• It was my first day in paediatrics internship after a relaxing month at ENT. The day had gone by pretty smoothly till the emergency call came to the department around 1.30 pm in the afternoon. 
    There had been a premature delivery in the obstetric theater and the resulting baby weighed a mere 900 grams; just a third of what an ideal baby should weigh at birth. The chances of the child surviving were meagre but we still knew that we had to do what we could. A tube was placed into the respiratory tract to assist his breathing and he was shifted to the ICU.
    Sadly, back then there were no ventilator facilities available which meant the baby's breaths were in our hands, literally. Being the junior most in the department as of that day, the task of manually ventilating the newborn under the supervision of a senior fell to me. Minutes turned to hours, afternoon to twilight as I continued ventilating the baby. Beyond the incubator where he lay, his chest would respond to my pressure on the bag, lifting gently up and down with my efforts. My hands cramped and cried with the effort and I remember switching hands to relieve the other every twenty minutes. I also remember watching the sun set that evening from the window as hours continued to pass by with no improvement in the child's vitals. Finally, my senior came by after his dinner to relieve me for mine, an offer I gratefully accepted. When I returned, he handed the bag back to me with words I still remember today 'I don't think there will be a replacement needed for you at 10pm." Checking the vitals, I knew he was right. The child had deteriorated even further. Half an hour later, in spite of all our best efforts, he passed away.
    While I was thoroughly demoralized, it was nothing compared to the wails of the baby's mother when we had to deliver the news to her. She had never even got to see her baby alive as he had been taken to the Neonatal ICU immediately after delivery. I remember marveling at the composure of my senior as he delivered the news, comforted the mother and then moments later, headed off for the next emergency which had come and handled it as if it were his first case of the day. It would be a few years before I would learn to develop that coat of mental strength that all doctors need to steel their hearts against the pain and suffering they see everyday.
    But more than that, it is always another humbling thought that haunts me when I think of that incident. Of the more than 11,000 evenings I have had the privilege to live in, I spent just a single evening with this baby. But this child spent every breath of his life with me.
    You always remember the first person who died in your hands. Perhaps that may seem more relevant to those not accustomed to the sight of death, but to us inside the hospital, the images may blur and memories fade but the scars of watching a life pass away always remain with us, whether we show it or not.


    Author's note : This anecdote first appeared in my column 'An appletini a day...' in the June 2013 issue of Tamarind Rice. You can read the entire issue online here.

51 Comments

Ritika T said…
I think doctors have the most hardest job in this world. Everytime I do even the smallest of the mistake, it keeps bugging me for weeks..I dont know how doctors shield themselves from the grief of losing a patient. Takes a lot of courage :)
Ritika T said…
PS : Love the new layout !
Ugich Konitari said…
What a touching post .

Death of someone, a baby , who spent all his/her life with you. At the other end of the spectrum, I have seen the same dedication , in the ICCU of one of Mumbai's big municipal hospitals, as the young cardiac doctors worked wonders reviving my then 83 year old Mom, from a complete absence of life-symptoms. The round the clock rushing, patient-first attitude, and dedication and ability to deal excellently with patient relatives. These docs were young chaps. She passed away 2 days later, not without patting their backs. I was very grateful that they cared for my Mom in her last days. This was in 2000. I wrote to their Dean about this. A heartfelt salute to those that care for us when we are sick.
I cannot begin to think about the feelings of the mother. This is why we say, every baby is a miracle. A healthy baby is a blessing - you should never take it for granted ! Again, I am glad I am not a doctor. Honestly it is not for weak hearts like me. Nice article doc. Its a good thing that you can write so well and share these experiences...
We were discussing this just a few hours ago.. a consultant surgeon and myself. He was telling the same thing - people dont realise the difficulty of the profession. It isnt just prescriptions and high priced drugs.. we can do everything right and still lose a patient. And we dont get a minute off after that - we must just carry on with the next patient.
Thanks... I love it too.. was searching for something different. x-)
Thanks Ugich... I wish more people were as grateful. I've seen so many react so adversely when their loved ones pass away - I understand the pain but to take out the frustration by abusing and beating up the ICU and casualty staff hurts a lot.
Being in an emergency faculty of any kind in the medical field is never easy.
Thanks Anita.. I dont remember the mother anymore but I still have vague memories of the child's features. Its been 8 years now, I think. Some memories stay no matter what.
Rachna said…
Oh Gosh! How horrible that must be? I often wonder how doctors do it. See so much suffering day in and day out and stay sane and detached. Thank you for sharing this experience with us!
I surely agree with you when you say that we remember the first time someone dies at our hands... pretty much like we remember the first delivery we took. (well, at least I do)... that was the first life you brought to this world....

