Close to heart

It was raining heavily. A twelve-year-old boy was brought to my clinic. He was literally hammering his teeth, two blankets and four umbrellas on his head probably by his mother, father and uncle. I was just shutting down my clinic then. Nishant was barely able to stand. I took them in and then into my examing room. I could feel the glass panes of my clinic rattle as he sat down in front of me. He was having high fever since past one week. Not a single blood test was done. But there was something which was staring at me. He had red spots all over the body. These were petechia, suggests low platelet counts and the patient bleeds because of this. In fact, the patient can bleed to death because of this. There can be bleeding in the brain and the patient can die. So Dengue fever caused by mosquito bites was a high clinical suspicion. The child was admitted and blood was sent for testing. Oxygen was started since the patient was having difficulty in breathing. The platelet count was just 2000. Normally it is 1.5 to 2 lakh as per his age. Platelets are blood cells which prevent bleeding. Hence platelets would have to be given to the patient and that too immediately. Then started the phone calls, one blood bank after the other. None of the blood banks had platelets. Some I called, some the relatives, some by the nurse, almost 15 blood banks were summoned, private and municipal hospitals. But to no use. The relatives suggested that they would give their own blood but then to process it and recover platelets would take at least 24 hours but to wait for long 24 hours was a threat to the precious life. The same day it was in the newspapers that Dengue fever was taking a heavy toll in Mumbai city. All the blood banks had gone dry for platelets. The clock was ticking and it was 3.00 a.m. in the morning. Finally, I called the 16th blood bank and to my surprise platelets were available which was a miracle indeed. The father rushed to the blood bank to get those platelets. Platelets given, the bleeding decreased and patient improved by next morning. My eyes were drowsy and brain was drained, no night to sleep but

the smiling patient I had, made my day. The next day, the father had gone to the blood bank for the bill and receipts. When he came back he told me, "Sir, the person for whom the blood platelets were reserved, died at 1.00 a.m. and hence we got it at 4.00 a.m. That man's death saved my son's life. Must say, on each drop of blood there is a patient's name, praise the Lord.

Another old grandmother walked into my clinic with her grandson. The child was being carried on her hips. He was probably old enough to stand and walk by himself. Why had the grandmother come with the child? The reason was clear with minutes of talk. The child's mother had absconded leaving her alcoholic abusive husband and the father was hardly bothered about the child. Since some past 4 months or so, he had been sick. He had been suffering from continuous cough, cold and fever intermittently. He continued getting weak till one day he could not walk. He could barely stand holding on to a sofa. The child was four years of age. He had started walking and standing at one year of age. It was when he was 3 years of age that his mother had run away after which the child kept on falling sick. The grandmother yet cursed her son, the child's father, for if there would have been any other woman in her place, she would have done the same. Who would stay with the alcoholic, abusive, addict husband? Her son was good for nothing. The child's health had continued to deteriorate from 3 years of age. Recurrent coughs, cold and weakness, he was not able to stand. They had been going to Municipal Hospitals still his health was not improving. His chest X-ray showed pneumonia and he was discharged from there on oral medicines. Since he was not able to stand MRI scan of the spine was advised. But because of his cough, colds he was not getting fit for anesthesia. As for this he would require to be sedated before the scan to avoid movements. So, neither the MRI scan was done nor was the treatment initiated.

On examination his spine had turned to the left in the thoracic region (Upper back region). He could not afford MRI scan in the private scan centers. This was the condition when the child was brought to me. A plain X-ray of chest and spine was done and the basic investigations were carried on. The X-ray chest showed a tuberculosis patch with a cavity and the X-ray spine showed wedge compression of the vertebral bodies in the thoracic region. The hypersensitive skin test, mantoux skin test, for tuberculosis showed a big patch at the site of the injection. This along with the X-ray supported that he was suffering from Koch's disease (tuberculosis or T.B.). So he was started on anti tuberculosis treatment and within a week his cough, cold improved. Fever disappeared and he started standing. Since his general condition improved he got fit for anesthesia. The MRI scan was done which proved it to be Koch's spine. And the child improved with a little God's grace and common sense. With time he got better. After about six months the child was brought to me for his routine check-up by his alcoholic father. I asked, "Where is his grandma??? He replied "She died because of T.B.

