With Santa



He was standing up in his crib, eyes glued to the door when I walked in. His face lighting up in a bright smile as soon as he saw me; jumping up and down in joy, his little hands holding on to the sides of his castle, he welcomed me into his kingdom — the hospital room that has been his home since he was a few months old. At last, after tiring of all the silly toys in his crib, he had seen a relatively new one. His little hands reached out for my stethoscope, ready to grab it and fling it inside his crib.

Meet Ruslan. Born two and a half years ago and abandoned at birth by his mother. He had endured a difficult passage into this world from the warm confines of the womb, primarily due to the plethora of infections that his mother had suffered from during her pregnancy. And the drugs and alcohol she had continued to consume even after the doctors explained to her the lasting effects they will have on her baby. As a result Ruslan was born following prolonged labour that deprived his brain of oxygen for longer than it could compensate for. And quite a few infections ravaging his little body. The infections were controlled, but the damage to the brain was irreversible.

In room #7, Ruslan had four other children for company. All abandoned, with varying degrees of psychomotor developmental problems and additional, potentially life-threatening congenital defects. All cared for by the ward nurses. All with a minimum of social contact except for their carers. And all cursed to live a lifetime in sterile hospital rooms.

Most abandoned babies would go to care homes as a rule, but these little ones were the exceptions. No children’s home wants a toddler who may turn out to be violent and disruptive later. With serious birth defects that destroyed any chance of adoption. They had their hands full with trying to find homes for the babies already in their care. The government and social services in Russia are not as sympathetic or organised in adoption and child placement procedures as their counterparts in the west. And the kids’ homes certainly can do without another few mentally challenged and physically challenging children that no prospective parent would want to take home.

So Ruslan stays in his crib all day long, longing for the little things kids his age will wish for. New toys, playmates, a run around the room, maybe even outside in the open air. A hug, a cuddle, a tweaked nose, a kiss. A few nonsense words in his ear. A pick up and throw in the air. A twirl round and round, till his head swims in giddy happiness.

He has plenty of clothes donated by people who feel guilty for their children’s relative fortune. And plenty of food, children’s formula and medicines the hospital is willing to offer, no matter the cost. And round-the-clock healthcare without insurance, of course.

But these things are mundane, of no interest to the little child. He still lacks the social interaction, the human contact, the warmth and love and security that he needs.

Of course it can be argued that Ruslan does not really appreciate his predicament like a “normal” child his age would. His brain is quite damaged, after all. At two and half, he still doesn’t talk – at all. He is unpredictable. He can be smiling and cooing one minute, then something will make him moody and violent; he will throw all his toys out of the crib, bang his head against the padded side rails. He may sleep all day and stay awake all night, crying and shouting, prompting his room mates to join in the ruckus.

But today, he was quite content to play with my stethoscope as I dangled it in front of him, not letting him grasp it. His shrieks were loud as he stood on his toes, arms held high, trying to stretch his fingers to get hold of it. His roommates stayed in their cribs, looking on passively.

I stayed with them for a long time, enjoying this little oasis in the middle of malaise and misery.


the best concert of my life

Today I was witness to the most wonderful concert. It was the *Day for Protecting the Child* here in Russia. The concert was in front of our hospital, where a makeshift stage was erected, sound systems connected, decorations hung and the kids brought down from their departments by their nurses.

There were a few professional musicians and dancers who had given their time ex gratia, and the rest of the ensemble was a motley crew of doctors, nurses, janitors and parents. It was well organised. The music was loud. The dances were infectious, for want of a better word (and, I thought, quite appropriate for an event held on hospital premises).

And the little ones had the time of their lives. It was a joy to watch them shake their booties and shout out the lyrics to their favourite songs in joyous out-of-key abandon. Without a care in the world. The injections could wait for the moment. The operations would be done on another day. Today was their party. And they had come to have a blast.

I noticed a little girl hanging on for dear life to the huge bunch of balloons filled with helium that was threatening to take her with it to the skies. She was shrieking in excitement, only the sound that came out was hoarse, like an old woman with a lifetime on cigarettes. She had a tracheostomy tube in her throat that helped her breathe because she recently had a cancerous growth removed from her vocal cords. And the rough rasping screams would be hurting her throat. But she was not bothered, all pain was given a back seat as she held on to the balloons, floating a feet above ground, watched carefully by her nurse. Her cancer had spread to her liver and lungs. She had maybe a few months to live. And very little time actually, before an oxygen cylinder and a portable ventilator would become an extension of her person.

