Mortal Crisis

By Dr. Diwakar Bansal

Sunrise Hospital - a tertiary care hospital for thousands of pregnant mothers. The doctors and the staff thrive hard to bring smiles to the patients and work day and night to care for them. It is regarded as an excellent hospital for its quality of service.

But all this is sullied when pregnant women begin to die without any clinical explanation. With the number of victims rising, the doctors and the staff battle to find the cause and curb the death toll. But the unknown enemy continues to take the lives of the recently delivered mothers.

During this outbreak, doctors Nandita and Rajeev, who have recently joined there, find themselves in the middle of a dark mystery surrounding the hospital. While attending to the sick patients, they accidentally stumble upon a buried secret.

Amidst the deep puddle of mysteries, enemies, deaths, media attention and public humiliation, will they be able to beat this enemy before it is too late? Will the hospital and its hardworking doctors find their way out of this enigmatic crisis?

• Language: English
• Publisher: One Point Six Technologies Pvt Ltd
• Release date: Jul 22, 2021
• ISBN: 9789354382246

Dr. Diwakar Bansal

Dr Diwakar Bansal is a practising surgeon at Shri Ram Group of hospitals, presently working in Jodhpur, Rajasthan. This is his second novel. He likes to write about the medical profession. He is presently national faculty as an advanced surgeon at many surgical conferences. Besides surgery, his passion includes reading fiction novels, listening to music, and writing of course. His wife, Dr Chetna Agarwal, is also a practising Gynaecologist. They are proud parents to two boys - Arnav and Apoorv who are studying.

Book preview

CHAPTER 1

Rajeev woke up to the shrill noise of alarm. He had come from the ward just four hours ago and had to reach the wards again before every other doctor. He stood up from the bed with much effort; eyes trying to close and legs not responding to his inner commands. His whole body seemed to be rebelling against him going to work that day. It needed sleep and food and rest and many other things which were not even remotely close to his work. He reached for his mobile and switched it on while making his way to the bathroom.

There were already ten unread messages in his ‘Paediatric Residents Ward 3’ WhatsApp group. He had been asked to report to the ward as quickly as possible and take care of three ‘very unwell’ babies. He had also been instructed to get the blood reports of few babies and X-Rays of other few ones. He cursed his stars, his seniors, his teachers, and every other person on the planet whom he did not even know and got ready as quickly as possible. He wore the same jeans from the previous night and a shirt from the pile of clothes on the chair, quickly put on the apron over it, and rushed to the wards. It was again going to be one of those mornings when he had nothing to eat or drink for breakfast. He could just ask his favourite nurse, sister Arpita, for some tea and toast.

He greeted Ramkishore, the guard in the Residents’ Hostel, on his way to the wards.

While walking away he shouted, ‘Ramkishore, please tell Kishore kaka to pick my clothes up and get them ready in two days. Last time he took the whole week to return. Now I am in the same attire since the last four days. The keys are at the usual place.’

Rajeev did not wait for the response of the guard and hurriedly rushed to the ward. He was greeted by other guards on the way. He also met few of his patients’ relatives on the way who acknowledged him for his efforts last night.

Rajeev was first year resident in the Paediatrics at the Sunrise Hospital and Government Medical College, Jodhpur. He was posted at the Department of Paediatrics in Sunrise Hospital which is situated in the heart of the city. He belonged to Jaipur where he pursued his MBBS degree. It had only been six months since he had joined the post-graduation programme. As a first-year resident, it was his responsibility to take care of all the admitted patients in the wards and also to help the seniors with their duties in the OPD and the emergency. He had just about completed his night duty in the emergency and was required in the ward again. His ward had strength of about sixty patients and a semi-ICU which had six beds. He was the primary level in-charge of all the in-house patients and was responsible for their care, investigations, and treatment. His duty hours stretched to about 14-16 hours a day and the majority of his time was spent in the hospital wards. He liked his job and took special interest in dealing with children. Rajeev had always loved children and to become a paediatrician was presented to him while he was offered the placement for specialisation during his interview. This passion mixed with love was the only thing that kept him going through this ordeal.

