the bewilderment and emotions come flooding back.

It was the end of a long year of internship, being witness to endless suffering, limited resources, some triumphs, but mostly the relentless grasp of death. I would not have survived the year without Sudha, Krish and Prakash. We made a great team, Krish and Prakash already famed for their surgical skills, and Sudha for her incredible compassion. What did I bring to the team? Yes, beauty, the flicker of green eyes would make ward boys spring to attention and supplies would appear miraculously, chief residents would stop making unreasonable demands, even the most crusty nurses could be dazzled by a woman’s beauty. I wanted though to be a brilliant doctor, and I knew it all, every fact in Harrison’s textbook, every differential diagnosis in Bailey and Love. What made me freeze then when faced with endless choices for the patient before me? Why did the answers their bodies hid elude me? Was I not looking hard enough? I envied Sudha. She had an intuitive grasp of the problems, and would cut straight through the red herrings which distracted me. She did not recognize her own strength, how she held our group together with her idealism and resolve. She did not see how Prakash admired her, or that Krish was in love with her. She always assumed that I was the woman everyone wanted. Strangely, both Krish and Prakash were immune to my looks. I was just someone who worked hard as the rest of them, who shared our tragedies and triumphs, and the endless fatigue. In that year for the first time I felt part of something bigger than just myself, I had people whom I could rely on to support me and protect me.

The thing I best remember about that day is how tired I was. I was sitting on a hard wooden bench in the Emergency room, between wakefulness and slumber and dreaming about “Quincy’s sign”, another useless piece of trivia that crowded my brain. The somniferous night sounds of the hospital enveloped me and outside the window the bright neon lights flickered above garish billboards for the latest Tamil movies. My dreams came apart, shredded by keening, inhuman wails from outside the ward. Instantly awake, I was outside as the ambulance doors were opened and a stretcher was pulled out from the back. A young woman was caressing gently the face of the patient, but I realized with a start that the intermittent wails were emanating from her, and not from the young man on the stretcher. I tried to step forward but stumbling, recognized just how tired I was. The woman turned towards me and her face acquired a new purpose.

“Doctor? Doctor” she was running towards me, her face twisting with grief. She was beautiful despite wearing a damp, crumpled sari, her long black hair loose, her eyes bright with a precipitious hysteria. I was paralyzed, rooted to the spot as the young man on the stretcher was wheeled past me, blood oozing from his head, his breathing stridorous and agonal. I did not need Sudha, Krish or Prakash to tell me that he looked bad, terminal.

“Please, please save him, save him”, the young woman begged, her hands reaching for me. Stepping back in a reflex action to avoid the full force of her naked emotion, something seemed to be clenching around my stomach, a giant hand squeezing my heart Shaking my head, I fingered my stethoscope for reassurance , trying to rid myself of this inexplicable reaction, but my heart was racing and my hands trembled. Where were the others when I needed them? Suddenly the woman was on her knees, holding my feet, in the ultimate art of supplication she knew.

“Please save my husband” she said, and looked straight at me. And I saw that look. The look of naked desperation I had seen in my mother’s eyes so long ago.

And suddenly I was spinning, hurtling back through time, eight years old again at the bedside of my dying father. For weeks my Father lay on that bed at another hospital like this, while mother and I waited anxiously by his side. “Doctor, how is he?” Mother would ask and “Doctor” would just shake his head portentously and walk away. Sometimes he would tell us how this “Condition” had no cure, but I did not believe him. My precious father could not die, that is all we had, each other, the three of us. Home and school became a distant memory as we started living in the hospital in the ward by Fathers bedside. We were not aware of the sickness and horrors around, numbed by the sight of the man we loved lying there, as colorless fluids dripped into his veins, and life ebbed out of him.

One morning I crawled out from under Father’s bed where I had spent the night on a worn, reed mat to find Mother’s face set with purpose. She had risen early and gone to the temple on the Hospital grounds, a fresh vermilion streak on her forehead, she had decided to take control of our destiny.

