My Kinwat Days - Chapter Excerpt

THE FIRST EVER CAESARIAN SECTION AT KINWAT

The very reason for escalating the cost of my operation theatre at Kinwat was my insistence of optimum equipment. I did not want to compromise. So I had an abundance of facilities. I had even purchased an operation table for conducting deliveries. I had general surgery and orthopedic instrument sets. I had enough stock of medicines to last six months.

Everything optimum and ideal. Except the place. There was a scarcity of good living place at Kinwat. As it was a Taluka place, many government offices were functioning from it as headquarters. So the Babu of government offices, the officers as they were called, had grabbed whatever possible. Very easily the rent asked for was around two thousands. So reluctantly I had to select a thatched roof construction outside the town, three km away as my hospital. Once I got it I made endless trips to Bombay and town nearby that was one hundred and fifty kilometers away to purchase required equipment. First of all I secured the loan money. But at last the dream came into reality. In villages all the tiny problems are magnified. There was no skilled electrician or carpenter. Whoever were available were just literate. They knew their trade but grossly. At last it was possible to get every thing in place.

I was pleasantly shocked when I applied for the oxygen cylinder. Indian Oxygen was a government run monopoly which supplied the oxygen cylinders for medicinal use. So naturally I expected the typical government attitude at the office. I met the official at an office in Bombay.

He made me fill in a form.

He assured that it was all I had to do.

“You will get the cylinders at your railway station after a month. Whenever the railway station will inform you, take a bank pay order; submit it to the railway parcel office. You take away the cylinders.”

Amazed I asked, “Is that it?”

“Yes” was the reply.

“Nothing even to pay right now?”

“Nothing.”

I got up and was utterly in shock.

I did not believe in him.

So I borrowed a cylinder from one of friends.

I forgot the whole matter.

One day I was intimated by Kinwat railway parcel office about arrival of my cylinders. I gave the pay order. I took the cylinders and came back to the hospital. It was one of the examples how India is run by few honest ones. A sheer miracle. A few do work with all honesty and integrity in every field.

So the hospital began.

But I avoided major surgery like caesarian at all cost. Whatever possible to avoid caesarian I did. But I avoided cesarean.

No one really will ever know what it means to practice major surgery in a village. After the entire ultimate question is of conscience.

Even though the woman is serious enough, she cannot afford the journey to the nearest town.

The fate rests in my hands.

In towns the situation is quite a different one. There are facilities like blood transfusion, there are colleagues to help in need, and you have always a mental relaxation with this assurance.

I got successful in Kinwat because I worked at Hemalkasa, under Dr Prakash Amte. I did operations in candle light. Otherwise the medical education in Bombay does not equip you to practice in villages.

In a village the very awareness that you are alone, makes the major surgery a sheer stressful thing. I was always terrorized by the thought that I was alone in the radius of one hundred and fifty kilometer radius. My responsibility was hundred times multiplied. And I had to take some decisions. I could not avoid taking one. That too in private practice. Whenever a single failure hits you in a village you get destroyed. In cities the patients are well informed about the risks involved including the possibility of death. In a city the patient has no power. The patient lacks man power in cities. And most importantly the news does not spread like a lightening. In rural places like Kinwat the operative practice is always a risky proposition. To cheat is easy. To practice honestly with transparency is always a problem. To adhere to logic is very difficult when the patients are irrational.

So I was on defensive.

I operated in major surgical cases only when the patient was dying. Otherwise in planned cases I was conservative.

All my admissions were serious cases. Some times I admitted meningitis, or obstructed cases. Maybe a very seriously dehydrated child. I had a big problem with assistants in the operation theater. My assistant Ganpat was an illiterate. I trained him. But my difficulty was how to train? Without actually assisting the operations how he would get training? So I conducted mock surgeries. It was a funny situation indeed. We were operating on ghost patients!

So he got trained.

There was one trained nurse who had retired long back because she had married a landlord in Kinwat. She was from Bombay. I pleaded her to assist me in major surgeries. She consented. Her name was Mrs. Meenaxi Ranade (Nagorao). She always came whenever called. Without her love and support Jyoti would never have lived in Kinwat.

She was a lecturer in the local college. She was the first; Jyoti was the second woman in the town who drove the bike.

