The Room of Blood, Panic, Tears and Pain

The Room of Blood, Panic, Tears and Pain

An ongoing study of the Indian Medical Association (IMA) revealed that over 75% of doctors have faced violence at the work place. Attacks on Doctors and Indian Hospitals have been continuously rising – exponentially so in the last 5 years. The attacks have not only increased in frequency, but also in violence.

In September 2013, a lady doctor on call at the Lok Nayak Hospital in Delhi was physically assaulted and apparently threatened with rape by a patient’s kin. Her only crime was attending to the sicker out of the two patients that had come in at the same time at which the other patient’s relatives had taken offence.

In early 2015, a doctor was assaulted in Allahabad and the infrastructure in the ICU damaged by the relatives of an eighty-year-old patient who came in a critical state in multi-organ failure and died in the hospital.

Just last year, a 3 year old child was brought in dengue shock syndrome to KEM Hospital, Mumbai. As there were no vacant ICU beds in the hospital, he was admitted in the ward after a written and informed high risk consent form was signed by his parents. Critically ill, the child  suddenly died despite all appropriate measures. Therefore, his father and uncle with two other people took it upon themselves to beat up three resident doctors with iron stools, rods and wooden sticks snatched from two female security guards.

The Maharashtra Association of Resident Doctors (MARD) alleged that one of the security guards was sleeping, while the other was working with a fractured leg. “Both had run away. The doctors were mercilessly beaten up with iron rods, which could have killed them,” said Dr Sagar Mundada, president, central MARD.

Such is the plight of the doctors who work day in and day out, often neglecting their own personal needs to take care of complete strangers.

“But that is the nobility of the profession!”

“That is why you took up medicine!”

“That is why you get paid so high!”

“Oh, come on. It’s not like you guys don’t mint money on the side from the poor suffering people by ordering unnecessary investigations and prescribing expensive medicines!”

Exasperating!

Hearsay and media have morphed the image of what doctors should be and what they are into abysmal monstrosities. Yes, we are servants of humanity- but we are not slaves to your every wish and fancy. Yes, we signed up for all the hard-work, but we did not sign up for physical and verbal abuse. Yes, there are doctors who are corrupt, just like there are corrupt people in each and every profession – and just like every other profession, they form only a minority.

However, unlike every other profession, doctors have no room for error. They have to maintain strict, almost military decorum at all times. They have the more working hours than any other profession. They work holidays and Sundays. Hospitals cannot remain closed for three days in a row. Contrary to popular belief, doctors are highly underpaid in regard to the work they do. Underfed and under-rested, they continue to work in sleep deprivation for days on end often in places where there are not even common public facilities like a decent toilet.

Despite this, they endeavor to give the best possible care to every patient at every odd hour, in every season and irrespective of the patient’s caste, creed, color or financial status. And yet at the death of a relative, doctors become human punch-bags for the patent’s relatives, mostly due to no fault of their own.

A bridge collapses. A building falls. A drunk driver topples a bus over. A driver high on weed hits a pedestrian. A woman after missing five follow-ups and medications for 3 days, as her son was too busy to be bothered, ends up with continuous seizures. All these people come to the hospital where they are dealt with by the doctors in order of the severity of their injuries and ailments. They are administered the drugs that are available in the hospital, sometimes not enough for the patient load.  The patients wait anxiously. And when a young doctor comes to break the news of their loved one’s death, all hell breaks loose on him.

Sadly, the doctors are not given enough power to even fight for their rights. While all dissatisfied people can stop the work and block roads,

Doctors are forbidden from even going on strike to make their voices heardLeft to constructive devices like the marathon run by the AIIMS doctors last year for the cause, their voice hardly goes out of the walls entombing the constant war between life and death with doctors functioning as the only force-field.

If by chance doctors do manage to raise their voices, they are again dealt with violence and thrown in jail as in Maharashtra; or their clothes ripped off and assaulted as happened to lady doctor in Bengaluru.

What is the cause of this resentment towards the Doctors? Why isn’t the engineer sought and beaten up? Why isn’t the driver thrashed into a pulp? Why the son isn’t held accountable for the neglect of the mother? Why does the society have such a vengeance only towards Doctors?

The answer is simple.

They are at the wrong place at the wrong time. Their profession places them there. It is their job to deal with life and death on a daily basis. Unlike every other profession, they are the only ones who directly deal with humans and human life.  Thus, they become easy targets for misdirected anger.

After my personal meta-analysis of the various reports and surveys, I have found a pattern in why and how these attacks occur.