He was rushing through the flock of patients, even this early in the morning, in the corridors. He tried to hold on to his loose apron over his shoulders while running. He kept his stethoscope round the neck and adjusted it after he wore the apron. He checked his pockets for the loose strips of paper to write the notes, orders, and prescriptions. As a first-year doctor, he was required to keep all the stuff in his pockets to be ready for anything being asked.

Early mornings at the hospital were always busy with the patients and their relatives lining up in big queues in the OPDs. The lines grew as big as the Great Wall of China till the OPD ran. The morning hours kept every doctor in the hospital on his or her toes. And it was the first-year residents who bore the major brunt of this machinery.

Rajeev hurriedly arrived at the X-Ray room on the ground floor.

He asked the technician, ‘I did x-ray chest of Madan and x-ray abdomen of Priyanka last night. I want the prints for both of them.’ He literally ordered the technician.

Those x-rays would be the first thing that his Chief would ask for in his daily rounds. He had to collect few blood reports as well from the central lab. While the X-ray technician fidgeted with the printer, Rajeev rushed to the central lab.

He greeted the beautiful technician Arpita over there. Arpita was a young lab technician who had recently joined the ‘Central Lab’. She was in-charge of the reporting of the daily blood samples although she was supervised by the pathologist, Dr Shyam. She had a wheatish complexion, small regular shiny teeth which shined when she laughed. She had an almost perfect figure and always wore tight fitting garments. Rajeev had mixed feelings for her, and he never missed any chance to meet her in person. Although the reports could have been delivered by ward boy, but he visited the lab just to meet Arpita.

‘Hi Arpita! I have some work for you.’ Rajeev smiled just at the look of her.

‘Anything for you, Dr Rajeev. You are always in a rush. Why don’t you come here and have a cup of tea?’ Arpita invited Rajeev.

Rajeev could not turn down the offer and sat on the stool nearby.

‘I would need the CBC and routine reports of five patients that were admitted last night. Choudhary sir will catch my neck if I miss even one patient. I have written the names of the patients and their required reports in front of their names. Please provide them as soon as you can. I have not even gone to the wards yet.’ Rajeev said while producing the slip from his upper pocket. He was hungry which he realised when he was offered tea. He quickly gulped the hot liquid from the cup and grabbed the reports in front of him.

‘Thank you, Arpita. I will try to come after the rounds to have another cup of tea.’ Rajeev said while leaving for the wards.

Rajeev reached the ward. The nursing in-charge was cursing at the sweeper for not doing the morning work right. The nursing incharge was Kishan Lal from Jodhpur. He was an aged fellow who had seen many seasons. He knew how to work with the manpower and make the optimum use of each person. Most of the junior nursing staff and ward boys were afraid of him. Kishan Lal always kept his residents happy and comfortable. Although the work pressure was always high for most of the residents but Kishan Lal felt happy to provide them with all the facilities. This kept most of the residents happy while doing duties in his ward.

Rajeev started to go through the files of the patients. He had about sixty patients admitted under him right now. Last night about fifteen new patients were admitted adding to the list. He had to fill the details of all the patients, check for the remaining investigations, and highlight the relevant findings for each of the patient. He had only one hour to do so.

‘I am going to be screwed today!’ He mumbled to himself while taking the bundle of files and marching towards the beds.

‘What seems to be the problem with your girl, Baba?’ He asked his first patient. Rajeev had about half an hour till his seniors would start arriving in the ward. Rajeev was busy completing the notes and the file work. Two of his seniors quietly walked their way around him.

‘Last night seemed to be too much for you, eh?’ asked Armaan. He was the second-year resident in his ward and hailed from Delhi. He always tried to help Rajeev with his chores.

‘Yeah. I was already running a full show in the ward and now there are fifteen new admissions. It is raining patients, day and night.’ Rajeev said while writing furiously on the case sheets. He did not even raise his head to acknowledge his presence or to greet him.

‘Why don’t you relax a bit bro?’ Armaan told him.

‘I can’t! Everything is haphazard. Chief is going to rip me apart today,’ Rajeev said in a worried tone.

‘Nothing is going to happen. Chief loves you. Tell me, what are you left with? I will complete the investigations. You carry on with the filing.’ Armaan told him.