There were quite a few kids with their own sad and not so sad stories. There were some in wheelchairs, a few with breathing apparatuses, plenty in masks, many with tubes in their arms and necks and bladders — feeding, draining, sustaining life and health. There were the “healthier” ones that seemed out of place, nothing to indicate that they were “inmates” except for the colour coded bands on their wrists. You would be surprised to see that the little boy jumping up and down with the music had a purple band on his wrist, which branded him as an oncology patient. You only wished it was nothing malignant, nothing that would ravage his tiny body, leaving him a wasted skeleton in a few months or years.

My favourite moment was when the MC took the mike to the throbbing bunch of children and asked them what was special about the day. There were different versions of the festival’s theme rendered. The words “child”, “protection”, “festival” and “party” floated in the air like fluffy clouds amongst much laughter and merriment. Then the mike was thrust in the face of a baby from the cardiology department, as pronounced by the green band on his wrist. He was a Down’s baby, probably awaiting surgery for a congenital heart anomaly, very common in these special children. He grabbed the mike with a big smile on his face, eyes wide open, and shouted, “Happy New Year!”

I noticed a young woman standing near me clapping the loudest, tears streaming down her face. And I didn’t have to ask to know who the proud mother was.


the write stuff

All the doctors in our department dread the second Friday of the month. That’s the day of the monthly meeting to discuss “mistakes”. The mistakes are usually quite minor – investigations done but results not recorded, consultations asked for orally but not written in the notes. Trivial matters, when you take into context the ocean of paperwork a doctor does everyday.

This time it was a letter from the Insurance Company. Apparently their “experts” found it hard to read some of the handwriting in the case notes. Special mention was made of particular doctors, and I am proud to say that our surgeons did not let their brethren elsewhere in the world down. Most of the indelible scrawls were theirs.

The Chief actually suggested that some of the offenders be sent back to school and cursive writing classes! Not such a bad idea, if you ask me. I really have no patience for doctors who scribble all over my notes when I ask them for an opinion and make me waste valuable time deciphering what the cardiologist means when he writes, “Patient presently shoes no sighs of confidential cordial abnormality, will follow hip batter in the week for an Echo.”

Many summers ago when I was an intern, one of my colleagues told me this story about a famous gynaecologist in the city. He was an extremely gifted surgeon and very popular with his patients; only he could not write his own name legibly.

One of his patients approached him for a medical fitness certificate to let her resume work after delivery and maternity leave. His secretary had forgotten all about the certificate and had left for home, but the obliging doctor promptly made one out in his own hand. When produced at work the following day, nobody could make head or tail – or even cervix – of the document. No worries, let’s go down to the drugstore; they’ll be able to read the doctor’s handwriting!

The pharmacist puts on his glasses, ponders over the paper for a few minutes, goes to the shelf and comes back with a few bottles. “Take two of these before every meal, and one of these capsules in the mornings…”

It’s not just me. Here’s Umberto Eco on where it all went wrong:

“The crisis began with the advent of the ballpoint pen. Early ballpoints were also very messy and if, immediately after writing, you ran your finger over the last few words, a smudge inevitably appeared. And people no longer felt much interest in writing well, since handwriting, when produced with a ballpoint, even a clean one, no longer had soul, style or personality.”


a rose by any other name…

All the talk in the doctors’ room this morning was about the abandoned baby. She was disowned by the mother, an eighteen year-old unmarried secretary, who also refused to name the father. The baby had an open spina bifida and was gravely ill-looking and cyanosed. She would probably not be fit for surgery. A cardiology consult was awaited to confirm congenital heart problems. She also had an HIV infection, a legacy from her mother. She would probably not make it till general rounds on Monday.

Now, it’s been more than ten years since I graduated from medical school in Russia and went forth to save lives in other parts of the world. And ten years since I have spoken the language to anyone other than my wife, usually when we need to keep something from our daughter. As in, “No ice cream, please; the kid’s got a cold.” ‘The Kid’, by the way, has learnt to say ice cream in seven different languages, so that doesn’t work anymore.

Talking about the abandoned neonate on the ward today, I inadvertently used the word for ‘aborted baby’. It was a genuine mistake; the Russian words for both are similar and it’s not often you use either in general conversation. It drew a hearty laugh out of my colleagues, though, and helped cheer us all up. The poor baby was on everyone’s minds. Abandoned after birth or aborted before you are born. By a mother that doesn’t want you.