Studying Dead!!!

As doctors we even don't spare the dead. The dead ones are asked for evidence, even dead bodies speak for themselves, leave aside the ghosts. The fresh dead bodies studied in the Autopsy room, to find the cause of death either natural or unnatural. The remaining circumstantial evidences were preserved in our forensic lab. Russell's viper, the cobra, the rat snakes, the python, all the common species of scorpions, honey bees and wasps were

preserved in formalin solutions. We were supposed to learn from them.

Whenever we entered the room, hissing sound of the snakes used to fill our ears. Guns of various shapes, sizes, pistols of various makes were present in our lab along with air guns and pellets. We also had a specimen of a suicidal skull with the bullet which had ricocheted inside, 'zip-zap zoom'. The skulls with various marks on them like the axe mark, the daggers which were pierced in them, bullet marks at various angles, whether suicidal or homicidal had loads of stories to tell us. Suicides, homicides and murders, section 302 I.P.C. was very evident from them. Sodomy, bestiality, rape, the natural and unnatural sexual offences were also a part of our forensic lecture series. Though our lab had less circumstantial evidence, the autopsy room spoke off the volumes of those several offences. Ganja, hashish, cocaine, smack, dhatura, aconite and cyanide; all the possible poisonous substances were kept in heavy locks lest someone would have committed suicide by consuming them. I remember of an incident. Our forensic viva was on, and my friend was running out of wits to answer the viva-voce questions. He just picked up one of the gun and pretended to shoot the examiner's ghost, 'bang-bang' in a comical gunshot which took the main examiner by surprise and others into a deep zone of never ending laughter. Today when I visit my alma-mater, the same skulls, pistols and all others are as it is. Only the students have changed and the story of the skulls continues Attending twenty autopsies were compulsory for us. Three days were enough to complete the task. In forensic science, the freshly dead were brought to our autopsy room. Death was present in a wide array of colours like drowning, suicide, murder, heart attack, kidney failure, liver disease, bullet injuries etc. It was almost like a cafeteria approach. The deaths with

obvious causes were never autopsied. The major task was only to differentiate death into two categories natural and unnatural. For example, an oldie of eighty five dies of sudden heart attack or a young child dies with meningitis you hardly need an autopsy, as the causes are known and very obvious. But, if a young chap dies under suspicious circumstances you definitely require an autopsy. Autopsies are usually done in the day time unless in certain special circumstances. Love, hatred, desires, luck and faith all are virtues of the living. The dead nude bodies lie in a stark silence with a blank and still look. Sometimes the hands and legs became stiff because of the phenomenon of rigor mortis which sets in three-four hours after death, which is predominant in case of unnatural deaths. The nude dead penis, the shrivelled breasts and the stink of the rotten vagina, only a necrophilic would be that impressive. The air in the autopsy room was pungent enough to decrease your libido drive for a week. The haunted feel came out of a herd of wailing relatives who waited outside the Autopsy room. An old oak and peepal tree stood outside our autopsy room. And as an outcome the sunlight used to trickle down its leaves to our window panes giving some really scary ghostly figures. The technician used to come with sharp daggers, scissors, chisels and hammers. With chisel and hammers, he would break open the skull bone and the chest bones. Fine splinters of skull flew around. We often wondered how our lab technician does that daily! But that was his job. His wife and kids survived on the money, he derived by butchering the dead. For the forensic technician his job was to open- skulls, chests and abdomen, take out the liver, spleen and intestines, about ten times a day. Our forensic professors would guide us into the research, "See those throttle marks on the neck, suggests of a force applied on the neck or someone else has tried to strangulate the already dead person. I witnessed a dead nude girl in the twenties, bare in front of us, raped and murdered. The circumstantial evidence of the superficial skin under the nails of the girl, her soiled clothes with the seminal stains of the rapist, the injuries on her face and breasts which suggested of the force and the marks on the thighs which suggested that there was definitely no consent for the sex, all those were enough evidences, to help the dead girl get justice for herself. Investigating the bullet fire was also another task in the forensic lab. The wound of entry and the wound of exit, the gun powder, the shell of the cartridges which were recovered, how much distance was the person shot from, all these could be told from the bullet. The Bomb blast victims whose bodies were charred beyond recognition, then the chains,

