Wednesday, September 03, 2008

White washed Rainbows

Guest Article: White washed Rainbows

By: Sucharita Roy

(This is written by one of my doctor friends called Sucharita. This article has always inspired me, and continues to inspire me. This is little long but trust me worth the read)

Something happened last year during my outdoor duty at the Department Of Ophthalmology that I must mention.A hastily gathered group of 20 odd students collect everyday around 9 30 am to see patients that would help them in knowing the subject better and in a more restricted sense of the term, help them sail through the 3rd professional exams.We have been caught up in this frenzied state of being ever since clinicals have started where we learn to see patients to get a proper hold on our subject. And may be caught up with th speed of learning up hundreds of diseases and their associated clinical conditions,differential diagnoses(other conditions that can masquerade under a different disease by mimicking its clinical presentation)….the number of explanations can be put up ad infinitum.Whatever the case,that morning 26 of us gathered in the outdoor department of the Department of Ophthalmology eager to learn and see some new cases.

The teacher we were allotted that day was Dr Madan Mohapatra,a very efficient doctor and a really nice person .And that morning he was his usual incisive yet gentle self, teaching us the nuances of ophthalmology that we could handle at that stage. The crowd was beginning to warm up as the day progressed and we were shuffling about in the small room all craning our necks together at the same time tryin to look into th pupil of a patient who just had a new lens fitted or to see the pattern of injury caused by an iron foreign body.Perched as I was,at the side of sir with the plan of seeing the cases better than most others because I was right next to the patients most of the time so even the tiniest pathology wouldn’t escape my notice, I was having fun in my own little way. Nothing seemed to be out of the ordinary, or so it seemed.

The next patient was a young boy, no more than 7 years at the most. He came holding this father’s hands and sat on the stool and was wearing a yellow T-shirt and black pants and had on a pair of black glasses the kind of which you get in hospitals or the ones immortalized by the Bollywood Surdas Rajendra Kumar.My mind started whirring at 3000rpm trying to spot the diagnosis as I did some mental maths.


Attitude-Cheerful (grinning to be exact)

Gait- Normal, no deformities

Skin and Hair condition- Healthy, no evidence of malnutrition.

Injuries-None observed except the eye area which will be revealed after he will open the glasses.

Most probable diagnosis-Childhood cataract operated and patient has come for a routine check up after lens implantation.

As my mind was doing this the boy was running his hand across the edge of the table. He was turning his head from where he supposed his father must be to the other side probably trying to find him out. Nothing about him to suggest he could not have been a boy straight from the fair, who had made his father buy him the goggles from a vendor. All he lacked was perhaps a red balloon; and I could half imagine him clutching one in his left hand. Or was there a lack that dint meet the eye? Only time would tell that,and in a few seconds it did.

I smiled at him when he turned his head towards me, and was about to make a face at him when unexpected words came floating upon my self-indulgent ears that makes me turn on music in a crowded hall oblivious to the surroundings..”A very unfortunate case..” , Madan Sir was saying. I was confused, `Did the cataract operation not go well? ‘. Things were not making sense. I wanted to know what had happened. But my playful indulgence had already cut off the reason Sir had given to justify his statement. I waited for him to take the child’s glasses off half wishing to do it myself but afraid lest I irritate his eyes. Madan Sir turned towards the boy who was now smiling at him stretching his hands possibly with the hope of shaking it. “And now there is nothing that can be done”, he said and took his glasses off. There was a single collective gasp.I was by the side of the boy so I bent forward to see wondering what could have moved even the stiffest students to flinch. And my jaw dropped at what I saw.

There was a fleshy crater in place of where his left eye should have been. At least 2 fingers deep and as wide and extending right to the back of the orbit where the bare remains of what should have been the optic nerve stood out like a stubbed cigarette butt. Across the back of the orbit were the stitches that had tagged the sclera into the roof. The black silk stitches were put there to prevent infection from spreading intracranially. The right eye was there but it was possibly worse than the other. The cornea (the transparent thing in front of the colored part of the eyeball which is what is actually donated when people donate their eyes) looked like a glob of pudding had fallen on his eyes there.

