Showing posts with label ICU. Show all posts
Showing posts with label ICU. Show all posts

Thursday, October 06, 2011

I see you !

There are ICU's. And then there are the people...

Not so much those inside, but those outside, waiting and hoping.

And there is so much to observe.

The last time I attended someone in an ICU, was 11 years ago.  The ICCU of one of Mumbai's biggest public teaching hospitals. Typically with the finest dedicated doctors working with  limited resources, huge dedication, and a greatly supportive staff.  They don't allow anyone inside; if at all, only one person is allowed inside , per patient.  And you stay put outside, for all 24 hours, since  the doctor  can ask for you anytime.

With hardly any infrastructure created for caretakers of patients and families, there was a huge square lobby outside the main door of the ICCU. About 8-9 chairs lined up on one side, and the remaining space had nothing. When they were occupied, we sat on the floor, waiting. Evenings saw droves of visitors coming in to inquire about the ICCU patient. Carrying, food, pillows, bedsheets and all kinds of stuff for the caretakers.

I had rushed there subsequent to a cardiac emergency, and all I had was my purse. Nights were spent on the cold floor, purse pillowed under the head, and the dupatta wrapped around giving a false sense of comfort. There was an elderly Sikh gentleman admitted inside, and his entire community  would come in the evenings. Young ladies, old matrons, pillars of society, strapping lads and so on. Much greeting each other in traditional ways, and wishing each other and touching of the elder's feet by the young ones.  And when they left, the waiting area would resemble a room with mattresses, pillows, covers, packed meals and so on.

An elderly Sikh lady got talking to me. (I blogged about that in a post titled "Touches of Class"  earlier.)  Asked after me, and who was the patient inside.  Shared fruit with me . And since she didn't think a young girl should be lying down solitarily in a corner by herself under the circumstances, took it upon herself, to arrange stuff so it looked like I was part of their group. Morning saw me covered with a bed sheet.   When some other caretaker of some other patient looked apprehensive and worried, everyone would go comfort him or her. No one cribbed about material comforts. You needed to go 3 floors down and then cross over somewhere for a cup of coffee. There was one public coin operated telephone, and it was always in use.

When it was time for us to go, we were sadly, one person short. At 2 am at night, after breaking the news to us, the doctor sat with us, talking about his experience of the patient, and how heart rending some cases were.

Cut to a recent experience with another ICCU.   Once again I was alone.   
 
One of Mumbai's leading superior accredited hospitals.  Centrally air conditioned. Every thing computerised.  They actually had a waiting area room for relatives of people in the ICCU.  They had folding pull-out sofa-beds, and sets of chairs (like you see at airports). A water cooler supplied clean drinking water.  A decent bathroom dedicated to the room. Electrical points, a television, and several charging points for cell phones, courtesy some cell phone companies.  There was a cafeteria two floors down served by numerous elevators.

People came in carrying several bags,  carrying lunches delivered by relatives, snacks, changes of clothes. Some guys sat with laptops ,  cell phones stuck to their ears. There was a lot of talk within families,  but almost none between the various patient caretakers.  People would get calls galore, and everyone would speak fairly loudly ( as they always do anyway) , and the rest would get a complete lowdown on who is admitted, why and since when. Sometimes, even the prognosis.  On the third morning, three gents in suits came by with papers, called out names, and presented us papers outlining our bills and estimated expenses, till that morning, so we could  think about mobilizing resources. It was all very practical and businesslike.

Life was compartmentalized.  So, it seems , were emotions.

Or so I thought.

  My last night in the room (things were improving, and the patient would leave the ICU for a ordinary room the next day),  and a cheerful young lady asked if the place next to mine was occupied by someone. She organized her bedsheets and stuff there , and asked after me and our patient. Her mother-in-law was in the ICU. She and her husband were taking turns . She taught school, and so left early in the morning to teach at her school, and came here after school was let out in the afternoon. The husband had taken leave for his Mom, and came during the day. Sometimes her own mother filled in for them, whenever it looked like schedules were getting messed up. She actually lived fairly close to where I did.

Both of us lay on our sides, chitchatting and talking about our families, how good the doctor was,  what we did for a living, and so on. Long after some security person had come in to shut off the TV, and put off the lights, we whispered into the night, careful not to disturb the others.

ICU's are very impersonal spaces.  A patient need not communicate anything, his machine readings communicate everything.   Sliding curtains ensure privacy,  Sometimes though, doctors have an excellent bedside manner, and have encouraging chats with the patient.  If at all the patient is awake. 

Over the years, the individual size of machines attached to a patient has grown smaller, but the total number of machines and wires attached to you , is possibly more.  All impersonal, the soft footfalls of the nurses and attendants , the beeps and the numbers telling the whole story. 

People too , outside,  have changed.  Rules decide who and how many can visit the patient.  A busy life means everyone waiting in the caretakers room, is quietly getting on, doing some work, some on a laptop, some reading, some just lying down, blankly looking at the ceiling.

Yet, meeting the lady on my last night there, and the fellowship that developed over that short time,  gives me hope, that  at least in the patient-caretakers area,  somewhere,  the possibility exists, that the ICU will actually mean "I see you !