bangles, rings, dentures and dental fillings gave us evidence to reveal the identity of the person. Hemorrhagic effusions around the heart, obvious clots in the coronary arteries, told us about the man's heart, his love and also of the terminal cardio respiratory arrest due to myocardial infarct which caused his death. Deaths caused due to drowning as well as those due to throwing of dead bodies in water, could be easily recognized by the water soaked lungs. The blood samples were also taken in those cases, where poisonings were suspected. Fine sliced out pieces of the liver and stomachs were formalinised. Death was systemically analyzed to solve all the 'ifs' and 'buts'. The autopsy room used to solve mysteries, it was like the mysterious hunt of Sherlock Holmes and our forensic experts were our real life Sherlocks. One thing which we learnt is- respect the dead. Only one case of exhumation brought to our autopsy room was of a body about one year old after the person's burial. The dead man was required for special investigations. Since the smell was so rotten that our guts fainted. We did it without food. Our technician could barely do things out of it. Most of the chicken-hearted were made to stay out of it. The dead body was in the stage of decay. Our forensic experts examined the body and verified the previous findings so it was not a big deal for them but it was an experience only once in a lifetime for us. Students change but the old oak tree, the banyan tree, the autopsy room, life and death all continue to remain the same.

Anatomy Dissection Hall

Our anatomy dissection hall was a big hall with seven cemented tables on which the dead bodies were positioned and dissected. And there was a big cement tank, filled with formalin. Formalin is the chemical used to preserve dead bodies. For the first time when we gathered in the Anatomy dissection hall, the strong smell of formalin pierced our eyes. Streams of lachrymatory water just rolled down our eyes as if thousands of onions were getting chopped over there.

The Anatomy hall assistant after wearing his gloves quickly placed the dead naked corpses on the dissection tables. Nude, lifeless, formalin sodden- six bodies were being placed on six tables. Our batch was divided into six groups of twenty students each. Each group had an instructor doctor. My group had the most number of good looking girls. In front of us laid a nude male body, ready to be dissected. Like a 'don' I led all those chicken hearted ladies. Two of them fainted on the sight of that corpse and I immediately came to their rescue. This was the first time in my life that I had not just one but two beauties in my arms. Before your imagination goes wild, let me make it clear that, there was no mouth to mouth respiration given as is shown in Hindi movies, but a fistful water was sprinkled and their beautiful eyes opened, one after the other. I assisted them to the chair nearby. I was soon honored with a title of 'The don with two queens'. It was indeed my day. I enjoyed the attention. With time, identifying those nerves, bones, blood vessels and dissecting them neatly became my inborn talent. But there was one difficulty. Group number five and six had the dead bodies with almost identical appearances. They were dark, nude, lifeless males with rotten teeth and no tattoo or birthmark, nothing as such as a death mark. So, one of the beautiful ladies just planted a Cadbury between our body's teeth so that we could differentiate. The very next day, the Cadbury was missing from the corpse. Had the dead man come alive after tasting the Cadbury or did he gulp it? Neither was the case, as we all had assumed. Later we cracked our heads to conclude that the Cadbury would have got dissolved in the formalin solution. As soon as we discovered that, our batch mate came up with another innovative idea. The purple wrapper of the Cadbury was tucked in his mouth. Then we could easily identify the dead corpse as our own. Soon, we had this strong sense of him belonging to us and also all of us belonging to him. It wasn't any horror show's experience, but it was something which made us graduate from chicken hearted students to the lion hearted doctors, that we are today. We are still obliged and respectfully owe our degree to the dead corpse which allowed us to perform dissection on its nerves, heart, blood vessels, testicles, kidneys, bones, hand, skull ; almost everything. By the end of the year, the Cadbury wrapper had also dissolved away in the formalin and the dead corpse's parts got butchered which accounted towards the fact of the life- earth to earth, dust to dust, ashes to ashes. So make hay when the sun shines and stuff a Cadbury down your throat when you are alive. The dead bodies were a testimony to the fact that however rich, stubborn, arrogant, naughty, haughty you are, you are born naked and die naked for after death there is plenty of time to sleep- may it be rich or poor. Those bodies used to be removed from the formalin tanks and dumped back into the formalin tanks, where they would sleep over, on top and by the side like

