10 Days in Hell

Names have been deliberately changed to protect people's identities. 

"Optics is everything," one of my friends used to say about the politics in medicine. How an action looks is given more importance over what it actually does. And whether you like it or not, politics and medicine are always going to inseparable.

There is no better example of this than the pandemic. During my first innings in a government setup, I only got a glimpse of the politicians at play. But it was during my second stint in late 2020 that they were truly front and centre.  

Back then, I was a young, hopeful doctor who was looking to serve in an unprecedented health crisis. I left entrance preparation midway to join into duty in a rural area a good 45 km away from where I lived. My friends thought I was nuts but I felt it was something I needed to do. Not only out of a sense of duty but also to get away after being alone for so long in an empty house.

It wasn't long after I joined that I was posted at a brand new Covid centre in Narnia. It was a Covid First Line Treatment Centre (CFLTC). It was a 10-day duty that required me to stay at the centre. Little did I know that those 10 days would be one of the most horrendous experiences I would have as a doctor.

Welcome to Hell

The CFLTC was a makeshift arrangement done at a central government school in Narnia. This was the first batch to come so everything was a work in progress. The problem wasn't just in trying to convert a school into a hospital in a matter of a few days. It was that this school (like every other one that year) had been closed for months. The entire place was completely uninhabited during that time.

The first day I arrived, there was a meeting where a doctor from the General Hospital of the district gave a short speech and some instructions about donning and doffing PPE. At the end of the lecture, he asked the local volunteer boys if they’d had any experience with PPE and their answer was no.

“No? Well ok, I guess you’ll learn soon then.” An inspiring way to finish the talk indeed.

It was quickly apparent during the first day that nothing was ready to start anytime soon. Construction was still underway to ensure adequate separation between patient areas and donning areas. The workers and local politicians had really no clue about what was to be done (which wasn't their fault). It was only after health workers arrived that the idea for the CFLTC truly began.

The team of health workers included doctors, nurses and other helping staff. There were 4 doctors - me, another doctor who was the main medical officer at his hospital, an ayurvedic doctor and a homeopathic doctor. I was by far the youngest person there with everyone else at least 15 years my senior.

There were a similar number of nurses as well. They were led by a Nurse Ratched. I still remember when Nurse Ratched first got a look at the building that was supposed to house the patients.

"What the fuck is this place?" Ok, she didn't actually say that but her expression and reaction didn't hide the fact that she was far from pleased.

From that moment onwards, Nurse Ratched would be in charge of developing the CFLTC. She was one of the few who had some experience with this before. She quickly began coordination with the politicians and workers to get things ready.

Pappu, the biggest of the politicians present, proceeded then to show us around and also tell a story about he accidentally ordered a hit-job on some people while he was half-asleep. Charming fellow but one couldn’t deny he could get things done. The other main guy from the village office was Hariharan. While Pappu was making extravagant promises, Hariharan managed to keep everyone realistic about what could be done there.

Pappu said everyone had to go for a political rally in the evening. It was apparent that nothing was going to happen the first day. Or the second. But one doctor had to stay because technically the place could become functional at any moment, even in the middle of the night. As I was the only person without a family, I decided to be a team player.

The room given for doctor's was okish one could say. Sure, there were a few birds living inside but it could have been worse after being uninhabited for months. But there was a problem for me. It only had Indian toilets.

I have a spine problem and have been living with chronic back pain for years now. It started back in 2018. Despite this, I did try to adjust to that room for the first 3 days. It just wasn't working. I then met Pappu to find another place to stay with a European closet.

The volunteer boys did manage to find me a room in another building which had this. But there was a catch. It looked as though it was uninhabited even longer than the other parts of the Narnia campus.

The cleaning staff had already left and since our duty began by that point, we were already assumed to be infected. This was the first year of Covid, before the vaccines came out. Everyone was just so much more afraid at that time. Whatever cleaning needed to be done, I'd have to do by myself.

The bathroom was literally the worst I'd ever seen in my life. It made the KSRTC public bathrooms seem like 5-star heaven. It was full of dust, insects and a giant spider was living in the closet. Not exactly what you wanted to return to after a few hours in PPE. But my spine had the final say in the matter.

It wasn't just the condition of the place though. It was also the feeling that the common people probably considered us every bit as dirty as that bathroom while we working in Narnia.

But that was only a small part of the reason I considered this hell.

Psychological Warfare

In the initial few days, Nurse Ratched seemed like a leader. The very best in nursing care. The type of person that would be dearly needed in unprecedented times. It was only after a few days when people started to suspect something was off.

From the start, she had created a small office for herself in one of the buildings. She kept the attendance register, which we had to sign every day, in there. If you wanted to meet her there, it was compulsory for you to wash your feet and change your chappals before entering. How Covid spread was still a controversy back then and Ratched's paranoia about the disease would only grow as the days went on.

She had a very specific way she wanted to do things. It didn't matter if you were a doctor or a nurse or the local politician. It was her way or the highway. And she had this magical ability of making you feel shit with her words if you didn't follow her orders.

