Indian Medic

It’s been a while since my last post, not much has been happening. Maybe I was in the ‘no-bright-ideas-for-a-post’ phase.
Then the Cricket World cup 2007 is on. After a humiliating loss to Bangladesh in the first match, the ‘Men in blue’ have made a stunning comeback with their 257 runs win over Bermuda breaking a few records on the way. It was one of the most awesome matches I have ever witnessed. All of them made those sixers and boundaries seem so effortless. And just when I thought it couldn’t get any better, Captain Rahul Dravid, who I never considered to be much of a sixer person, finished off the innings in style with a huge one.



And oh yeah, I’ll be starting my new job any time now. I interviewed for it last week. I am yet to get the word officially but a friend of mine already employed there have me the heads up. The post is of a Junior medical officer, sort of a house job / residency post. The hours are going to be difficult as is the workload. I might not get much time for studying which is in a woebegone state as it is. The pay is only average. The only good thing about the whole deal is that the hospital is part of the DNB programme and if I manage to clear the Primary entrance test, being employed there already might marginally improve my chances of getting in.

What I need probably is a crash course in time-management if I am to concentrate on both the job and the long-term goals.

3.00 pm

UPDATE: - It is official. I got the call this afternoon. I have to go for a medical fitness test on the 23rd and will be employed as of the 24th of March.

It’s story of three brothers who are separated as kids. The father is on the run for a crime he did not commit and mom has left to attempt suicide. Many years later the three brothers Amar, Akbar and Anthony meet each other without knowing that they share the same blood…literally!

The particular goof up I’m talking about happens when the mom, who’s but blind, suffers a vehicular accident. Coincidentally, all three of hers sons are present at the spot and rush her to the hospital, unaware of her identity and each other’s as well. The doctor says she’s lost a lot of blood and needs a blood transfusion and all three of them promptly offer their’s. What happens next is probably one of the silliest moments in Indian film history.

All three sons donate their blood, which is collected in one single bottle. Directly from that single bottle comes out an IV line, which is transfusing the mother. All in one single shot. No blood grouping, no pre-transfusion tests. Maybe the director was uninformed or he thought the audience was stupid. The aesthetic value of that scene made a huge impact on moviegoers 30 years back when the movie was first released. All three sons unknowingly save the life of their own mother…made for a great formula film.

And the message of ‘Unity in Diversity’, which my country is so proud of was delivered with great gung ho. The title is itself is suggestive of the theme, the three protagonists are brought up as per the customs of the three main religions in this country, Amar as a Hindu, Akbar as a Muslim and Anthony as a Christian.

It was a great movie…still is! Except for the blood transfusion scene that never fails to split me up.

Blood is one of the most important organs of life, though most authorities don’t consider it an organ. It is a body fluid that runs in and out of every nook and crevice of the human body making sure all the supplies necessary for the function of the cells get there in time and takes away all the harmful contaminants to be thrown out of the body. Then of course, it has the function of carrying on pressing responsibilities like transporting white cells to combat infections and platelets and coagulation factors to sites of blood loss. It can be fairly said that blood and blood vessels are the lifelines of the human body.

Another credit to the beautiful red fluid is that it is the easiest organ to transplant, or rather transfuse. Just plug in the IV line and let the blood flow. A wide array of clinical conditions can be amended with timely transfusion. Shock, anemias, coagulation defects, etc, etc. If not whole blood, then platelet concentrates or only RBCs or even only specific coagulation factors. Needless to say, blood has always transfixed me. In the good way, please…

My first brush with the life saving capacity of blood transfusion occurred when I was around eleven years old. My mom had been in a horrible MVA. When we reached the hospital, though she was conscious and coherent, she was still in the red. I remember trying very hard not to cry and to put up a brave front. She had suffered a comminuted fracture of the right tibio-fibula, with a massive concussion and countless lacerations.