“What’s in a name? That which we call a rose
By any other name would smell as sweet.”
(William Shakespeare — Romeo and Juliet II, ii, 1-2)

Make no mistake, I am no “pro-lifer”, I am not against abortions. They will save lives and marriages. There will always be people who either forget contraception or are let down by it. There will always be those blinded by lust or by plain stupidity. There will always be women raped and women abandoned, facing the terrifying prospect of coping with life ‘after’. There are numerous reasons why abortions have to be carried out, both medical and social.

I have a problem with people who think they can get away with murder, literally in this case. Back in my ED in India, I got to see quite a few teenagers complaining of an acute lower abdomen pain whose urine pregnancy tests came back positive. They had never done anything ‘wrong’. They hadn’t known what they did could make them pregnant. And they didn’t want their parents to know, please. So what did she want me to do? To please give her some of those tablets they show on TV. Well, young lady, they are now sold over the counter, at a drugstore near you. You should have got some as soon as you realized that the boyfriend had not used a condom.

Maybe I’m being a little harsh on these young people. The basics of safe sex and contraception, I think, should be part of every school’s curriculum. I was taught some sex ed in school, but I remember it as being very vague and did not tell me much that I didn’t already know. And nobody took it very seriously. Indian parents still like to believe that teen pregnancies are extremely rare. They would be surprised if they spoke to a gynaecologist at a busy city medical centre.

Whether by genuine ignorance or crass carelessness, more and more school kids are getting pregnant in Indian cities. What these young people need to be taught is that an abortion has an immense impact on a young girl’s psyche, not to speak of her body. You’re never the same afterwards. I will speak to my daughter about all this in a few years now and hope that she understands. Anyone can make a mistake, especially if she is constantly not reminded of the consequences.

‘Abandoned’ or ‘aborted’? I wouldn’t have made that mistake either, if I had stayed in touch with the language.


food for thoughts

There were so many little things to do around the flat that I had put off indefinitely. So I decided to take the proverbial bull by the horns on a lazy Sunday, did some house cleaning, washed some clothes, went to sleep in the tub. All that work made me ravenous, so I decided to try this restaurant that I’d seen on my way to work. It had mouth-watering pictures of food displayed in the window. Having no idea what some of them were, I decided to find out first hand. This is not about the food, which was okay, or the prices, which were not. They had these twin waitresses taking orders and the sight took me back in time to when I had first landed in Soviet Russia.

There were about fifteen of us on that Aeroflot flight that landed in Moscow. We had come on a student exchange program, enrolled in courses ranging from aeronautical engineering to comparative literature. Oh, and a few of us future docs as well. It was testicle-freezing weather. Of course our Embassy had messed up and there was no one to meet us. We had four words of Russian in our collective vocabulary and thwarted advances from that universal entity in any airport, the pushy cabbie, by equal amounts of “yes”, “no”, “thank you” and “hello”. After a miserable wait of about eight hours and umpteen cups of dishwater tea, the embarrassed Embassy sprang into action and sent us one of their minions. We were taken to a summer camp for Muscovite schoolchildren, which was understandably empty at that time of the year and would double as our base camp. Till they sorted out who goes where. We were to spend another week there.

It was plenty of fun and games at the camp. We were all assigned bunks and given a per functionary tour of the place. It was huge and covered in snow and had a kiosk selling vodka which we could get at through a hole in one of the walls. Vodka in the middle of nowhere, right next to a kids’ camp? Hmmm…

The camp had a tiny cinema hall that showed Soviet movies about the might of Communism and the scourge of Capitalism, with plenty of steaming sex thrown in–to keep the youth at camp interested, I suppose. Every war was won by the Soviet Union and every Western spy was killed, except for the blonde American beauty with the bazooka boobs. She would fall in love with the dashing handsome Soviet Special Agent who would make gentle love to her in a surprisingly plush bedroom with Victorian furniture, which I suppose was allotted only to the most senior of undercover agents. My bunk was freaking killing my back! Anyway, the carnally satiated lady would then change her allegiance towards Mother Russia. The capitalist pigs were wrong; this was the coolest ideology in the world. Plus the hero was kind of cute and grunted a lot in bed.

There was a large mess hall with fixed timings for absolutely unpalatable meals. And identical twins for waitresses, blonde beauties called Maria and Madina with more lipstick on them that at the cosmetics counter of your local supermarket. They had identical breasts that cast a shadow over your table when they came to take your orders. And identical bottoms that would butt into your face when they bent down to place a plate of the most horrible bland purée on the next table. And identical moles on their lips. All the guys in that camp had identical wet dreams every night of their stay.