We waited together for the doctors’ rounds. After stopping for what seemed like an eternity at each patient, they were here at last to see father. “Doctor” was there, looking as pinched and sallow as ever, the others hovering around him in a frenzy of activity, flipping through the case sheet, ready to react to his faintest gesture or word. He placed his stethoscope fastidiously and cursorily on father’s chest and prepared to step away, as one of his minions scribbled furiously in the chart.

“Doctor, please wait,” Mother’s voice had an extra level of pleading. Doctor turned warily, he had seen too many demanding relatives who expected him to do the impossible.

“I am sorry sister, we have done everything. You should take him home, there is nothing we can do”, he said wearily, like he had said the same words to a thousand other desperate families.

Mother’s face was set as she pleaded, “Please doctor, please try. God has given you this power, Please”.

The poignancy in Mother’s voice turned to hysteria as she slid to her knees begging over and over and holding the doctors feet. I caught a brief look of the Doctor’s horrified expression as he disengaged himself and turned to leave. After that we were numb , we stopped praying, and Father died a few days later.

I was looking at the young woman at my feet and something snapped inside me. I spun around and raced after the dying man on the stretcher. Pushing the nurses aside , I tore his shirt off, and yelled, “Start CPR!” I caught the startled expressions on the nurses faces as I started heaving on the young man’s chest. The man had stopped breathing and his pupils appeared fixed and dilated already. “Intubate, intubate!” I yelled, as I heaved on his chest with all my anger. The anger that I hardly saw my Mother laugh again, the anger that we were left to fend for ourselves in a world not made for women. I heaved with all my toxic, corrupting rage.

SUDHA

Roopa finally came down, elegantly late, looking stunning as ever. She grazed her cheek against mine perfunctorily and then Krish’s.

“She does not want us here,” I realized. And she had not forgiven me.

“ So, Prakash tells me that Krish is a brilliant cardiothoracic surgeon at General Hospital. And what do you do now?” she asked distantly.

“Well Krish tells me Prakash is a brilliant Mass General cardiothoracic surgeon. I am an Internist, you know I love all of medicine. Could never choose a specialty,” I ended lamely. “What about you?”

“Oh, Dermatology,” she shrugged.

We glanced over at Krish and Prakash and I felt envious that their bond had survived all these years of absence, true brothers of the soul. Roopa was busy straightening things on the perfectly laid out dining table.

Did she remember my impossible infatuation for Prakash? Oh, how I had loved his brilliance, his kindness and charm. I used to pour my heart out to her over and over, but I never did go tell him. Probably because I never felt I was good enough for him, maybe I always secretly thought that Roopa and he made a beautiful couple. After Roopa had stopped speaking to me and started pursuing Prakash, I accepted it as inevitable. I remember the day I realized that the dynamic between them had changed, when she had smiled at him, with head tilted and lips arched, and he could not look away from the mesmerizing brilliant green of her eyes. They would sit in a corner of the canteen and a brief courtship later they were married. I was heartbroken, every sight of them together caused me lancinating pain. The double blow, the loss of friendship, and lost dreams and fantasies of love too much too bear. I was not invited to the wedding and because of that Krish did not go either. Quiet, decent, Krish, and handsome, charming Prakash, their wonderful friendship torn asunder in a war of women, forced to take sides. Krish and I were both mourning the loss of our best friends and our close knit group, and we discovered each other. He could make me laugh with a dry, even sense of humor. He helped me find that I all the courage and strength I needed was within myself. I loved his sense of purpose, his unwavering dedication, his love of Tagore and Maugham, and me.

My thoughts wandered back to that day when Roopa last spoke to me.

“Bitch,” she had spat at me.

It was one of the last days of internship and I was with Krish and Prakash in a small room off to the side of the ER, inserting a chest tube into a motor vehicle accident case. A ward boy came panting up to us and said, “Come quick, the green eyed doctor has gone crazy!”

We ran down to the resuscitation room and found a couple of staff members at the door holding back a wailing young woman from entering. Inside we saw Roopa holding the paddles over an obviously dead person. The smell of singed skin told me that she had shocked him a few times already.