but, of course death is seamier and a bit more .. well... heavy.. so the whole memory of a death would be different from that of a birth.

But, you know,,, the coolness of a doctor who can smoothly move from one patient to another is sometimes interpreted as coldness, which is truly not the case! And sometimes when you walk between places in a hospital, and you are talking over the phone or even laughing over something with your friend, it is considered very wrong.

I feel it's being very hard on doctors. Yes, there is illness and death in a hospital but then, there's also cure and birth.... amidst all this, a doctor whose every day would begin and end in that hospital cannot actually just keep roaming around with a grim face!!!!

I don't know! but sometimes i feel this world is very hard on docs!
Sunitha said…
Admire Doctors so much. I'm a software professional, and some times , I feel relaxed that the max harm I do would be to spoil somebody's report .. :) Doctors work deals with Life and its so many million uncertainties. Loved the post.
Meety said…
;( for once.. I feel good about being an Engr.. at least my work is not dependent on somebody's health/life...More to that.. I know death is an unavoidable situation in any doctors life... You guys always had my admiration for being the one to save lives... Doctors rock :D
I won't sugarcoat it... our lives can be hell. I've done literally 1000s of surgeries and yet, every time my heart races as I take in the next one.. will everything go alright? What could go wrong and how many seconds do i have to correct it before it turns fatal.
We are considered cold and heartless... honestly, is there any other way to survive watching people die day in and out? Not have enough money for food for their children and watch them die slowly and painfully... so many doctors themselves quit the profession because they cant handle it. I will never blame them for a moment either.
Almas, I remember my first delivery for a different reason.. the mothers name was Shakeela :-d !!

And yes, as I was describing in an above comment, people called it cold hearted but they dont see how much of a struggle it is to survive through that.. a single posting in ICU is enough to scar a regular person for life, I always feel.

As for smiling et al, I try to find my own balance.. being an anaesthetist has that advantage.. I stay behind the drapes most of the time so patients rarely know me in the wards .. 8-)
A senior staff member was just talking on that yesterday. How his parents were in the garment business and some days, he wishes he had stuck to the family business, because the worst that can happen is your sales go down... atleast noones life is at stake. I totally agree with him.
Sigma, even after 13 years in the field, it still affects me big time when I watch a person die in the ICU or see poor patients struggle. I want to say I'm immune now to the suffering but I dont think I ever will be- haven't been able to harden the heart that much inspite of everything I've seen.

The case I just did right now comes to mind: I still bribe small kids with mini-Twix chocolates after doing surgeries on them ( they never see the surgeon touch them.. just the anaesthetist who pokes them with a needle before they fall asleep; hence I'm their enemy :-t )

And of recent times, I think the pressure is getting to the younger generation of docs.. I know half a dozen docs who quit practising AFTER finishing the course - just felt it was safer to do business/PR etc than struggle saving people's lives at the expense of their health and any family life.

Touchwood, things will improve in the days to come.

Alka Gurha said…
I always wonder how doctors control their emotions. Does it affect your personal life? My dad was a doc and I know it was tough.
Nisha said…
I saw a movie called 'Ankur Arora Murder case' recently. The child died 'coz of negligence. I am sure no doctor would want something like that to happen. Wonder how one feels in that scenario. It is indeed the hardest job on earth.
Bhavana Nissima said…
This gave me a glimpse into doctor's lives and perhaps more than that made me feel that doctors have tender hearts which they manage to hide and overcome...I felt your humanity in this process. thanks for sharing...
It must have been so agonizing going through that experience. Doctors have one of the toughest jobs in the world. Talking to people during the worst time of their lives needs so much of dedication. I am glad you are writing your side of the story Roshan. Most of us forget that Doctors are also human and have the same emotions like us.