Firstly, the victims of such assaults are mostly the resident doctors who are young and are still starting to deal with such delicate situations. One has to understand that the doctors are not only dealing with the physical ailment of the patient, assessing the severity of the same, formulating management plans, treating them side by side, documenting everything for medico-legal issues but also simultaneously trying to gauge the mental status of the patient’s relatives, assessing their financial constraints, trying to make them understand the illness according to their educational status and counseling them regarding the bad prognosis of the patient and the little hope of his survival after which they also have to deal with their emotional turmoil – all this, within a few minutes, with the abysmal personal condition of the doctor himself and without any room for error and maintaining good manners and a warm countenance throughout.- Phew! They are given no special training to handle such circumstances. They have never been taught mob psychology or the fine art of counseling.  There are no counselors available at hand. They have nothing to rely on except their short experience. I will leave you to judge if it is too much to ask of a human being.

Secondly, most of the attacks happen during evening and night hours. This is so because the hospital staff and personnel are less and the senior doctors are often unavailable to counsel patients in an efficacious manner.

Thirdly, in majority of the cases, the patient has been bounced around a number of quacks, babas and various other hospitals or places and sometimes just neglected at home for indefinite time before they are brought to the hospital in a very critical state. Some patients do not have enough money, some have already handed their life savings to people mentioned above before they were turned to a teaching hospital as a last resort at the eleventh hour.

On top of all this, the educational status of the patients makes it very difficult for them to understand much, if anything, about the illness. All they know is that bringing a patient to the hospital automatically means miraculous cure.

They cannot understand how a hospital can be short on resources or how their loved one could ever die. They are already angry at the world – at the engineer, the bus driver, themselves, their fate or the entire universe. The system is to blame for lack of amenities. However, these people can’t be caught hold of. So they unleash all pent up wrath on the helpless doctor in front of them without a second thought.

While raising the wisdom of the society and making them more liable to deal with their emotions maturely is too much to ask for, short and intermediate term measures can be taken for a smooth functioning of healthcare system. Increasing security for the protection of the doctors and allowing only one or at the most two relatives at a time are a few immediate measures that can be taken at the level of hospital administration.

The government needs to be moved to provide adequate appliance and drugs, more health insurance schemes and increased manpower. This, coupled with an upper limit of working hours for doctors and providing day off after being on call will keep them functioning at the optimal level. The medical education should involve courses regarding mob psychology and counseling. Grief counselors should be appointed 24X7 in the ER.

The media, too, cannot be absolved of its sins in this regard. Blowing up the follies of the minority of botched up cases, finding faults where they are none and parading them in front of the world using famous people with no medical education takes away the faith of the society in doctors. A faith that is the lifeblood without which healthcare cannot function. Restraining public shaming of doctors and stopping the envenoming of the society’s mind against them is high need of the hour. Unless this demon is bridled and the real facts made understood, there is bleak hope of improvement in the condition of doctors in this nation.

The most pure and pious profession is painted in a portrait so ugly and atrocious, it is nauseating. Doctors are portrayed as heartless demons who run a business for personal gain and live lavish and comfortable lives at the cost of others’ – a picture so far from reality it is almost fictitious.

The truth is, medicine is a hard and trying road. One needs strength of character to go through this furnace. A person who has never walked this path, will never understand the pain and the glory of it. Let it be known that a doctor would never want to see his patient suffer. The sound of the cardiac monitor beeping after a CPR cycle is the sweetest music to the ears of the doctor. It is proof that half his life that was spent in books, all the late night parties he missed, all the functions he failed to attend, all his education loans , all his workaholism has finally not failed him. Would a Kshatriya be proud to lose a battle? Would a Brahmin be proud to lose his Knowledge? Would a Baniya be happy to lose a bargain? Could a farmer who has worked his fields for the whole year stand the destruction of his crop? Could an artist stand the soiling of his masterpiece? A doctor is all these and much more in moments like these. The patients’ relatives who are convinced that a doctor would willfully harm his patients, have never understood the profession at all.

When interviewed later, their simple answer is “We were so struck by grief and emotion, our minds did not know what our hands did.” Grief makes people blind.Doctors know this, and don’t expect people to hold together at such times. Oftentimes they even help the relatives to cope with it. For grief is the right of every human being who has loved; and without love there is no humanity. However, grief does not give anyone the right to vent out the frustration on and physically injure others – least of all on one of the few professions that save lives.

Your panic is not the excuse for violence.

Your pain is not a reason to inflict it on others.

The tears from one’s eyes do not give them the right to hurt the hand that heals.

The blood of one’s relative does not give one the right to draw blood from the chalice pouring elixir of life.

The room of blood, panic, tears and pain is a place to heal, not to avenge your fate.

Let the staff of reason prevent us from poisoning the hearts that care and the minds that cure.

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