“Last night we operated on a pole dancer, who, while performing the Crooked Chopsticks manoeuvre, slipped and fractured her cervical spine,” presented a neurosurgery resident. This exotic discussion took place at the weekly clinical-case discussion meeting, which I attended on a recent visit to the Cleveland Clinic in America. While I got into the nitty-gritty of spine stabilisation and fixation techniques, I couldn’t help but speculate over the kind of medicine that’s practised in the United States and the kind we’re exposed to here, in India.
Every city in America has its share of gunshot wounds, stab injuries and crazy assaults. In our country, you may think that we’d mostly hear about this in the interiors of villages, but it’s becoming a reality in the bigger cites as well. In the West, road rage is a common cause of death, while in India, a similar number die of bull-gore injuries. I remember working in Vellore and tending to a man who was brought into the emergency with a horn that had pierced his eye and come out through the top of his head. They had to saw the horn off the bull before bringing him in!
While the suicide rate is about 8 per every 100,000 Americans between the ages of 10 and 24, in India, we cannot rely on statistics. We can only ruminate whether it’s privileges or poverty, affluence or depression that results in our suicide numbers. We can only deliberate whether it all boils down to parenting patterns or peer pressures. In an age where indulgence in social media can isolate you and an obsession to shine the brightest can burn you, all we can hope for is to want the best for your child, not for your child to be the best. Because sometimes, just sometimes, they get lost.
Health-care systems and policies are different. While most people in the West have insurance, most people here don’t. However drunk, broke and addicted you are, America will pick you up from the streets and treat you—whether you deserve it or not is entirely a different question. In India, depending on the kind of condition you have or the strata of society you belong to, you may either be treated well, but occasionally; you may also end up on the street.
The day we can provide equality in health care is the day we would have evolved as a society, because the state of our nation is only as good as the state of our health. Till then, the least we can do is let the ambulance—whose siren wails behind us in traffic—pass. And for the sake of our loved ones, if we don’t wish to be whisked away in that ambulance someday, we need to wear those helmets on our heads and not on our forearms or adorning the bike handle that is often ever so sickeningly the case.
There is a difference in the lifestyle of doctors too. In North America, whether you are in academics or private practice, you will earn a salary decent enough for you to live a content life. Indian doctors having gone there mostly don’t want to come back—the air is cleaner, the roads are smoother and the grass is greener (but you have to keep mowing it on the weekends). Here, in academics alone, doctors struggle to make both ends meet, and in private practice, very few succeed without succumbing to the ways of the world. But, as they say, there are pros and cons to every system and it almost always is what you make of it. Struggling a little bit introduces you to a deeper understanding of yourself.
As I travelled alone on the interstate Greyhound, leaning my head against the big glass window—watching the crimson glow of the beautiful sunset on the right and a black guy with earphones grooving to hip-hop music on my left—I was at a crossroads of sorts. Reflecting on my training in India, my soul was constituted of images I could not erase, almost like a grainy, old, often silent, often flickering film. Looking forward to further training in North America, I can see only a few forms waiting to take shape, and a few blurred halos waiting for their galactic outbursts. Our lives are not planned in advance, but rather, assembled by pieces of our passions. And what do you do when your passions are all over the place?
While I am deeply rooted in the culture and ethos of this country, I believe that the way medicine is practised here needs to change. Doctors in our country still carry sterilised drums of instruments in the boots of their car running from one hospital to another to save lives—most often their own. Patients who require emergent care are incubated in nursing homes and not transferred to tertiary-care hospitals, where timely treatment could perhaps have saved lives. It is when doctors stop putting patients first and put themselves above all things ethical is where the problem really lies.
I firmly believe that how we care about the people we treat needs to change. I’m not saying America is the Holy Grail of the practice of medicine. They, too, have their share of improper care, botched-up cases and breaches of protocol, which are often impossible to fathom. But they are held accountable in a way we don’t have here in India. People are allowed to get away with things. I sometimes feel like I inhabit a life I don’t deserve, but then, don’t we all walk this earth feeling like frauds? The trick is to be grateful, and hope the caper doesn’t end anytime soon.
It is this dichotomy of life—this ever-changing, never-constant state of things that yet possesses incredible similarities—which is the very nature of the beast. One yearns for perspective, for closure, for peace—all the while living in this dichotomy and breathing it in every second of every day.
As I ended another whirlwind trip, always being the last to board the plane, the sprightly stewardess told me there wasn’t enough space for my hand luggage in the overhead compartment as all the cabins in Economy were full, and offered to tuck it away in First Class. In my cheeky baritone, I asked if I could be placed there too, and pat came the reply, “Certainly not, but your bag will let you know what a wonderful flight it had!”
Sometimes I’m lost. Just sometimes.