a nude orgy, listless, lifeless, seaming less, meaningless for life does come and go, only the remains existed in our anatomy hall. Daily these bodies were being removed and by the end of the day after being dissected; maybe the hand, the liver or the heart, they were placed back into the formalin tank. Later as the dissection progressed- the hand, the leg, the stomach were detached into an entity far from the parent body. They also formed specimens after neat dissection. For example heart or kidney sample, it was sorted out, treated with formalin and kept in a jar as the specimen collection in our Anatomy specimen room. From all those bodily dissections, our hearts too became thick like crocodile skins and the beauties who fainted, got acquainted to the truth of life. There is nothing as such living, death, spirit, soul, sin, evil, dead, corpse, ghost. It's all about the life we live and how good we live it. For we have only one life to live, eat, drink, suck, make love, shit, urinate, shout, laugh and experience sorrows, sins, remorse, happiness and joy, so live it with grandeur. This was the teaching which we got from those naked dead bodies. On the fifth floor of the college building, crowning it was the Anatomy dissection hall and in the neighborhood was the Anatomy reading hall. Neatly cut and dissected specimens of lungs, liver, heart, brain, testis, uterus preserved in formalin bottles were kept on the iron shelvesmay be at least 25-30 years old. So batches after batches of students learn from them, admire them, and fumble on them or even crack exams from them. I still pay a visit to those dissected kidneys, genitals and hearts which had helped me to become a doctor that I am today. Writing about the anecdotes and memories about those patients, which have turned my hair gray, I feel so great. We studied at that place, sat on the floors- cross legged, slept on those floors, and partied on them as well.

those three children

Its a hospital story of Mehtaab and his friends. Mehtaabs dad was a vegetable -seller on the streets of Kamathipura, the red light area of Mumbai. Mehtaab used to be admitted at least once in six months of my posting in the pediatric ward at Nair Hospital. Why? Because of his roly-poly body, bloated up like an orange with thick swollen eyes and chubby cheeks along with a protuberant abdomen. Even his skin was coarse. At the end of treatment, his balloon like body used to get deflated and he used to become Hardy from Lauren. He had nephrotic syndrome in which his kidneys were unable to manage water and electrolytes balance and his body used to swell up. Urinary tract infections or upper respiratory infections would precipitate the kidneys into water retention, so, every six months Mehtaab used to give regular attendance at our pediatric wards. Calculated steroid doses had made him a steroid responsive rather steroid dependent nephrotic syndrome. It had become a regular routine for the vegetable seller, his father. Early morning he would come and admit Mehtaab, buy those steroid medicines for his son, most of it known to him and then go to sell some vegetables. In the hospital Mehtaab would be pampered and taken well care of. He would sit on his bed and watch other children play. He did not like mobility. It usually used to be a group of 3 people: Mehtaab like a king on one side with nephrotic syndrome as his crown, Rumella like a queen in between with aorto-arteritis as her realm, and Raju on the other side with Rheumatic heart disease as her domain. They were the three chronic visitors of our pediatric ward. Their beds also used to be fixed at the window side, wind, rain or sun. In addition to their chronic diseases they shared one more thing, their poverty. At home many times they used to stay without food. But in our Municipal hospital they used to get free food twice a day, a glass of milk twice a day with biscuits. They used to wait for the lunch bell. Ting, ting, ting the maushi(maid) used to ring before serving food and our three musketeers used to get preference over the others. An extra serving of fruits and chapattis used to be readily available