We call that clinical condition Keratomalacia. A blinding disease caused by the dietary deficiency of Vitamin A, which causes blindness and makes the skin flaky.In layman's terms it simply melts the eyes.But its not something people need not buy expensive capsules to treat or prevent; it is found in abundance in all green leafy vegetables and if one even ate the papaya that grows in abundance in our state one will never get that condition. However what was shocking was that someone who looked so healthy and had no other manifestations of a deficiencyshould suffer from it;weird to explain but at imes more frequent than sometimes a disease silently creeps up stealthily from behind even though there is no outward manifastaion of a lack thereof or something happening. His skin looked pretty healthy and it was hard to imagine what amount of depravation he must have faced before this happened to his eyes. And I wondered what his parents were doing till then instead of getting him to a hospital sooner. And the only thought I could possibly have that time was which was worse to have- a hole on the left with the lids sinking into it or a non-functioning eye on the right that the lids could not close.

The right eye was beyond repair was what we heard from sir, and so the inevitable reoperation a few weeks after to take his right eye out to prevent him from dying because once the cornea on the right melted and dislodged, the right eye would become a nidus of infection that would gnaw into his brains and kill him within a week. I was feeling suffocated, and i wanted an explanationfor the fact that such injustice be done to someone so young and what were we doing at all if we could not save vision even in one of his eyes with all our unbridled pride for saving people's lives.. I wondered what sort of life we were sending him back to. Sooner or later he will be relegated to begging on the streets and cursing the doctors who took his eyes out to give him a life he hated with all his might. And then if we were claiming to make so many advances in medicine why we could not do something that was so widespread in a country like ours where 10% of the children born suffer from avoidable blindness so if we have a 10% of a billion odd population it makes 10 crores of children under the age of 5 out of which at least 10 percent lose their sight in any eventuality..which amounts to 10000000 blind kids in the country and growing every second. I was confused and embittered about what I felt to be the handiwork of poverty that can stifle so many lives and take the light out of any meaningfulness in it.

“But surely sir there must be some way, at least a cornea transplant; couldn’t that be done?”, I had blurted out just as he was about to resign this patient because the wound on his left was healing appropriately. All heads turned at me, known as I am for my abruptness and near disrespect for behaving like a subdued student who thinks every word spoken by the teacher is the rule. Madan Sir looked at me and I began to wonder if I had blurted out something stupid.My classmates looked as blank as the whitewashed walls.I wished hospitals were painted any other colour.yellow,green or even black or red..would be something instead of blankness.At times a white can be a dark as a black.Only we can see it..we see it everyday.And i hope it remains to us.

“Good question”, he said. “But do you think we can consider that possibility here?”, he asked me.

“May be sir”, I struggled with the ineffectual abilities of an amateur at the science. “His entire cornea is sloughed so there will be no rim to place it “,I was thinking inside.

“Maybe sir if we could find a big cornea from a donater”, I blurted feeling incredibly stupid because I knew there being no supportive tissur in the boy’s eyes to support it, it would be just a matter of days before the graft would slough off.On the outside I waited for him to chide me for speaking like a “civilian” ( excuse me for this but its essential for us to maintain this language code. You have no idea how difficult it is for me to write about it in proper English. Its just that I want to put the thought across and I hope you will sympathise with me in my ineffectual efforts to do so).

For a moment Sir regarded my suggestion. I still don’t know if it had a truth value in its import. But whatever there was he started to say “Even if we consider a transplant we will at least have to see if it will be effectual even if its grafted into it”. “And for that “, he said and looked around hopin to receive an answer which at that instant was not forthcoming from anyone including me, “We need to see if he has any PR and PL because otherwise we do such a huge surgery and find his eye melts right after 2 weeks,and its just not worth it”.