Anonymous said…
A profession only for the brave hearts.. it's a huge responsibility you Doctor's take.. Kudos to you (h) ..
As in other professions few rotten apples do spoil the name of the whole lot.. I had experiences with both, doctors like you (0) as well as those who earned the degree just for $-) But the sad part is that its the good ones who end up getting slapped for the acts of the greedy ones.
Seena
Rachna said…
I understand Roshan! People see the nobility and glamor and forget about the human being. When we trust our lives to them, we let go and they take on the burden.It is not an easy burden to bear. Watching so much dead and suffering, how do you cope and not let it affect your own health? I am glad that you write; that must be cathartic in a way.
Alka, it does affect the personal life honestly. Most docs bring their work back home with them in some way - whether it is the disappointment of a bad day losing a patient, the fatigue and annoyance of a long day, even sicknesses.
I never got to see it but heard the theme. Negligence does occur... but its rarely an intentional deed. Can be human error, machine or instrument failure, fatigue.. any number of reasons contribute there.
Thanks Bhavana.. doctors will continue to be demonised in our country for years to come. We've kind of gotten used to that fact after watching a decade of patients. But yes, every doc who's made it through the cracks into the system has had his share of similar experiences, I'm sure.
It is something that makes us feel sad honestly... that people come to us only when they are sad or sick. I know how silly that sounds coming from a doctor but still, it would have been nice to see patients who come by with a smile just to let us all that 'all is well' too. Can be a morale booster on rough days, knowing they thought of you.
I never deny the presence of rotten apples in any profession, including ours. But yes, when we are all painted with the same brush because of their crimes, it does hurt and make us resentful. You have to consider that many give up their personal life entirely, including the chance to see their wife and kids just because there arent enough docs in the area. At the end of it all, to be insulted after all that can easily breed discontent among the docs.
I really wish I was a little more sensitive to this post of yours...but sometimes your own pain acts as Anaesthesia towards other's pain...

Nevertheless I really sympathize with doctors with that extra red in their hearts...have a cousin who is a doctor.. dude did not go to the hospital for 2 months after his first such experience... but then went on.. I often ask him how he handles it.. he says it just keeps getting difficult...
Anonymous said…
I loved the part about the new born spending all his breaths with you. Recently stumbled upon the blog! Very nice! I am about to start postgraduate in medicine . Bracing myself!
Bhavya said…
Wow! That was so touching. And to remember it all with such clarity even after 8 years, the incident must have left an indelible mark on you. We never think of this side that the doctors have to go through, we judge based on what we choose to believe in, always find fault with people without even trying to understand that there is another side to the medical profession.
This is my first time on your blog and I think I will keep coming back for more. Do keep writing. Thanks.

Bhavya
http://ishithaa.com/
Sumana said…
Nice one
Sumana said…
Just read the winnie the pooh quote ..Dont know how i missed it all these days..So apt for me today..Thanks :)
Meety said…
Of course.. it will improve..... (p)
A lot depends upon a persons mental strength in the end.. having good marks alone doesnt guarentee anything in this profession. I know gold medalists whose skills leave a lot to be desired and the converse as well.

As for affecting our health, well... who says it doesnt? Most of the general public get exposed to a couple of infectious diseases in a given period. We get exposed to all of them simultaneously.. I know so many docs who got diseases from their own patients. Heck, now that I think of it, I got swine flu too the same way - and that was a month before my biggest exam!

