Who tends to the healer's scars

Dr Abhishek Kumar followed standard protocol.

Before you read a single line more, you need to realize this - he did exactly what every doctor in his place would do. 

The first year post-graduate student and his colleague were called to the emergency department at 3 am to attend to four patients who had arrived at the R G Kar Medical College Hospital following a road traffic accident. Having tended to three, Dr Abhishek correctly diagnosed that the fourth patient seemed worse than the others. So he did the sensible thing - he stabilized the patient and sent him for a diagnostic scan to rule out the presence of any hidden injuries within. The standard protocol followed in hospitals all over the world.   

And that is why he is still in the intensive care unit today battling to breathe, with severe muscle damage, internal injuries, struggling with kidney failure and requiring dialysis at the age of 31.

Having left his care, the patient took a turn for the worse while undergoing a scan and passed away. And just like that, the handful of good Samaritans who brought the patient to the hospital turned from Dr Jekyll to Mr Hyde, mushrooming from 5 to 50 as they returned to the emergency department. Abhishek's female colleague was rescued and locked up inside the operation theatre before the mob could get their claws on her. Abhishek was not so lucky. Brutalized by the mob, he remains in ICU even today ten days later, as I type this, his prognosis guarded.

But of course, you don't care. 

Dr Abhishek Kumar followed standard protocol. If it were a temple, he dutifully removed his sandals before entering. If he were a flight attendant, he respectfully bowed and welcomed you aboard his plane. He did the right thing and you tore him apart.

I wish that I could say that he was a minority Muslim or a Dalit. Which word is it, pray tell me, which? Which word is it that will trigger some emotion in you to care for him? Indian? Modi? Rahul? AAP? Secular? Beef? Nationalist?  

A group of six who brutally raped a blameless woman aboard a moving bus rightfully brought out all the pent-up collective rage within you all and forced a nation to change its laws. Unfortunately, Abhishek chose to be a doctor in India - one of less than 9 lakh in a country of a billion and a half - a blameless man who was assaulted by a violent mob of fifty to the extent that his kidneys stopped functioning, yet is deemed unworthy of even your basic sympathy simply because the tag of being a doctor removes his identity. You are so sure he is guilty in some way because in your mind the present day doctors of India are money minded, soulless gold diggers who deserve to be assaulted - the same way you are okay when violence befalls members of a caste or religion different from yours. Revenge for the sins of the guilty extracted upon the innocent.  

I had spoken about this earlier here - the innocent being

victimized for doing the right thing. 

Can I talk to you in different groups please?

The words may be harsh or polite but I need you to listen. Because, like Dr Abhishek, I too follow standard protocols and now, I know that 

• I may lose my life for it and 
• you won't even care when I get killed for staying awake at night looking out for you.

To The General Public:

My dear friends, you do not realize it yet but you are inadvertently promoting a cycle that hurts us both. Allow me to explain -

1. When you beat me for the natural death of a patient, I will be more inclined the next time a similar case comes to refer it to a higher tertiary center equipped with better facilities and security. 
2. The patient will still unfortunately pass away if the disease or trauma has progressed too far, but 
3. you have now paid twice the amount for it while inadvertently wasting precious time. 
4. More importantly, since doctors now have to be legally prudent, I will follow protocol and demand all investigations to rule out any other systemic involvements rather than trusting my instincts and knowledge.
5. That angers you and when the outcome remains the same, a new cycle of violence and mistrust is born within you. 
6. And a new bunch of doctors realize they are better off referring the patient to a higher center than take on a risky case in a secondary center themselves. 

You need to end the cycle. You need to end the violence. You need to stand up and speak for us because our voices do not matter. Rest assured, we are doing the best with what we have.

• There are less than 10 documented countries with a smaller doctor:patient ratio than India, as per WHO's own workforce statistics. 
• The likes of South Sudan and Lao are among the ten countries whose governments spend less (% of GDP) on their people than India. 

What that means in layman terms is that there will always be a shortage of doctors in India for a population of a billion. What it means is that with government spending on your healthcare so abysmal, the burden of paying for expensive drugs and procedures will fall upon your wallet instead of theirs. If you want more money spent on your own health by the government, demand it from them instead of talking over and over about temples and reservations. Because to us, the health of the community overweighs factors like religious iconography and caste.  