(PR and PL are medical acronyms for Perception Of Light and Projection Of Rays ,which measures the basal function of the retina which ,once gone, can never be regenerated. Projection of Rays is the last function to go in blindness.Its the pixel of vision if you might call it in clinical terms.)

Madan Sir took a torch and put directly into his eye and asked him if he felt anthing.He didn’t.“No PL”, “Bad sign.Lets hope at least th PR remains”, he said and took the torch to all the 4 quadrants askin the boy if he ever felt something coming from somewhere he should say from which side he felt it was coming from. Notice he used the terms "something", and "feeling" instead of "light" and "looking" because the boy had no idea what light is all about.He had the condition ever since he was a kid until his eyes ginally gave way like wax which made him seek hospital attention.The boy immediately took a fancy for what he thought was a game. As sir showed the torch from all sides he giggled and tried to catch the torch each time.For 15 seconds the room was filled with 20 nauseated students, an expressionless father, a doctor assessing a patient if he could do something more other than taking his eyes out, and the blissfully innocent giggles of a kid who had possibly no idea what vision is all about so something in place of the nothing he saw or rather felt to be exact made him think life was beautiful.

And he played a good game.PR was lost in 1 quadrant. So in short there was some hope of a graft working in theory. Sir told had circumstances been a little more beneficial they would have even risked the benefit of doubt to a graft and see how the body responded. Sometimes the human body responds in ways no one can explain and miracles can happen. So who knew. But in this case “Where is the money to go on about it?”, Sir said as he looked at me.“The father had to be convinced the first time if we didn’t operate his son would be dead within a week. The hospital is going to do the second enucleation for free” . There was my half nodding and 25% of a half lipped smile as I understood what he was saying through his eyes. This is the language people of a profession share when they talk about the impotence of a situation that cannot be helped. This is the language a doctor buries in his heart and his lowered head when his family members disconnect the lines and take away their patient because they cannot afford the healthcare costs and if they put the patient in the hospital they will be dead before long because they haven’t eaten for last 4 days

Something started to sting my eyes.And mostly it was guilt.Guilt at having an intact life ;having resources to sustain and indeed enjoy that intactness at times even abusing it; and guilt at the injustice I was doing to the vastness of possibilities in my existence weighed against my own protestations of the injustices I felt were done to me for every mundanely unimportant thing that had upset me.Gulit at the privilege; and guilt at what I was doing about the responsibilities bestowed with the endowments.And disgust mostly at myself for my procrastination of happiness because of my own weird reasons that at this time seemed corrupt with selfishness.

And disgust.A lot more of disgust actually.Disgust that someone like me could make myself so miserable about things that seemed nothing in comparison to this blind boy in front of me who has never seen a ray of light in his life and whats worse, he has no idea what he is stepping into.And disgust at him for being happy in a situation like that.His smiles burnt my beliefs and faiths and smothered my self indulgences. I cant say I liked him.Its weird to explain. I hated him because he was missing something he didn’t know.I hated him for what was going to happen to him.And I hated him for not questioning for his being the way he was.For being happy with his losses.I was despising his happiness.

What struck me much later for his appearance that belied hs codition is a fact that most patients in our state think going to a hospital is a special occasion, much akin to going to the house of a relation, so its not unusual to see ladies bedecked in jewellery and pata sarees even if its only to open the petticoat and lie down crumpling all those folds for a pelvic examination.So in all possibilities he was probably dressed ina fresh pair of clothes borrowed from someone and thoroughly oiled and groomed by his mother for his hospital visit.