Writing is definitely cathartic for me.. others have their own hobbies and way to detach from medical life. This is mine.
true.. I use my own personal losses as an anaesthetic for others - so they can see that they dont have it as bad as me :-d

I empathize with ur cuz... it's never easy. We steel ourselves from the constant sorrows we see, but its always there somewhere in the back of our minds, lingering.
All the best man (h) ... pg life is gonna be a life-altering experience. Trust me on that.
Thanks for stopping by. I've written a lot in the past on not judging docs based on the acts of a few rotten mangoes in our bunch. I still stand by that... have seen so many senior staff who are a million times more dedicated than I can ever be - giving up their families and sleep for patients. Imagine a physician and gynacologist who are back at work two hours after watching their child get married. Its not the money for them - they get a fixed salary. Its the overwhelming workload and the need to lessen it for their fellow docs in the hospital.
You're welcome.. I loved its theme...
Very moving, Roshan. Indeed if there is anything I am scared of in this wide universe, it is death - and not mine, but of others around me.

www.volatilespirits.com
In many ways, so do I, I guess..
arun shetty said…
i agree to the bare bone on this one, we ll never forget our first patient, first look of gratitude, the pain and death.. always lingers.. u just lit up the cornered memories in my head.. cheers...
DocPriya said…
Yes it's true.. Delivering news about death.. Dealing with death and its aspects is really difficult.. And when doctors have to deliver it its even tougher.. Wish that the relatives understand what the doctor is going through after a death and wish they just don't become aggressive or judgemental after the news is delivered.. Love the topic you chose.. Beautifully written.. Love the quote on your header.. Gives me some hope each time I read it..!!
I know what you mean Priya.. have seen both extremes of reactions after watching patients die - them breaking down and crying to them turning violent.

And yes, I chose that quote because it gives me hope too. And I know that there would be others like me who could use a little hope once in awhile.
Karanth S R said…
Good one, this will remain in my memory for a long time though its not my first blog read.... :p

As you have mentioned in the reply, these days Doctors are being demonized (we all know its bcoz of the few rotten stuffs here n there) but not always.... You too must have had the experience of patients thanking you for saving the life of them/ their loved ones. Ours is a country believing, Vaidyo Narayano Harihi.... Trust me, people do have a lot of respect to doctors even today cheer s I personally believe doctors are kind of walking gods who dare to take the responsibility of someone's life (while the relatives will be fighting on who should pay the medical expenses)

I was amazed and speechless when i got to see an Oncology Surgeon walk around in the wards after major surgeries, so cool (not cold), calm and composed, smiling at the patients and colleagues and responding to the queries from relatives of patients... :) Kudos to you brave hearts :>) (h)
Thanks Karanth.
Getting over a patient's death is never easy, no matter how many times it occurs. But we dont have a choice really - we dont get a five minute break after the loss. There are others on deaths door in the very next bed who we have to tend to. Yes, in the endm it makes us cold... but its not what we want to be. Its a survival mechanism, I guess, in the end.
Shalini said…
Reading your post reminded me my own experience...it was back in Yen. Internship days.A 28or so guy, was in the med ward for about 4 days with persistently high fever, pyrexia evaluation all negative. On the 5th day during evening rounds, I convinced him that this is just a fever and will subside soon. He was kinda panicky and there was some fear within him. Anyway I spoke to him, turned and just walked a few steps when I heard his mom cry out loud. Running back, I found him motionless, he had arrested. Tried hard to resuscitate in the ward, took him to ICU and continued the same. Nope. Nothing. It was the first time for me, and the most shocking. No reason till now. And I realized that it could take just 2 minutes for everything to end.

As always, kudos to your write up and comments Roshan!
Thanks Shalini. Since then, have seen death in many unexpected and sad ways. Many patients whom you talk to the previous night, you return back the next day and find out they passed away.

Tough getting used to it, no matter how many times it happens.
Shini said…
Doc, u guys have a real tough life....i have to admit i was unaware abt many a behind the scenes...until i started reading this blog...cribbing at times, when a doctor arrives late ...not knowing he/she must be busy attending more crucial cases or fatigued after a bad day of events...thanks for allowing us a peek in ur lives...was an eye opener indeed...u guys certainly deserve a lot more!
sigh... it is an unforgiving profession Shini. For every life that is saved, many pass through our fingers in spite of our best efforts and it can be horribly demoralising.. I know many who have quit the profession after passing the course .. I actually envy them on tough days.