Before I settled in Kinwat, the obstructed labor case meant danger of death. Very few reached successfully to the government hospitals one hundred and fifty kilometers away. Janabai came.

As an obstructed labor case. She was in labor for more than forty eight hours in her village twenty kilometers away. The government doctor had admitted her for one more day. But without any help. The government hospital was not equipped for major surgery and the government vehicle was standing idle due to lack of funds to repair it. So she could not be transported free of charge to the town. She had no money. She was just eighteen years old.

So after three days of obstructed labor she came to me.

She had one hundred and three degree temperature. She had just five grams of hemoglobin. Normal range starts with twelve.

She was in agony.

She had to undergo caesarian. It was a race with death.

I prepared all of her relatives for possible death in operation. I gave a long sermon. As if I was giving a lecture to post graduate students. I warned about all possible dangers.

Jyoti prayed to her Goddess. I was atheist.

I remembered all the steps. I ran it in my mind. Like a film. Jyoti anesthetized her. Meenaxi was assisting in the operation theater after a gap of twenty years. Patient’s general condition was deteriorating. I was hurriedly going in my steps, as fast as I could. I removed the baby and handed over it to Ganpat. It was alive. A miracle!

Jyoti moved with panic. Blood pressure was falling. Jyoti sat on the stool with loss of nerves. Meenaxi had forgotten her spect. So she was taking time to thread the needle. The death was near.

By reflex Jyoti got up and went to the gasping child. I shouted and reminded her to leave the baby and concentrate on the patient. She turned.

I was calm.

I sutured her back. I was sure that I was suturing a cadaver. I did not even look to Jyoti. But Jyoti did wonder. The BP shot back.

The patient came out of spinal. She moved.

I asked Ganpat to hold her legs. We never had guts to re-anesthetize her with general anesthesia in her poor health. I finished skin.

Threw the gloves.

I was perspiring. Dizzy.

She was irrelevantly speaking. The mother in law. The goat. The hut. And many illegible things.

I inquired with Jyoti.

She had no clues except fear that her brain must have been damaged due to low BP. But she was puzzled.

“Her BP was never below seventy. I had given jolly good oxygen!” she exclaimed. “This is not a brain anoxia.”

She was clueless.

“Maybe low hemoglobin is the culprit.”

She concluded.

I came out.

The very fact that Janabai was alive was a cause enough for the joy outside. All were jubilant except me and Jyoti.

I gave another lecture.

I let them understand about the seriousness of the patient.

We just could not expand the cause for her irrelevant talk.

So what could we give her to cure her?

It was three at night.

The IV line was on. She was in OT. I had no post recovery place. Suddenly I heard a cry from the baby on the table. We ran to it. We had all forgotten it.

Jyoti lied down on the delivery table in the adjacent room. She was exhausted. She joined me after some time. We sat on the steps outside the hospital facing the road and the sky.

She held my hand.

The woman was about to die.

It was my first major and is as going to be a failure.

The word would be spreading around fast.

The hospital would get shut down. No doubt.

So after conceding total defeat and after having lost all hope I got completely calmed down. I began thinking rationally.

Why I was presuming that condition of the patient was related to operative procedure? Was there any other cause?

What could it be?

What could evoke irrelevant brain response?

Alcohol?

I sprang. I ran to the relatives who were sitting away in a corner of my hospital compound.

“Was Janabai addict? Alcohol?”

“Tobacco” came the reply.

“She needed at least five packs everyday!”

I came and hug Jyoti!

“This is the bloody tobacco withdrawal syndrome! She is deprived of her daily dose for the last three days. It was all obvious.

I inserted some tobacco in her mouth under the tongue.

She quieted.

She slept.

We had won.

At four thirty, we returned home.

We slept in a hug.

We could not sleep; neither could we speak a word. Nor was there need.

Slept just as we were.

Because we were there Janabai had lived. The baby had lived. Between the death and Janabai was our Biradari Hospital. It was the first ever operation in the entire one hundred and fifty kilometer radius.

The rays of a hard earned achievement of the man in the form of science and technology had reached Kinwat for the first time because of our tiny efforts.

The hospital had started functioning.

The question was whether it would sustain itself financially?

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