for them. Mehtaab's father was a vegetable seller, Raju's mother used to sell bindis to hair pins in local trains and Rumella's mother was a fisherwoman. Still they were not getting proper food. The milk served in the hospital used to go down their throat in one gulp. How can fussy children not drink milk and not eat food? Leave them in an impoverished house with no provisions. I say, it will work wonders. Mehtaab used to be very unhappy to leave the hospital. It meant no food. He would have to share half the chapatti with Aftaab, his brother. No doctors to pick him and cuddle him, no nurses to give him medicines on time, no aya-bais to give him an extra serving of fruit salads. Mehtaab would cry bitterly when injections would be given, but his parents were never around to console him. His father would be off to sell vegetables. His mother would manage Aftaab in their hut and pay frequent visits only in the visiting hours. Good care was taken of Aftaab by his mother. She was fed up with Mehtaab and his chronic illness requiring hospitalization. She wished at least Aftaab would turn out to be healthy. It was all because of our Charitable Municipal Hospital that Mehtaab was alive otherwise he would have been dead, long back. In his last few admission episodes, he was not responding to the normal steroid medicines. A kidney biopsy was done which showed a steroid resistant pattern of a focal segmental glomerulonephritis (FSGN) affecting the kidneys and probably progressing into a chronic renal disease, an end stage renal disease. High end medicines, dialysis were all started for Mehtaab. Mehtaab was on peritoneal dialysis. Fluids used to be introduced through a canula placed in his abdomen and then withdrawn so as to remove the toxins which his kidneys were unable to do. His puffed up face with catheters in the abdomen used to make him feel like a cute extraterrestrial being. He had tubes put in his abdomen; but he braved it all, fought back with courage and showed a recovery which was not expected. Dialysis stopped, injections stopped, Mehtaab this time was happy to go home. This episode was a bit too much for a child to handle: Injections, kidney biopsy and catheters for dialysis. But little did he know he would come back in a week's time. Yes he came back, just to collapse and die. Though acute renal failure was the cause of his death, poverty was the main reason as his father couldn't afford the costly medicines. The entire ward, doctors, nurses, aya-bais, Rumella and Raju were in a state of shock. Rumella was a queen. She lived in her own mystique aura. Though her mother used to sell fish, she used to carry herself with the pride and dignity of an uncrowned queen. All nurses,

doctors, aya-bais to her service. She along with her two gang members Mehtaab and Raju used to rule the ward. Rumella Khatun, the 3rd female child born to an alcoholic abusive father and a hard working fish selling mother. Adversity really gives you a cutting edge. She was a sharp and fierce Bengal tigress. She had a cot reserved for her near the windows and her two friends who would always be there to invite her. She always used to come with cough and respiratory distress. Her blood tests and x-ray chest would be normal. Her 2 echo for the heart was normal. The recurrent cause for her breathlessness was a matter of concern. No pneumonia, no heart disease, no asthma, no bronchitis. It might sound as if I have no fiat, maruti, nano, santro but I have a Mercedes. Yes, she really had a rare and complicated cause of breathlessness, Aorto-Arteritis. Her pulses were not felt the same, bilaterally. That is what we call as clinical finesse and our head of the department had cracked the elusive diagnosis. Rumella was responsive to medicines initially but gradually the disease started spreading, the coronary arteries of the heart, the renal artery of the `kidney and the temporal arteries of the brains were all affected. But the queen was unperturbed by the constant invasion of the predators from within. She continued to laugh, play and boss over Mehtaab and Raju. She was suffering from such a disease which science is still somewhat clueless about. We were still to demystify it. What would be her line of treatment? -was a question troubling us. Artery biopsy had proved the diagnosis, but what was the treatment. Steroids and immune modulators all were tried but no help. This disease was like cruel British Raj zeroing our queen of Jhansi. But she kept on fighting valiantly on and on till one day she died. She had died with a smile on her face. The queen of Jhansi through her sacrifice had given the moral boost to India to throw away the British Raj but the way Rumella faced the disease boldly; she was our queen of Jhansi. Her courage spoke for her- You cannot take my smile away. Come, what may. A fight to the finish is more important irrespective of whether you win or lose. The fighting spirit is important. Long live our queen, our Jhansi ki Rani. Rajmati, ought to be the name of a queen, but she was a queen of the roads. We used to call her Raju. The beggar queen, her mother used to sell clips and pins in the local trains. She was another kid who had overcome her adversity. Being a street girl, she knew all of Mumbai's slang. She knew of sex, rape, girlfriend, boyfriend and menses. Toiling on the streets, day and night, begging and selling pins, was her way of survival. Survival of the fittest. She knew for herself that ice-creams and cold water aggravate her cold and breathlessness. Breathlessness meant no begging, she would come to the hospital and get admitted, admitted for food, medicines and self care and would get to meet her two friends