It will take at least a minimum of a 100% rise in public healthcare spending from the government and a decade of fresh new doctors to make up for the back log and deficiencies. You can trash us all if you don't believe me but you can't change facts. In the end, you may be left with only ayurvedic noodles to keep you hale and hearty if you kill all of us.

To my fellow Doctors -

I know how confused you are right now. You no longer know what is the correct procedure to follow as even doing everything right can get you killed. The apathy from the powers above you - the media, hospitals, the LAW ENFORCERS themselves and even our own medical bodies & ministries - leaves you feeling orphaned. I wish I could say it will get better. But I fear that there will be darker nights ahead before we see the first rays of sunshine. And so I say this to you: 

Stand up for your peers across the country instead of continuing an 'ostrich in the sand' attitude. Just because it does not happen in your city today doesn't mean that it will not happen tomorrow. Each act of violence that goes unpunished emboldens a new set of violent goons to carry it out in a new location.

Another day, another unreported case of violence against doctors

Demand that CCTVs be made compulsory in high tension areas within the hospital including the casualty and ICU. If nothing else, it may make a potential assaulter think twice.

Kindly stop with these idiotic black ribbon protests. It means nothing to anyone outside the hospital doors. Stand up and speak your mind on social media and be heard.

In the face of violence, stand up for your peers. The new system of local doctor groups via whatsapp (wherein at the possibility of violence, an SOS is sent and doctors converge from all nearby areas) is actually successful till date, though I wish it were unnecessary. 

Understand this, the first time a hand is raised to strike you, the doctor-patient relationship ends and you are now a victim of a crime. Defend yourselves accordingly.

Seniors, stand up for your juniors instead of belittling them and talking of the good old days... there has never been more mob violence against doctors in India than in the last five years. You know it too. Comparing eras accomplishes nothing... I repeat  over and over again, Dr Abhishek followed standard protocol. He did exactly what you have done a thousand times over the years and paid the price for correctly identifying a patient in distress. The rules have changed and the goalposts keep moving. The new generation of doctors need your guidance and support now. They need the power of your authority to stand up and have your voice heard, defending them. Stand up. Be heard.

Stand up. 
Stand up. 
Stand up. 

To the News channels and papers:

My first tweet on this topic ended with an expletive directed at you. I am sorry. You hear enough expletives for whatever you say, whether you choose one opinion or the other. 

Did any newspaper make d news of a young doctor getting assaulted by patient relatives n losing both his kidneys d headline?No?Well,F**k u!

— Roshan R (@pythoroshan) January 16, 2016

The simple truth is that at some point before it is too late, I do hope you introspect. I do hope you find it in you to connect the dots we struggle so hard to point out over and over again and that you become proactive as a voice of change. 

Every time you ignore an act of violence against doctors while magically appearing to showcase the harm done by doctors on strike to protest this violence, the disillusionment within a thousand members of a new young generation increases and they wonder whether they should treat the next patient who is rushed into casualty or send him or her away. That is truly disheartening... Someday, that could be your parent or child. Someday that could be mine. 

Yes, we are flawed as doctors and will be found wanting at times... but we are not killers. And we do not deserve to be lynched for doing the right thing.

Your absence is a key link in this chain of violence. We need you to step in.

To the Hospitals -

Stop looking for a compromise. Violence in any form is a crime. If you know standard protocol has been followed, then you know you have a duty to stand up for the victim instead of worrying about a decreased footfall once the public finds out your hospital gets goons arrested. 
By deliberately suppressing such news and asking the doctor to suffer the lacerations and bruises silently for the sake of your reputation, you come off no better than an archaic khap panchayat that forces the rape victim to accept 5000 rupees and a billy goat as compensation for the loss of her dignity and self belief. Except we end up paying for our own billy goats even after being assaulted with nary a compensation from your side, is it not?

Stop being stingy on security, especially in today's India. Hire appropriate man power.

You needed us to work well beyond our shifts over so many nights to make up the case load. We need you now to defend us so that we can confidently give our best for you. 

To the Medical authorities -

At this point of time, it would be nothing short of a miracle if you were to stand up and fight strongly for our rights. Over the last one year, the one advantage I have had over doctors of the previous generation thanks to the rise of social media is the ability to reach out and connect with doctors beyond just my hospital or local IMA. I am in direct contact with doctors working in over a dozen states, am a part of various medical groups exclusive to doctors across all fields, ranging from interns & students to super-specialists and  ex-/present heads of IMA.

