“Go to the ID ward. There is a lymph node biopsy” The Senior Resident ordered. I was the second year Resident. It was the year 2000.
A small jolt of dread colored my mind. ‘ID Ward’. People talk about it in whispers, in JIPMER. It was the medicine men who go there. We surgeons did not even know where it was. But we knew what it contained- scores of men and women who were Positive. Positive for HIV. Many suffered from AIDS.
It was a relatively new disease, and evoked terrible fear. If any disease could be worse than death, in my mind, this was it.
I had first heard of it when I was around ten. My father, a doctor, was talking to my mom.
“The other students don’t want to be near them. They can’t even go to school. What a tragedy!”
He was talking about a Surgeon who was recently diagnosed with AIDS. He was one of the first talked-about cases in the state. He had done a fellowship in the US, years back. My dad was talking about his children. I could see the suffering of the family through his words. A boy and a girl- treated with disgust. Ostracized. Punished. Tortured.
“He is such a nice man!” My father had said.
Devoted to his profession and patients, he was indeed, a nice man. But that is only to those who knew him well. I heard many talking about him derisively.
“Must have done something there, you know. A lot goes on in America.”
We humans simply cannot handle terrible things happening to good people. We have a pervading ‘belief in a just world’. It is probably good that we have. Otherwise, our world would collapse. Or go bad, like a bunch of grapes nibbled by cockroaches.
If something goes wrong- it is Karma. Or God’s wrath. When these things clashed with modernity, we do mental gymnastics to see how it has to be the victim’s fault. Or someone else’s.
India was a ‘good’ country, where the Human Immuno Deficiency virus, was supposed to face its waterloo. This was the talk in those times. Many said that it will return to the lands of sin, shamefaced after being soundly beaten by our superior morals.
The good doctor died, alone and uncared for, in a ward in the place where he had worked. Other doctors were extremely reluctant to treat him. Even his friends. That is life.
By internship, we had an HIV clinic at Government Medical College, Thrissur. A few consultants slowly began to care for them. ‘HIV’ loomed in our psyche, while drawing blood from patients, like a spectre from a Hollywood horror movie.
The first patient I touched, who had HIV, was a young twenty year old girl. She was pregnant, and in labour. I was final year then. I was assigned to monitor her. I remember putting my bare hands on her abdomen, and checking for fetal heartbeat. She had smiled. I learned that she got it from her husband, who was dead.
Many treated her like dirt. She was an aberration. An abomination. She was a risk, dammit! Those labour rooms! At the best of times, Government labour rooms were not known for kindness.
I had met her on the corridor during discharge, while going for class. She came up to me.
“I will never forget you. Thanks.”
“Uh. Why? What for?” I asked.
“You are the only person who touched me.” She said.
Well. Of course not. She had delivered a baby, for heaven’s sake. But I understood this.
This is one of the episodes in my life where I am proud of me. Dont get this wrong. I am in no way better than your average doctor. The one thing that doesn’t come out in my stories is the pages from life where I have been callous, and even cruel to patients. Mistakes- Yes. Honest mistakes can come out. But the other- No. I can’t. I choke. Then pen won’t move. My fingers refuse to meet the keyboard. But God knows they have been there. Especially when pushed to do too much, during continuous hours, and thirty six hour shifts. That is one reason why I am vocally against the glorification of overwork.
I have dithered. The ID ward is a kilometre away from the main building. It was kept hidden among the trees in a corner of the campus.
A miasma of gloom spread over the ill-lit, ill-ventilated ward. The nurse appeared, pushed a case sheet at me and disappeared. A middle aged emaciated human looked at me. He was without expression. A blue cross marked the swelling at the neck. This was what I was supposed to take out.
I led the man into the dingy room that passed for a minor operating theatre. An overhead lamp cast an eerie glow. A tray filled with a laughable paucity of instruments was thrust at me. A dressing trolley was already there. Autoclaved gloves nestled in a drum.
“No mask?” I asked.
“No, Doctor. No masks.” Then the nurse disappeared. Again.
If I wanted a cloth mask, I had to walk a kilometre and back. I had a case waiting in the main theatre. If I was late for that, the Anesthetist would shout.
I wanted to scream. I wanted to throw a tantrum. I wanted to take the drum and smash it over the Nurse’s head. I looked at the patient looking at me. I felt like strangling him.
I did not do any of these things.
Instead, I tried to focus. Double gloves. Inject local anesthetic. Careful now- no re-capping. Then I changed the glove, painted and draped. I prayed, though my belief in him was sparse and episodic, like the rain in Pondicherry. Then I started.
A spurt of blood erupted into my face. I ducked and averted my head. The crimson droplets stained my shirtfront.
Fortunately, the whole thing came out easily. I applied the stitches. Then I washed my hands, face and eyes. I remember repeatedly washing my eyes. I had no glasses.
I never talked to the patient. Not a word. My entire being was concentrated on trying to avert a disaster. For me, that is. The patient was just a job to be done.
That was my first surgery on a patient known to be infected with HIV. Without mask, without glasses, and in my rolled up shirt sleeves.
Now, occasionally we do elective surgery on positive patients. I don’t blink an eye. We have all protective gear at my elbow. I simply don them, and do what I have to do. The cases have become frequent enough to take that fear-factor out, too. I talk to them, and shake them by the hand. No big deal.
In case anyone was wondering, I did not change my shirt. I forgot about it. And wore it the next day too, and the dried droplets made a bizarre artwork on my chest. (Jimmy Mathew)