whom she felt as a part of her extended family. She knew the doctors and nurses by their names. She always demanded for that extra ration of fruits and milk, for once she would be out on the streets, fruits would be meant to be seen only in the stalls. She had Rheumatic heart disease. Her heart valves were affected. She had fever at five years of age after which her joints became stiff and since past two years her breathlessness had increased. A 2D echo of her heart was done which showed all the valves were defective. Mitral Stenosis (MS) with Mitral Regurgitation (MR), Aortic Stenosis (AS) with Aortic Regurgitation (AR). Most of the heart murmurs were well heard by examining her. For students during examinations, she used to be like a juice case presentation. Students used to get good marks taking her case. She used to tell the upcoming doctors, "I am Rajmati, Rheumatic heart disease, MS, MR, AS, AR. As if they were some M.S., M.D. degree. She knew her medicines well. Antibiotic tablets twice a day, white tablet daily, stop on Sundays. That was Digoxin. This white tablet causes lots of urination (lasix). With time, all her heart valves were progressing from bad to worse. Valvular replacement was the only option. Cost for her valves was a major issue. For one year we were mobilizing the medical social workers to sanction some fund for her valve replacements. We even asked for some donation from philanthropists, quite a lot in Mumbai. And finally with cheques and cash from our efforts made us reach the desired figure. She was all set to get the operation done. But it was the time when Mehtaab had just died. This was a major mental block for her. She could have come out of it but she died on the operation table due to some anesthesia complication. 3 children, 3 lives, 3 deaths- all united by some karmic connections. Raju- the boss of the streets, Rumella- the born queen and Mehtaab- the roly-poly, they had a triangular affair to remember like the Bermuda triangle.

It was June and for me my early PG days. One day, it was raining cats and dogs, the usual pouring for Mumbai. It was in my first posting as a pediatric resident. We had just started learning to do blood collections and establish IV lines, start saline dextrose drips to babies. We were babies in the department. The complicated cases, the ventilator babies, the difficult syndromes were not our cup of tea. It was raining very heavily outside. There were no seniors in the hospital ward. We were just running about all over the pediatric ward, from one baby to the other, from one blood collection to the other intravenous line fixation. It was the day of our post emergency ward rounds. All the routine work was to be done like the common household chores. In the middle of all, a small child about an year old was brought with severe dehydration. He had around twenty vomits and some fifty odd motions. Come, come and go, go. At one moment pulse was felt the other moment it was not. The moment he was brought his heart was still beating, in matter of seconds he just gasped once and didnt take any further breaths. I had to be with the child rather than informing the seniors. It was now or never time. I quickly called for two nurses, got the intubation tube (endo-tracheal tube), pulled on the suction machines and suctioned all the secretions out of his mouth, cleared the airway, applied a pillow under his head, held a free flow oxygen tube near his mouth, gave a few cardiac compressions, and then gave him positive pressure ventilation by the ambu bag. I was not even well versed with resuscitation of children; still without thinking of why, what, I did it. But the child was still not breathing so as a last attempt I decided to intubate him. Never had a chance before, only had seen it on dummy and heard of it in lectures and seen it once as a student in the medicine posting in graduation days. But practical on a child, damn difficult!!! With the gloves on, I removed the tube from the sterile plastic covering, the laryngoscope in the other hand, I got myself seated at the head end of the patient, rather a dead boy, saw what I could. I, with almost no hope, lit laryngoscope light. With the laryngoscope held in the left

