Helping a Broken Human Being

ERs in peripheral hospitals are a completely different experience from those in tertiary care hospitals, as one would expect. Peripheral ERs involve a lot of primary care and preventive medicine. Only a fraction of the total number of patients coming per shift will actually need referral to a higher centre. Although technically meant for "emergency" cases, you'll always have someone come in just to check their BP (even at fucking 4 in the morning). 

Some patients used to come daily. I had one patient who used to come almost daily for vague problems. She was an old lady and I learnt that she lives attached home alone nearby and just feels lonely. After that, every time she'd come during my shift I'd crack some stupid joke just to cheer her up a little bit. This wasn't exactly the kind of medicine we thought we'd be practicing during MBBS but you learn these things after a few years of practice. Working as a doctor in a village is like being a celebrity in the area, you can go to shops and people will know who you are even if you don't know them. 

When I returned to work a few months after my father died, I was in a more stable position financially. I wasn't spending much money on me. I cooked and cleaned the house myself. And after years of not really spending anything for myself, I wasn't really able to get out of that mindset. But I did decide I wanted to help out people much more than I was able to in the past. 

After 3 months working, I realised my bank balance was almost the same. While travel costs had skyrocketed because of Covid, it was also because I was spending an insane amount of cash for patients. Someone is having a heart attack but can't pay for the ambulance? I'd pay the 1,300 Rs. Someone needs a troponin test but doesn't have Rs 800? I'd pay it. It's not like I was looking for credit or anything (much more likely to get scolded for stupidity than anything else) but I just didn't want anyone to suffer inadequate care just because they were poor. And the ambulance issues during Covid were so bullshit that I couldn't help just stand there watching that nonsense go down.

Everything there was so much more personal than the detached way we handle things in tertiary hospitals. The side effect is of course that some incidents will haunt you for a long time.

Emotional Trauma

If you really want to get an idea of how common mental health problems really are, one should work in the peripheries. I personally know a few people in the area who had lost someone to suicide (they never saw it coming either). Almost every other day we'd see someone having a mental breakdown. It's difficult to get these people the help they need because a lot of the time, they aren't ready to accept that they have a mental health issue. 

One day I was working the afternoon shift when a young lady, Miss C, was brought in by her family. Her face was so dejected and she was clearly in pain, just not of the physical variety. She wasn't speaking and seemed too weak to stand. 

I did the usual workup we do in such cases. All her vital signs, examination findings and labs were normal. I kept her in observation for a while on some IV fluids (which is a trick to just buy time until you figure out what's going on/what to do). 

I spoke to her mother and told her that I thought her daughter was having a severe form of depression and should consult a psychiatrist as soon as they could. Her mother was surprisingly accepting of the news that her child had a mental health problem. Usually, the reaction I'd get is denial or anger or a mix of both. It was only later that I found out why she was so accepting. 

A Broken Soul

The best people to ask about a new area are obviously the nursing staff. They would have most likely been working there for ages and live near the hospital. 

One of them asked me later during the shift about what was going on with Miss C. C had apparently tried to take her own life earlier in the day only to have been stopped by relatives. 

Don't be surprised that the family was not more open about this. Remember, while the legal clauses are still vague, self-harm is still amazingly against the law of our land. Not to mention the social stigma around such an incident. 

There are many barriers to giving these patients the type of care they need and deserve. First of all, the social stigma around mental health is something you can't convincingly remove when you're the lone doctor on a busy shift. Secondly, we don't have a convenient route for getting these patients to followup with a psychiatrist in a reliable manner. Thirdly, there is no good way to make a woman (who may have faced some trauma no one else knows about) comfortable enough to trust us in this sort of scenario. 

I Try to Help

In my overzealous attempt to go above and beyond what someone would normally do, I tried to reach to Miss C to get her to start counselling at once. 

I figured this is the kind of problem where someone with a Y chromosome will probably not be the best person to begin the conversation. So I got one of our nursing staff who is politically very active in the area to contact C's family.

I got the number of a good lady psychiatrist and had it given to them to get an appointment (this doc had helped a colleague of mine so I knew she was good). These kind of things usually need multiple conversations over a few days to weeks to make any kind of progress so I knew I had to be patient and persistent. 

C's family made some changes at home over the next couple of months to make her feel better but they were still extremely reluctant to go to a professional because of the social stigma. They said she was getting better but this can often be misleading (one can still look quite functional while being broken inside). I was not convinced. 

Unfortunately, all my efforts would go in vain when I learnt that they had again visited the casualty, this time when a more senior doctor was on duty. She told them to "Just close your eyes and pretend none of it ever happened" and said counselling wasn't needed.

If you're think "Dude, what the fuck?" right now, well you're not the only one. But this isn't really surprising. Even some people who graduated with me had horrific views on mental health and one cannot expect it to have been any better decades back when this lady graduated. But it still makes me sad. 

I thought about going to their house myself to talk to them but decided against it (or rather had barely enough time to do such a thing as I was burning out with Covid duties and all the other extra things I was taking on). The other doctor was from their religion and in issues like this in rural areas, that kind of shit counts unfortunately. 

An Unknown Conclusion

I left the job to pursue higher studies after a couple of months. The last time I enquired about Miss C, the reply I got was that she was still "doing well". But I still felt we failed her overall. 

Depression that bad just doesn't disappear like that. It can have peaks and troughs. It can stay dormant long enough for people to not notice anymore. And when it eventually comes back, C may not be so lucky next time. 

This incident was so long ago, I can't even recall C's real name now. I dread the idea of enquiring about her again because I know my worst fears about her can come true at any moment. 

Note - some details here have been changed to protect people's identities.