Not one doctor - I repeat, not a single one - came out with a comment suggesting we could rely upon the powers-that-be to help us. Can you begin to fathom how disillusioned we are with you? Your silence in this case - as in every other case prior - remains deafening to the ears of every doctor here in India, rest assured. Dr Abhishek had a better chance of being cared for after being hit by a train than after being one of the members of the medical family you head, for all the apathy you display.

So to you, I would say - Don't do anything. Bhai, tu rehne de. Please do not strain yourself trying to help lest you pull a muscle. Instead, could you find it in you to redirect some energy towards:

a) Fighting to get the healthcare spending by the government raised from the appalling 1.3% it is right now (the same healthcare funding you cut by 20% in 2014 prompting even the Lancet to wonder what you were up to). I need to ask this here though - forget 1% of doctors, is there a single doctor in India who felt that cutting funding to healthcare spending on the public was the right move? 

b) Actually equip the rural areas where you want doctors to serve with medicines & surgical instruments, instead of sending newbie interns empty handed to get trashed there just to make up your deficits. Teaching a warrior how to use a sword is good; sending him to battle and expecting him to fight without that sword is foolhardy. 

If you are capable of none of these things or you just need to continue appeasing the powers above you by showing how much money you saved, then I really don't think anything more needs to be said. Nonetheless, I will leave you with three words that were taught to me... three of the most important words in medical history. They are words that resonate with every doctor in some form or the other within his heart before he takes on a difficult patient. Today, I say these words to you: 

"Primum non nocere." 

  First, do no harm.

Eight months after my post went viral, today I remain more convinced than ever that I was right. I still would never allow my children to become doctors in India for exactly the same reasons as I typed down that day. 

The only counter to my stand is idealism - an idealism that says being a doctor and saving lives is a honour. And the funny thing is that it isn't a counter at all - for I totally concur with you. The day you realize that there is a difference between the above mentioned idealism and the fatally flawed Indian medical system that needs to be urgently reviewed, rehauled and reborn, you will instantly see why the majority of doctors in India (and even China) no longer wish their children become doctors.

Increasing medical expenses and patient expectations, a woefully understaffed medical system struggling to find the right balance between quantity & quality of care, poor health awareness, wavering ethical choices, loss of trust and of course, a readiness for violence against easy targets.
These are the key ingredients that led to the breakdown of the hallowed doctor-patient trust.

Unlike us, China at least chose to acknowledge it - the first step towards a corrective course - after nearly 40% of their health personnel admitted they planned to quit the medical field for fear of their lives.

My selflessness is as a healer, going into the belly of every ailment and contagion, fighting microbes and relieving pain. It is a selflessness that takes me away from my own family and makes me giggle at dreamy concepts like 48 working hours a week.

It does not however include violence.

I need to be practical even in what codes the oath of Hippocrates require of me. And part of being practical includes the common sense to realize that I need to be alive to serve everyone. Being beaten up because a man who drove while inebriated and rammed into a pole died in the hospital is not an option to me. Being killed because I refuse to reveal the sex of your baby during a prenatal ultrasound scan is not an option for me. Being beaten up because your elder relative dies of lung and liver failure after decades of substance abuse is not an option to me.

I have spent the last 16 years literally living in hospitals across the country for you.

But dying for you is not an option.

I'm sorry.  I am just not that selfless.

And I fear you will find in the days to come, neither are the other members of my Indian medical community anymore.

   

Authors note -

Image courtesy: Dr Ajmal

Dr Abhishek in the ICU following dialysis. 

I don't want your prayers for him. 

I have more faith in the doctors working day and night for his survival than your fleeting sentiments.

I want your shame.  

You should be ashamed of yourselves for proving me correct. Every bone in your body should have been itching to prove me wrong when I said that I would rather have my child be a pole dancer than a doctor in India. 

What is even more painful is that all of us doctors voicing our opinions so strongly together for the first time ever (from first year MBBS students to ex-heads of IMA) still could not elicit stronger action to curb violence against doctors. We could not matter to you. 

And I really wish it weren't so.

We could have saved Dr Abhishek and all the others who work into the night to save your loved ones had we - had I - been able to convince you all to end this cycle of violence we are stuck in. 

I want you to introspect, India. I want you to do some serious soul searching.

Before another healer gets scarred for life.

*****