hand I depressed the tongue and the epiglottis so that I could see two holes: the larynx the entry to the trachea (air pipe) and the esophagus (the food pipe).The air pipe opening (anterior) and the food pipe opening (posterior). Would I be able to place the tube correctly in the air pipe? I was the dilemma. But there was no time to think. It was the time when pure action was required. It was like a virgin lover on his first wedding night not knowing as to which hole to go into. Even if the lover failed there would be a next time but here there would be no next time. I pushed down the endo-tracheal tube, connected it to the ambu bag, removed the laryngoscope and fixed the tube to the angle of the mouth and started ambuing to push oxygen into the lungs. The expansion of the chest revealed that my tube went successfully into the anterior hole. After about eight to ten ambu pushes, with continuing cardiac compression massages we finally heard the first lub-dub on the stethoscope. By that time a lady senior resident came in shouting on the top of her voice as to why she was not informed. But looking at the resuscitation scene she stood there with a startled look. She took it over from me and continued the C.P.R. (cardiopulmonary resuscitation). By the time, I could establish the intravenous access and push in some intravenous fluids. Then stepped in our pediatric intensive care resident doctors who took over the child and connected the baby to the ventilator. By around fifteen minutes time the baby was shouting loudly as his endotracheal tube was removed out of his mouth.

The child recovered from almost a cardiopulmonary arrest due to grade III dehydration due to acute gastroenteritis. What followed was a shower of praises from seniors beca use alls well that ends well. A life saved, the job done. As time went by, I had revived many babies but that first intubation episode was special just as the first night of the newly wedded lover. The right hole mattered!!! Well, after such hectic schedules what we really wanted at the end of the day was our hostel. Our hostel bathrooms were cleaned frequently. The toilet had holes all over the door making it breezy. If someone enters without precautionary measures of knocking, he gets to see a public display of private parts. Our bathrooms had been separated by walls. Two had hot water showers which were a luxury sometimes. The separating walls were not full length. We always thought that there was a gay ENT registrar who had not allowed building the complete wall. Maybe he used to climb on the pipes to have a look at those nude dudes bathing. The girls washrooms were different. So we presumed he was gay. Even if it was true who had the time to get bothered. We were happy that at least we had a good canteen. The taste was very good despite the fact

that one may find a fly in the coffee or a cockroach in the Chinese Manchurian running over it. Without a commotion, we always paid the bill and still continued to eat to our hearts content. Philosophy was simple, if you get typhoid, T.B., malaria or jaundice you pop up those pills down your throat. It was like a rule, if you are a good resident you had to get one of those diseases. Yes, I had my share of viral hepatitis in my 3rd post, my friend had T.B. and another one had typhoid. A few proxy signatures on the muster were allowed. Saturday night the cable operator used to put a blue film for the entire male college hostel. Occasionally, female doctors would pop in to damage our liberty. Three years of residency, hostel life was just passing by, how no one knew. From nine in one room I graduated to two in one room. Here, there was one cot per person and one cupboard to each for books. Pictures of JLO, Kareena Kapoor already adored the walls. Pictures of various Gods and Goddesses were on the book cupboards to give us an extra momentum to pass the exam. There was a so called clothes rack where all undies in various shapes and sizes would hang. Clothes were usually pressed and washed by the dhobi. The senior registrar room was close to the canteen kitchen, though I used to get dabbas from home. Mumbai has this unique dabbawala system. Hot home food comes to your work place daily by these dabbawalas. Poor mummies think that their babies are chronically starved and require good nutritious food. Today, as a parent I think the same. I was nearing the end of my third post in pediatric residency and I had got an unusual case of a child born to a commercial sex worker. She was HIV positive. She had taken Zidovudine as a prophylaxis; an anti-retroviral drug which prevents vertical transmission of HIV from the mother to the unborn child. It was a baby boy born by a cesarean section. Things were alright for about a month but soon the child was admitted for cough, cold and respiratory distress. The x-ray done was suggestive of pneumonia. Spot HIV-test may give a false positive result as the maternal antibodies can interfere, but in this childs case we got a positive HIV test both by the spot method and the ELIZA method. Though a repeat test would confirm the HIV status after 6 months, it was almost certain that the child was HIV infected at birth. It is compulsory in all the Municipal Hospitals to treat HIV patients as normal patients. Doctors are supposed to use universal precautions like face masks, caps, gowns, double gloves, HIV goggles, almost look like a Zombie (green colored) with all this apparel on, sodium hypochlorite solution washed floors which kills HIV virus in blood spillage, clothes and gowns