Whatever it was, he was bade away.I wanted to rush to him and hold hime in a tight embrace and I dont know why i wanted to do that. He would have most probably run awaythinking I was a mad woman. A part of me chided myself for transfering which is a term used when doctors feel more than they should for a patient.Its what brought Seth Lazarus a brilliant surgeon in Erich Segal’s DOCTORS to commit multiple acts of euthanasia on experimental dogs at first and then terminally ill patients.Sometimes I put myself in that position and think what I would have done..And there is not a definite “Yes” , but at the same time there is also not a definite “No to that.Because transference really affects a doctor’s ability because out of compassion he might just be the reason for the patient's death for not thinking logically and clearly.

I cant lay more expression to what I was feeling for my ability to express falls way short of my feelings at that time. And I most certainly didn’t want to look up and see what my friends were growing through.Summarily the case was dismissed as the next patient came to have his 5 minutes of fame with our audience.And the Boy from the Fair was forgotten for the time being.

But what I remember most at this time after 2 years is not my angst and frustration or revolt against things way beyond my powers to modify.In some weird way that cant be explained I only preserve within the confines of my memory the realization that day of a human’s capacity for happiness.In the little we have from life its just that it takes just us and only us to make us feel the way we want to.And for that, I feel proud I met that boy who showed me that one should not waste life in misery thinking about what the morrow will bring because anyways a person has no idea about that..and to waste time thinking about the darkest of possibilities and in turn being sad for something one has no idea of, life is too short to indulge in this way.

The world of nothingness from which the boy came that day and into which he disappeared was in ways way more colourful than all our starched white formalin sprayed existences.And way more white.If anything his shirt and my imaginary balloon made up for yellow and red..and his smiles and possibly the sighs and the silent tears of the rest in the room that day made up for the rest of the colours of the rainbow that bloomed in OPD2; and still blooms in my mind when I think of him after so long.Against a whitewashed silent blackness, its a rainbow hued smile that inspires you to rise up and to try to be better at what i am doing..Because people like him need things from this world.And people like us need to do it for the world.

And that completes a circle.

God bless him wherever he might be.



Mridula said...

If I had to read only one thing today, it would be this. Thanks for sharing.

Naanthaanga said...

"There was a fleshy crater in place of where his left eye should have been. At least 2 fingers deep and as wide and extending right to the back of the orbit where the bare remains of what should have been the optic nerve stood out like a stubbed cigarette butt. Across the back of the orbit were the stitches that had tagged the sclera into the roof. The black silk stitches were put there to prevent infection from spreading intracranially. The right eye was there but it was possibly worse than the other. The cornea (the transparent thing in front of the colored part of the eyeball which is what is actually donated when people donate their eyes) looked like a glob of pudding had fallen on his eyes there."

Your comparison of a patients deformity to a pudding and a cigarette butt looks absurd..

Abirami Sivaramakrishnan said...
This comment has been removed by the author.
Abirami Sivaramakrishnan said...

An eye opener !!!

nimit said...

A great post ..... it is very few times that you are touched so much by what one writes ......
Good one!
Keep on writing.

Vallath said...


It is just as absurd for you to expect her to describe what she was seeing in medical terms which cannot be understood by us laymen (or 'civilians' as she calls us).

PK said...

Welcome to Medical Practice. In years to come you will face many instances like this.Thanks for sharing this. Atleast people will know this other side of our life.--PK

Goli said...

@Mridula great. Thanks for linking it to Blog bharti.

@naanthaanga I did not see him, Sucharita did her best to describe it in layman terms I guess.

@abirami Thanks

@nimit All thanks to sucharita.

@vallath Agreed.

@Pk Very true, Most people dont realize how much stress most of the doctors go through.

indicaspecies said...

Perhaps a simple thing like a doctor's visit may have been a very positive activity in his life that kept him cheerful and made him happy that day. Happiness, after all, can be just an emotion at times, and not necessarily something that we try to obtain from living a so called ''good'' life. A human being's capacity for happiness is beyond comprehension.

Thanks to Dr. Sucharita and to you for sharing these thought provoking words.

"Because people like him need things from this world. And people like us need to do it for the world." With these words the article has been summed up beautitfully.