Rajeev was relaxed a bit after Armaan offered him the help. He tried to put everything in order. They only stopped working when Kishan Lal announced the arrival of the Chief.

His chief was Dr A.L. Choudhary who had been in the department for the last twenty years. He had produced and trained many students under him to make them paediatricians. Many of his students were posted in reputed institutions all over India. He was very proud of his accomplishments. He never took anything lightly and demanded full dedication from all his students as well. That also required day and night work without considering the hours the students spent beside the patients and in the wards.

He entered the ward with two third-year resident fellows and two assistant professors by his side.

‘I despise each of them except Chief. Everyone else is always waiting for any minor mistake from my side. They glorify that in front of Chief and make it look like a major blunder and me like a stupid idiot,’ Rajeev sadly told Armaan when he saw the team entering the ward.

‘Welcome to the real world, Bhai. They are not here to applaud you for the work that you have done, they are all interested in what you failed to look or do,’ Armaan replied.

‘Good morning, sir.’ Rajeev wished the Chief with a little hesitation in his tone. He also acknowledged the faculty behind him and the seniors following closely after them.

Rajeev was a little worried as he was on every ‘post-admission’ day. There were many unanswered questions pertaining the new patients where the initial management was started by him on some guidelines. But the theories gave rise to more theories and every step was scrutinised and then criticised by the seniors and the faculty just to demean the first years and sometimes just to settle some scores.

Today Rajeev had about fifteen new patients and he knew he would be grilled at every new admission for his decision. Although he knew Armaan would be there for his rescue but even he would not be able to save him every time.

‘Sir, this is a new admission, an eight-year-old female suffering from cough and fever for the past ten days. I did X-Ray and I think it is suggestive of ‘Broncho-pneumonia’ on left side.’ Rajeev spoke from the notes on the bed-ticket and held the X-Ray up for the chief to take a look at it.

‘It still does not give a clear-cut picture of ‘Broncho-pneumonia’. This looks like an initial stage of Bronchitis. Did you get the sputum examination done?’ probed Dr Gupta. Dr Gupta was a new addition to the department who had been posted couple of years back. He always tried to show his superior knowledge and expertise over the residents and tried to impress the staff and the chief by demeaning them. Rajeev was red from ear to ear. He suppressed his rage and spoke softly.

‘Sir, I did not think of Bronchitis. I will get the sputum examination done today,’ Rajeev answered with a lot of effort. Dr Gupta did not like Rajeev and vice versa. Dr Gupta was always looking for an opportunity to humiliate Rajeev in front of his teachers and colleagues.

They moved towards the other patients where again the nagging continued between him and Rajeev. He continued to question his judgements about management and Rajeev silently faced the heat. Armaan helped to ease the situation quite a few times but overall it was another grilling day for Rajeev even though he had worked so hard at night and did all that was required for the patients.

The work was never ending after the rounds. Rajeev was entrenched into the work till late in the afternoon. He even skipped the lunch more so because he lost track of time while working. Only when he was reminded by Armaan, he regained his sense of time.

‘It’s five in the evening. Did you even eat?’, Armaan asked as he came from the ground floor.

‘No, I was working all the time. This work has taken a toll on me and I still have few more reports to do. I think the mess would have already closed by now. I will directly have dinner now.’, Rajeev said with a faint smile on his lips.

‘You need to feed yourself to continue to work like this. Come on, we shall go to canteen and grab something.’, Armaan pulled him by his arm and forcefully took him to the canteen.

‘This Dr Gupta. I will teach him a lesson, once I clear my exams,’ Rajeev said while waiting for sandwich.

‘Ha Ha Ha! That is going to take eternity. You can already teach him a lesson by just one simple thing,’ Armaan said.

‘What is it? Please tell me!’ begged Rajeev.

‘Just follow what he is doing to you. All you have to do is look closely at all the patients that he admits. Just scrutinise him and if he commits even a single mistake, just make it a point that you subtly drag the attention of Chief on to that mistake.’ Armaan said while stuffing a large piece of sandwich into his mouth.

‘Well, that is a killer idea,’ Rajeev said while laughing.