Now, I'm the sort of person who has a high tolerance level for all kinds of toxicity. I did tolerate a very toxic relationship for 3 years which had only ended the year prior. So 10 days should have been nothing special. But this person was something else.

Because no one had really much CFLTC experience before, the doctors and myself didn't really have fixed shifts like the centres I would go on to attend after this. It was quite loose, often with me volunteering to go in place of one of the other three. Ratched wasn't a fan of this and would never miss an opportunity to insult someone if she felt they were chickening out. I remember the Ayurveda madam was close to tears on her first day (she had come a few days late) because of Ratched. I would also be at the end of the insults from time to time.

Narnia was originally planned for a capacity of 100. But the higher-ups wanted to increase that as more space was available. Ratched was hell bent against this idea. One day, the CFLTC was technically full. But an ambulance came with some Covid positive patients due to some miscommunication. We had to refer them elsewhere.

They didn't go and eventually we got a call from an MLA to help make space for them. No one really had a choice. All the workers had left by that point, so me and the other volunteered donned PPE and helped make accommodation for the extra people.

Ratched was absolutely livid with me that day. She was acting as though I had endangered everyone's lives and that I should be ashamed to be a doctor. It was the kind of insult one would never expect from a colleague. The horrendous living conditions, the time in PPE and now this. I think I myself was close to tears that day.

Turning Point

That day however was a turning point of sorts. It was a day that everyone suddenly realised that Nurse Ratched wasn't the type of leader we had initially imagined her to be.

I did get a non-apology from her the next day.

"I'm sorry if you got hurt by any of my words," she said. Yeah, thanks for that.

It was around the 6th day that everyone, including the nursing staff began noticing that Ratched never actually entered the building with the patients once it became functional. Nor did she even once don PPE. Even the other nurses started turning against her.

After the MLA incident though, her influence over the Narnia began to wane. It was on day 8 that her husband came to visit. In his presence, she suddenly transformed from a ferocious lion into a reserved little kitten. The Ayurveda madam wasted no time in getting her revenge by making fun out of her like anything afterwards in front of Pappu and friends. It was the only time we could say that Ratched got humbled somewhat.

The rest of the days were relatively better. Psychological warfare had ended. Almost everyone became friends (excluding Ratched).

Well, it was better until we found out that we would have to spend an extra 2 days because the first 2 days of arrangement work didn't count. So, it would become 12 days of hell instead of 10.

Biriyani Time

On a Sunday, it was decided to provide chicken biriyani for lunch to everyone. The problem was that the number of packets calculated was almost an exact number and later it appeared that some packets went missing.

The people who didn't get began to riot. This would be a recurring theme with subsequent spells in CFLTCs and even CSLTCs (second line centres) - food management. People would start screaming at the on-duty doctor about the food. The fucking food. Not exactly the kind of service I figured I'd be doing when I joined. It was always a struggle to explain to people that the same food was given to the health workers as well. People were angry to begin with because almost all had minimal symptoms to begin with. So if the food wasn’t to their liking, they’d start rioting.

But biriyani day was one occasion where the problem was that the food was too good. Couple of days later, the culprit was revealed - an advocate who claimed to have worked closely with some state government politicians. The biriyani packet that day was big enough for 2 people I thought but this guy had managed to eat 5! His roommates ratted him out. He was the one who caused the shortage of food.

There was an all-staff meeting later where the chief cook pleaded with us to please order even more food than what is required. Such meetings were common and quite constructive actually. It gave everyone a chance to speak and you got know of issues that you'd have never even have thought about otherwise.

But at the end of the day, Narnia really didn't need a doctor. I barely did any doctor stuff in those 12 days. This would be impossible for me to do now after enjoying the adrenaline rush of saving lives in the ED for the past 3 years.

Heroes and Winners

The real heroes of Narnia were, without question, the volunteer boys. These guys were basically just out of school and had more guts than the likes of Nurse Ratched to learn how to don a PPE and walk with us inside the main CFLTC building.

Doctors like me are in a way obliged to come out and face things like Covid. It's part of the job. But it takes something really special for someone from a non-medical background to stand up for the community like this at a time when most people were running scared.

And they did this for absolute peanuts in terms of pay. That too had little guarantee.

The real winners though were the politicians. Pappu even donned PPE and went inside to get some photos. He must have gotten more than publicity to win the next election.

The party workers were having a nice party in the first 5-6 days or so with booze and a recently installed satellite dish. This was in a separate building.  Hariharan managed to tell them to cut that out after that. Looking back, that man did do a commendable job mediating between the politicians and the health workers.

Good Riddance

Never before in my life had I been counting down each day left in a posting. That too one which was technically just 12 days.

The place. Nurse Ratched. PPE. And the overwhelming feeling of being useless. I'd much prefer something like this never happen again.

And ultimately, this is one of the things that pushed to advance further in my career to leave such jobs behind.