All those memories came flooding back in that restaurant, and waking up from my reverie, I noticed one of the twins smiling at me. And I kid you not; she had a mole on her lip! I didn’t wait to find out if the other girl had one as well, that would have been too creepy.


a beautiful morning

It’s a beautiful morning. The air has a chill to it and there has been a fair bit of snowfall at night. It’s still snowing as I walk in the door. There are no surprises on my ward rounds. There have been no overnight admissions, a welcome rarity, and the nurses are having a slow day. I join them in the pantry to some warm tea, great home-made muffins and a few moments of engrossing shop-floor gossip. I am sure that “all is fine in this fine world.” Till I go to baby A’s room.

Baby A had not started life well. He had been born with hydrocephalus. He had endured severe birth trauma and asphyxia during the delivery, resulting in cerebral hypoxia. His brain was deprived of oxygen for long enough to have permanently damaged it. His cry was feeble, he had to be fed through a tube as he hadn’t really learnt to suckle at the breast yet and he reacted very little while being examined. He has been with us for over a month now.

His mom had known about his condition only during the last months of her pregnancy, when it had been picked up by an ultrasound scan. What was surprising was that Mom A was a nurse; yet she didn’t go for a scan till her third trimester.

Behold! The Medical VIP syndrome: When your patient is a nurse, a doctor, or indeed anyone working in healthcare, or a close family member of any of the above, expect Trouble. With a capital “T”.

They will either present with absolutely unexpected complications or react violently to a perfectly common medication. Or have an obscure syndrome that will take weeks and an eager-beaver intern to diagnose. Or end up with multi-organ failure when all they had come for was to get rid of that ingrown toenail.

Mom A was a community psychiatric nurse and really didn’t seem to understand much about her baby’s condition. The team had tried unsuccessfully to explain the extremely bad prognosis to her on previous occasions and failed. It was like talking to a wailing wall. We felt helpless in front of her tears, her pleas to make her baby better. Baby A’s head kept growing alarmingly.

The neurosurgeons would have nothing to do with him either. He had a badly infected spinal fluid, which meant that they could not operate on him until we managed to control the infection. He had been given all the antibiotics in the book, and then some. He was resistant to most of them, and the ‘safe’ ones didn’t seem to make any difference. We did umpteen spinal taps to relieve the pressure inside his head, and prayed for a sterile fluid. And the labs disappointed us every time.

Mom A is not her usual weepy self when I enter the room hoping to get in a quick exam and get out fast. Things are still running to form; head circumference has gone up by a centimetre over the weekend. Baby A is unconcerned by my probing and prodding, winces a little as I put a cold stethoscope against his chest. Mom is watching all this in silence. I am done in a few minutes and ask the usual questions about bowel movements, urine, sleep, irritability. And then the Big One: does Mom have anything to ask me?

She asks me to sit down, offers me some orange juice. Damn! This is going to be another hard long talk. I decline the juice, sit down in the uncomfortable wooden chair, and wait. She gets up and paces a bit, unsure how to start, turns around suddenly, faces me and asks, “Do you think I am responsible for my baby’s condition?”

Say what? I didn’t see that coming. Her eyes are focused, no tears there, just deep and clear. I look away, thinking of a way to answer her, and she explains. “My husband and I had a long talk yesterday; he wanted me to get the scan in my first trimester, but I thought it would harm my little one. I should have got it done earlier and then my baby would have been fine.” So that’s what it is. Guilt. It happens all the time.

The saddest part of working with seriously ill neonates, for me, is talking to the mothers. Most of these babies are born with asphyxia, cerebral hypoxia and intrauterine growth retardation. At best they’ll need surgery to correct a congenital defect. Many will have learning problems. Some will need lifelong treatment.

All the mothers will live in hope for the rest of their lives. Many will blame themselves for their babies’ conditions. It’s a difficult cross to bear.

I look out the window at the softly falling snow; compose my speech in my head. The scan would not have made him ‘normal’, it would most probably have given the parents the option of not bringing him into this world. Of course there are procedures that are done intra-utero, but not every defect can be rectified. Not every anomaly can be picked up by the antenatal scan either. And Baby A would still have suffered the birth trauma. As I turn to her to explain, I notice the tears. I hear the wretchedly silent sobs. She doesn’t want my ‘expert opinion’. She wants to share her guilt and sorrow with someone. She wants me to understand her.

I hold her hand till the tears run dry, and she smiles at me. One of the many sad smiles I will see on these mothers’ faces over the years. I walk out the room with a heavy step. The day no longer seems so beautiful.

October 2019
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