‘I did that when I was a first-year,’ Armaan replied.

‘Did Dr Gupta torture you as well?’ Rajeev asked.

‘He does that to everyone who enters as first year. Unless you give him an answer in his tone, he will be after you till your last day in the college,’ Armaan said.

‘Ah! I have one more news for you. You have been here in the department for six months and now you have been promoted,’ Armaan said with a meaningful smile on his face.

‘I don’t understand. I thought we get promoted only when we get our juniors,’ Rajeev quizzically asked.

‘No, my dear! You do get promoted. Now you have been given the extra responsibility of the ‘Labour Room’ and ‘Caesarean calls’ for the new-born,’ Armaan dropped the bomb.

‘No, No, No! You can’t do this. I am already deep under the waters here. You cannot possibly do this to me, Boss,’ Rajeev said in an imploring tone.

‘You are not the first one to do this, Rajeev. Come on, we all have done this. You will be okay,’ Armaan consoled him.

‘No Boss! I am already struggling with the ward work. I do not have any time to read the subject. I have never handled new-borns. How can I possibly detect any pathology with them? They do not even complain. All they do is cry all the time,’ Rajeev was afraid.

‘You will do fine. I will help with your initial few calls. Whenever you find anything you do not know, call me,’ Armaan tried to help him.

‘I am going to be a prisoner in the ward and the hospital. Besides that, Dr Gupta is going to eat me up alive,’ Rajeev sadly realised the truth.

‘There is another great part about this ‘call’,’ Armaan tried to cheer him.

‘What could be great in this hospital?’ Rajeev sulked.

‘You get to meet and talk to the beautiful fellow residents of Gynae and Anaesthesia during your calls. You can talk to them, make friends, and party when you are in the second year like me,’ Armaan winked at Rajeev.

Rajeev smiled for the first time since morning. He was aware of many relationships and affairs that started with the same ‘call duty’. The seniors were always full of stories that started in the ‘Labour Room’ between paediatric and gynae residents.

‘The proposition looks good on paper but still I don’t know anything about these new-borns,’ Rajeev said to Armaan.

‘Okay, let us start your training right now. I have a call from OT (operation theatre). You accompany me there and I will introduce you to my crush’, Armaan said with a cute smile.

Rajeev and Armaan both finished their snacks and headed towards the OT. Till that time Rajeev had only imagined about the OT. He had always thought of OT as very special place. The thought of performing surgical procedures on the patients gave him a different feeling. He had thought of that place to be very quiet in order to be able to perform the complex surgeries. The staff would be gentle to handle the advanced cases. The doctors would be very caring to help the pregnant patients deliver the babies. All the scenes from the movies that he had watched came before his eyes. The surgeons, anaesthetists, the operating staff, the operating tables, and the surgical instruments began to form a mental image in front of his eyes. He was excited to go to the OT. He felt lucky to be a part of the operating team.

CHAPTER 2

The big waiting area outside the OT was buzzing with all the different activities. There were many attendants sitting and standing near the door. He could see that few of the people standing were nervous and seemingly discussing among themselves. There were still others who were celebrating by distributing sweets a few metres away. The ‘Main OT’ gate was guarded by two people. The guards were old and looked like they had retired from their active service previously. They did not seem capable of being of much help in an emergency to deal with the public or with any other casualty. They were sitting on old worn out stools with three legs and busy among themselves. Occasionally they would glance in the direction of the waiting hall just to check the proceedings.

The waiting area was full of attendants. Used plastic teacups, wrappers of biscuits, fruit scrapes and eatables were strewn everywhere. The dustbins were overloaded with the waste and looked like they had not been emptied for weeks. Few of the attendants were lying on the bench, making use of the full bench, oblivious of other people sitting on the floor or just standing there. There were more ladies around as the entry for gents was restricted at the main gate of the hospital. The way was crowded and the two of the doctors had to snake through the public to make their way to the main OT gate. Few of the people did not budge even after noticing the apron they were wearing or the steth around their necks.

The guard got off the stool to wish Armaan.

‘Good morning sir. How are you today?’ the guard said politely bending forwards.