if there is spillage of HIV infected blood. It was a good learning experience, though bad for the patient. How to treat a HIV infected patient? How to treat a resistant pneumonia because of HIV infection? Also how did the baby get HIV? The mother of the child was a commercial sex worker in Kamathipura area (the red light area) in Mumbai. A Nepali girl forced into prostitution about five years back. She had contracted the disease somewhere in these 5 years by un-protected condom-less sex. She used to serve minimum four to six clients a day. Used to make about six to seven thousand a day in those prime years, but her skin trade decreased as the news of her HIV spread. As the disease groped her, the news of her pregnancy came along. She refused to abort, as she wanted someone to live with. The AIDS control cell said that because of anti-HIV drugs there were chances of the baby being free of HIV. But that didnt happen. The baby also had turned to be HIV positive. She did not have much idea about HIV, except that it was a sexually transmitted disease like syphilis, gonorrhea or genital herpes. But her recurrent cough, colds, fever, vaginal infections, recurrent doctor visits and rejections by her clients made her realize that it was a fatal disease with no cure. The pregnancy somehow sailed through, till the eighth month when she had premature pains and she delivered. The delivery was in the Kamathipura Hospital. The Gynaec hospital situated in the red light area, where there were many HIV infected patients. Not knowing a lot about HIV, she had only one thing in her mind that she and her baby would be cured of HIV and one day they both would shift back to her village with lots of money which she had earned. Well, when the baby was admitted with us in the neonatal intensive care unit, I was one of the residents for on call duty. The IV line of the child failed regularly, so every time a new intravenous access had to be found. The child was about a month with us, had his IV lines changed every three to four days, his veins were not at all easy to access. It used to take almost an hour to establish the IV lines. Clean slowly with spirit and betadine. The neocan canula inserted and the needle was withdrawn from inside the canula, blood would trickle out in a stream then only the IV line would be properly in or it would be a failed attempt. During the first attempt itself I managed to get the intravenous access but as I was sticking the IV line with plaster taper, I accidentally pricked my hand with the needle which I had removed from the same canula, by a catastrophic carelessness. So it was a prick by a HIV infected needle. Was I to get HIV infection? Was a single needle prick sufficient to get HIV? I was to get married in another 6 months time, will my wife also get HIV? Will she marry a HIV infected doctor? Will my career and life get ruined after HIV infection?

Panic struck as I ran across to the students welfare committee where I was advised to wash hands immediately with sodium hypochlorite solution and to expel as much blood from the prick site by pressing my finger. Only a few drops came out. The Zidovudine stock was over. The same medicine was even prescribed to prevent transmission of HIV from the infected needle, which the mother had used in her pregnancy but it didnt give her any success. It is to be best taken immediately after the needle prick, but I had to wait till the morning till the pharmacy stockist would open and make it available to the store. All the questions kept on repeating in my mind. The HIV counseling unit in Nair hospital would also open in the morning. A simple prick by a HIV infected needle had disturbed me and rightly so. What was my fault? Someone had unprotected sex with someone who had HIV infection and now I was the one to be HIV positive. I just broke down into tears. My parents just came over to the hospital to console me and give some words of hope. Doctors who work with HIV patients are at constant risk of getting infected, one of the many aspects of HIV. Next morning it was a different situation. Zidovudine popped up, the department bosses at the HIV counsellors cell. HIV tests were summoned. P.C.R. test was done. I was on Zidovudine prophylaxis almost for 3 months. I used to get nauseated by the medicines but there was no alternative. Three reports for HIV done over six months. All turned out to be negative. I was finally HIV negative. HIV does try relationships and patience. Doctors, patients, relatives, husbands, wives, spouses, children, neighbors and the stigma of getting HIV infected. The mother apologized to me when she came to know of the episode. I consoled her that there was no such need to be sorry to me. I just patted her back for the sadness and the bitterness which the world would have against her fatherless child. The child went home from the hospital after being treated for the infection. Having almost stepped into the shoes of a HIV positive patient was an experience which I laugh at, thinking today.