Wednesday, November 04, 2009

Interdisciplinary medical specialities

Aeons ago, when you had a severe cold/sore throat, a concoction of lemongrass, ginger, cumin,cinnamon , ajwain , a "Mendel's paint" swab in the throat (done with a knitting needle), and a decent steaming of your throat, under a towel, held on your head(over boiling water), often did the trick. Not to forget gargling. Some super conscientious folks even forced you to drink hot milk with turmeric, to the intense delight of your siblings.

Sometimes, some of the household solutions were delicious. Diarrhoea often resulted in someone making a wonderful concoction of nutmeg, ginger, ghee, and I think, honey(could be jaggery), all stirred together in an cast iron kadhai. The patient as well as his/her siblings partook of this with great relish, and often hankered for more, till a parental stern look intervened.

Doctors entered the fray only when fevers and stuff happened. And even then it was mostly the family doctor, who you could never fool.

While medical folks of my generation might remember these household solutions (which they swallowed till they got their degree), today's folks are more interested in specializing . Last counted, there were at least 53-60 specialities.

About 50 years ago, one heard basically about G.P.'s , gynaecologists (because they delivered kids), and orthopaedicians (who plastered the relevant fractures when these kids managed to acquire them).

Around 30 years ago, we were suddenly familiar with pediatricians, neurologists, ENT specialists, Ophthalmologists, urologists and so on.

Today, the field is studded with neonatologists, endocrinologists, oncologists, surgeons (of various subspecialities), fertility specialists, gerontologists, internal medicine (physician), cosmetologists, pain specialists, cardiologists, anesthesiologists, pathologists.

And several other things I cannot spell.

What has intrigued me is guys called Intensivists. These guys are supposed to specialize in Critical care medicine, and basically treat people who are in life support situations in ICU's.

In India, this particular speciality takes on a slightly exciting flavour. In keeping with blurring of distinctions between disciplines, and newly favoured interdisciplinary approach to things, it is possible that intensivists may have to take special courses, in ethics, sociology, psychology and political science.

ICU's in India , particularly in public hospitals, keep on standby, one or more VIP ICU beds.

While you and I have to get in line, and god forbid, wait for one, these beds are often patronized by politicians, who have something to hide.

A few decades ago when the government was after the Indian smuggler mafia, it was a routine thing, for one of them to complain about chest pain , uneasiness, and get admitted to the ICU. Particularly of government hospitals. This disallowed police interrogation, till the doctors agreed. It also gave decent security to the hounded man, and his minions periodically came by and his business continued unabated through the hospital corridors.

Recently, there was a case of a leading elderly politician, head honcho of an industrial and educational empire, who had also periodically bumped off his election opponents in a casual manner, supremely confident that no one could touch him. Greatly successful at organizing crowds in his own support even when an accused, when things got too dicey, he complained of chest pain, uneasiness, and got himself into an ICU. And the speed of investigations suddenly fizzled out.

Within this week itself, a politician, ex Chief Minister from the north who was being investigated for embezzling an amount ( that would have , if allocated, changed the face & fate of the peoples of certain agrarian parts of India), suddenly complained of abdominal pain, giddiness, nausea, and vomiting. He was promptly admitted into the ICU of the local hospital, where investigative reports are taking their own time coming in.

Politicians are getting smarter. While chest pain would always have you wired up for an ECG , which cannot lie, abdominal pain is a masterpiece. You can claim it at will. It can happen. it can stop. You can't be electronically diagnosed in real time with this. With all the indiscriminate imbibing of edible and monetary goodies, existence of gas suitably obscures ultrasonic images. Suits you admirably. There are so many causes for it. Currently, the patient is off all investigative enquiries of the non-medical type. And the doctors are "watching" the patient.

Intensivists who have to deal with such entities, must get extra training in linguistics, psychology, recreational political thought and dramatics.

"You are fine" may imply (a) "Your BP is 120/80", or (b) " We've fobbed off the journalists/police/investigators for a week". In addition, the intensivist may be an expert at hiding his real emotions on initially examining the eminent patient on admission. An ability to make a variety of worried and serious faces would help. Inventing hospital rules that disallow outside security, would get him a huge stamp of approval from the eminent patient.

We might define a new name for this speciality. Intensive Escapology.

Which brings to mind some other escape efforts.

Papers are often replete with stories about people, predominantly Nigerians, being arrested and taken to hospital for trying to smuggle high value narcotics in various places in their bodies. Some desperate types even swallow the stuff , packaging and all, when faced by the police. They are then admitted to hospitals, scanned for movement of the stuff , and treated for outputting the same, through all possible body apertures. I have never heard of anyone quickly operating on the chaps to retrieve the drugs. I wonder why.

But maybe, we need to define another super speciality. Guys who watch the crooks' alimentary canal, and the stuff bobbing down through it, driven by reluctant peristalsis, all the way down, or up, as the case may be.

Great investigative medicine. Doesn't need an ICU. Just a keen eye, and detective proclivities.

AlimentaryMyDearWatson-itis ?

Maybe Sherlock Holmes would approve...