One night in the er room

One night in the ER room

In the ER room –dates do not matter. Things happen so fast that time is always a blur –but things seldom change. Only faces do- and masks. The gurneys, the examination beds, the blackened tube light above, the short supply of drugs, the abuses of relatives of patients, the good natured flirting of the nurse, the shrieks of people with broken, crushed , mashed potato arms legs and organs, or the silence of the dying –it all repeats itself like some ghostly murder scene in a haunted house.

Once you crossed the fluorescent board which read –‘’emergency section’’ In red lettering –you had to let the auto pilot take over. Reflexes, routines, habits, protocols –those were your friends and defense here. You sit in the chair that someone like you has vacated minutes before- take over the charge from him/her, sign on the register, the vacant bed list and the stock drugs list –and sit back and enjoy the ride.

But sometimes things happen which knock at the door of your indifference so hard that it breaks down –and you sit up shivering, staring and shocked –all your covers of routine snatched from you.

Usually there are signs-like the night going exceedingly quite- u become uneasy, you know it’s the lull before the storm. Or sometimes it’s just”luck" or a "team” thing –when you and senior cardio resident rongita sinha with her hourglass figure are on call together –things happen.

Like that day in December –close to my birthday. They rolled him in just after one in the morning. Rongita looked up from reading an ECG –‘’oh no, not him again.’’ I was curious –memorizing patient’s faces was not her forte.

To my unuttered question –she said-‘’triple vessel disease-angina every other week. Always signs out against medical advice.’’

He was alert, interested in the proceedings around him –even winked at the four yr old boy next to him with a pea grain blocking his left ear.

As I entered –he beamed at me- ‘’new here?”
Me-no, we just never met I guess. So what’s the problem?
He-oh I was at this party, and then I started having this chest pain –same as before. I was breathless – guess I had another attack-but I’m feeling better already.
He beamed again.
He certainly was dressed for a party –his middle aged well toned body was tastefully fitted in a grey suit and while shirt .black shoes, flashy watch and mobile.
He looked out of place in this dingy government hospital. What’s he doing here- I asked myself.

I examined him-checked his chest, took his pressure and pulse. The former was low- the latter fast. I ordered an ECG.

He was sweating –but he assured me-‘’ oh I know the signs. I have had 3 heart attacks, four surgeries and seven catheterizations- this one was just a false alarm I know that.’’
I walk away without replying.
As I wait for the ECG strip to slowly roll out of the machine – I check his records on our newly installed computer data base. He has not been lying about his heart- he did have all those interventions. Plus an episode of asystole-when his heart stopped for three minutes. Shock and drugs had brought him back.

When I go back to him –he is already buttoning up his shirt- his cologne hits me. I ask about his asystole –he says yes I was dead for 3 mins but your hospital saved my life.

Guess that’s why he came back here.

The ECG is unmistakable – I order I/v cannulation and write out directions to the nurse. He talks to people, tells jokes to kids and flirts with the nurse. He seems ready to leave.

I step in-‘you can’t go, you might have another attack. A more serious one. You need to be monitored, for a day at least.’

He says-‘I will have one for sure, but not for many days yet- they never come together. Trust me.’’
I call rongita –she’s the cardio resident- she has to take the call.

His face lights up as she enters –be my nurse –and I will stay forever. She laughs-nervous, blushing. She reasons with him, pleads even –but it’s unconvincing – I can see he’s not gonna listen.

I lose my temper- shout at him. Tell him to stop putting on a show an act as if he’s in a movie. People are dying around here- if he didn’t notice and throw the DORB (discharge on risk bond) form at his face.

Everyone is surprised at my sudden burst –a child gets scared, starts to cry softly. My guy still smiles- but he’s a bit put off. He signs the form –an ornate, flowery, flourishing signature. Then starts to walk off- stops, and turns back. ‘Son you are young. You are a good doctor-a caring doctor. You just don’t do your job. You love it. Keep it that way.’’

I’m still furious- I point to the door
He shrugs –leaves-walking briskly.
Rongita pats me on the back. ‘He’s a nice guy-just a bit flamboyant. Once he had told me –when I die I want to be buried in the hills, in the sleepy town called Kurseong, I have a small cottage there. I want to be buried in its garden. Hey –if u ever visit Kurseong, light a candle for me.’’
The night rolls on. More road traffic accidents, drunken brawls, burns, dysenteries, more heart attacks-many deaths-and then its almost dawn.

I put my stuff back in my overnight bag-and wake Rongita up. She washes her face-and our replacements arrive. We hand over charges-exchange civilities-leave. As we exit the surgery block-they roll him in again-taking him out of an ambulance this time.

There are more differences –he’s not sitting up, not smiling, not flirting. And his mouth is covered in a white sheet, just like a movie. Kurseong – hills-grave-candle –the words whiz by.
Its someone else’s job now- someone else job to find out what happened- when he had another attack ,who found him ,who brought him etc etc. some one else’s job to check his pulse, his pupils, listen to his heart, check his pupils. Soon someone else will pronounce him dead. We –me and rongita – just stood there.

Then she takes a cigarette –I turn away. Look at the rising sun and then back to the burning sun in her mouth.

Feel cold, numb. Will he be buried in kurseong?-I ask Rongita sends some smoke spiraling into the red dawn –looks at me –and smiles- a sad smile. ‘’nope, I think he was lying about that.’’
I nod. I think so too.”
“Let’s go” she says- “the winds cold”
We button up our jackets, cover our ears –and disappear into the fog.


Partha