‘I am fine, Girdhariji. How is rush today?’ Armaan took the help of the wall and started to undo his shoelaces. Rajeev also did the same watching him. They put the shoes in the shoe rack beside the guard and wore slippers for the OT.

‘Today is horrible. Aparna madam is going nuts. The patients are coming in trucks today. They have done seven caesareans till now and have a waiting list of about ten more,’ the guard briefed Armaan who just nodded.

‘I would pray that we do not have a big influx into the nursery today with this heavy rush in the OT,’ Armaan muttered.

They both entered the OT complex. Rajeev was astonished the moment he entered the OT. It was exactly the opposite of what he had imagined. The trolleys were lying wayward in the waiting area of the OT. The patients who were operated and waiting to be shifted into the wards were lying on the beds with their babies besides them. The staff were running from one end to another and shouting numerous orders for anyone who met them. The ward boys and the class four staff were too much occupied having more than one instructions and chores assigned to them. The OT complex smelt of some chemical used to clean the floors and the beds. The people were running everywhere shouting. There were OT nursing staff, ward boys, class IV staff, doctors and everyone seemed to be extremely busy.

Rajeev just stood at the gate and forgot everything. He was watching the scene with half of his mouth open. Armaan came back to him and nudged him back from his stupor.

‘Hey buddy! What happened?’ he asked.

‘Oh! I just… I just,’ Rajeev could not explain his mental state.

‘I know. Quite something that you cannot imagine,’ Armaan said.

‘Yeah! I am totally looking forward to work here,’ Rajeev said sarcastically while pointing to a pregnant lady who was awaiting her turn for the surgery but was wailing in pain on the bed. The attending nurse was all too busy to take care of all the pre-op and the post-op patients single-handedly.

‘Give yourself some time. You will get used to it,’ Armaan told.

‘Get used to it? How can we ever get used to it? Can’t we get some more staff and doctors here?’ Rajeev could not get used to the situation.

‘Look bro. Our job is to do the work assigned to us, study and take the degree and exit from the hospital,’ Armaan explained to him.

‘Our job also concerns the patients, the pregnant ladies, their babies and the community,’ Rajeev retorted.

‘I am here to see three new-borns who were just delivered. I will think about the emotional part of it when I am free. I have to complete the ‘calls’ and head back to the room, complete my assignment and come back in evening for the rounds. So, you see, my hands are already full,’ Armaan said while walking towards the nursery area.

Rajeev stood there for a few minutes and then reluctantly followed Armaan towards the nursery. As he had already told there were three new-borns lying in the cot. A nursing staff was nearby, taking care of them. They had been marked at the foot for their respective mothers. The infants were lying comfortably under the electric warmer. Armaan approached the table and took a cursory glance at the little guys.

‘How are you doing Sister Anita?’ he addressed the nurse taking care of the infants. Rajeev was lingering at the back of the room. Armaan took out his stethoscope and started his examination. He leaned over to the rail of the infant-cot and looked closely at all the babies. In a short time, he completed the examination of all the three babies. He then turned to Sister Anita and winked.

‘Where is she today?’ he asked shyly.

‘Sir, she is not here today. But why don’t you talk to her yourself rather than asking about her to everyone?’ She chirped a little noisily.

‘I will, someday achieve that feat,’ Armaan replied thinking deeply.

‘Ok. Now, what about these three here?’ Anita asked him.

‘These two are fine but I will have to admit this little girl to the nursery. She does not look good, she has grunt, the breathing is laborious. She will have to spend some days with us in the nursery.’, Armaan lovingly caressed the girl child with his gloved hand. At the hint of Armaan, Rajeev then stepped forward and examined the three of them. He spent a little more time on the girl. He tried to understand and learn the findings narrated by Armaan.

Rajeev got busy with the file work of all the infants. He completed the notes in the files, discharged the other two and prepared the transfer sheets of the girl. While they were preparing the sheets, a girl entered the paediatric section of the OT. The girl was young, of average height, had a fair complexion, and sharp features. She was wearing a worn-out apron over her salwar suit looking weary and extremely famished. Rajeev could not take his eyes off from her the moment she entered the OT nursery.

‘Boss! What is the verdict for