“All clear,” she yelled maniacally and applied the paddles to the chest. The body jerked spasmodically as she looked frantically at the flat line on the monitor. “Resume CPR,” she said presumably only to herself, as a couple of nurses were merely hovering anxiously and trying to collect the pile of empty epinephrine and atropine vials lying on the stretcher, seemingly trying to maintain an atmosphere of clinical calm.

“Forty minutes, doctor, she has been doing this for forty minutes, and the man has been flat-line all the time,” whispered one of them to us.

Krish was trying to calm Roopa, tell her it was time to declare the patient dead, and inform the family, but she sharply elbowed him away. Then Prakash and Krish tried to grip her arms and steer her away, but she flailed hysterically at them with a syringe with a 2 inch long needle.

“Is she going to attempt a pericardiocentesis?” I wondered.

“What is she doing, what is she doing to my husband?” the young woman at the door was screaming.

I looked back at Roopa , she had inserted the needle between the man’s ribs and was trying to draw blood. After a few pokes she discarded the needle and started heaving on his chest again, as the young woman started wailing and screaming even louder. People had gathered at the door now, nurses, patients, ward boys, watching Roopa continue her resuscitation, oblivious to the sound of the dead man’s ribs cracking under her palms, the flat line on the monitor, the onlookers.

“Roopa,” I called urgently, “you have got to stop. He is dead.”

Roopa looked at me blankly, her green eyes opaque and flat, rivulets of sweat running down her face. I wanted to save her. “Do something,” I said to Prakash and Krish, but they were watching slack jawed as Roopa raised her fist above her head and brought it down forcefully in a magnificent thump on the long dead man’s chest. I winced inwardly, this was no indication for a precordial thump.

I grabbed her elbow, “Roopa, stop!” She twisted out of my grasp. And that is when I decided on shock therapy. I raised my hand and brought my palm hard across her face.

There was a hush as her eyes snapped back to life, she registered the onlookers, her dead patient, the helpless nurses, the wailing woman, and finally turned to me.

“Bitch!” she hissed. And never spoke to me again.

ROOPA

Sudha looks young and untouched by life, still gazing dreamily at Prakash, as he talks non-stop with Krish. He is so excited about the last beating heart surgery he did, their enthusiasm is palpable. Sudha’s two sons are almost grown men but she looks innocent, almost fragile. I missed her naivety, her belief that things could always be right in this world. After what she did to me, I took a perverse pleasure in shattering her fantasies and marrying Prakash. What I did hardly mattered though, Krish was and still is clearly besotted by her.

I wish this evening would end soon. The bond this group shared ended twenty one years ago, by the bedside of a dead young man, with his wailing widow’s screams piercing our thoughts.

I have had dinner catered by India Palace in Boston. We sit down to eat and things get stultified as the men realize that they have to include us in the conversation. Krish starts asking about my Dermatology practice. “”Nothing to tell really,” I reply. “Just some moles and rashes all day.” Yes, I was not a hero, and I knew it. Prakash has picked up the damned blackberry and is texting furiously. Does everyone notice how he looks so fondly at the blackberry and smiles with palpable excitement when those messages come?

SUDHA

I wish this evening would end. Krish has been a perfect guest, talking politely to Roopa, now that Prakash has become mesmerized by his blackberry. I am excluded from the conversation and gaze out at the front lawn. Prakash leaves the room for the third time to make a call, he seems jumpy and restless. There is a glint in his eye every time the blackberry buzzes, he seems happy and excited.

“Most Medial Men use Morphine”. I do not know why that pneumonic pops into my head except I remember Roopa painstakingly preparing for a lymph node dissection of a patient’s armpit and memorizing all the nerves which traversed the region. I cannot remember what the MMUS stands for anymore but I have never needed to use that nugget of information in my twenty year career. I am sure Roopa knows what those nerves are.

I turn to ask her. She is staring at Prakash who is again absently smiling at a message on his blackberry. Her eyes speak of deep and profound sorrow. I catch my breath, wanting to reach out to her. In that instant she turns and catches me watching her, and her expression changing so rapidly I do not know if I was mistaken a moment earlier. She looks at me, her eyes an impenetrable forest of green, a fortress of lost, bitter years firmly between us.