The ‘hospital’ was a very small polyclinic, the closest to the site of the accident. They had already transfused her with two units of the whole blood they had in stock. They asked us to arrange for at least four more units of whole blood, they could possible need for surgery. The problem however was that she her blood group was ‘O’Rh negative, which is only the rarest blood group around, maybe next to AB negative. My father was not in town then, so the only people around to help us were our neighbors and mom’s colleagues. Armed with a cross match sample and a list of blood banks in the vicinity a few people set out to get the O negative blood. But they returned soon saying that the half dozen places they had hit in the nearby area did not have O negative blood.

My siblings and I, were huddled near the head of the bed holding onto our mother’s hand. When I heard what the adults were talking about, the first thought that came to mind was “I’ll let them have my blood if that’s what it takes to save my mom’s life.” My eyes met my brother, who was nine at that time, and I could see the exact same emotion reflected in his eyes. My sister however, a couple of years older than me, and a whole lot more sensible, explained to us the concept of blood groups and pre-transfusion testing and that they probably did not take kids’ bloods under any circumstances. And all of us were anyway B Rh positive. My only experience so far with blood transfusion had been what I had seen in the old Hindi movies, where the hero would valiantly offer his blood to save the life. Sufficiently informed, I now prayed to god to devise some means of helping us get the required blood.

By then a few more people had set out to search for it in locales farther away. Among them were mom’s boss and her best friend, we called them ‘uncles’. As the rest us of sat waiting for their return, the chief orthopod came to examine my mother and we were shooed out. Apparently, he also advised that we be taken home, hospitals were no place for small kids. Despite all our protests we were taken home, were we spent the rest of the day sitting by the phone waiting for news. The call came that evening, from my father who had returned by then. The surgery had gone well and mom was doing fine. But I had to know about the blood, to which he replied that the ‘uncles’ had taken care of it.

A week later, when everything had settled down, we learnt that the blood had been obtained from the blood bank of a civic hospital at the other end of the city. And that my mother’s friends had donated their own blood to get what was needed. I was shocked to say the least. What kind of barbaric custom was this, blood in return for blood! Why couldn’t they have just paid in cash? My mom, by then well on her way to recovery, explained to me that blood was so precious a commodity that money was worthless in comparison. If everybody started paying blood with money, where would more and more blood come from? So the practice of donating blood in return for blood, so that someone else could benefit from it some other day. I was never so thankful to god than I was that day. For me it did not matter that the blood donated by my mom’s friends had not been used directly. It was their blood that had saved her life. And I have revered the strength of blood form that moment.

Also, I felt indebted, not to our benefactors, but to God and humanity as whole, I think, if that makes sense.

And I got to repay the debt in medical school. I was eighteen years old, weighed over 50 kgs with no over health problems. Thus having met with the necessary criteria to donate blood, all that was there between me and repaying the debt was my own hesitation. I was scared, I don’t know of what. Not the needles for sure, or of pain, which I knew was not involved. Maybe it was the whole big deal of it. I was going to enter the cycle of human kindness by giving a part of me to save the life of another. It was akin to giving life. In retrospect, I find my thoughts at that time a tad silly. But I was a first year med student, not yet well informed as to how the machinery worked and I was being bowed down by all sorts of altruistic notions. The enormity of it was making me hesitate. But I thought of my mother and I knew it was meant to be. Someone’s donated blood saved my mother’s life. My blood could save someone else’s. It was a simple equation.

The experience was like none other. When I saw the bag fill up with 350 ml of my B positive blood, I felt positively ecstatic. I tried to find out later, for whom my blood had been utilized, but the information was confidential. In return for donating blood, we received a card mentioning our blood group and date of donation. It was a Donor’s card that could be exchanged for one unit of blood of the same group within six months of the date of donation, from any government operated blood bank. Though I was confident that my blood had been utilized, I did not need to cash in the card and it expired. Over the next two years, I collected six more such cards. The official time interval between two donations was four months, but quite a few times, I used to donate within three months after lying to the blood bank officer. Luckily enough, I never suffered any ill effects from doing so.

Our blood bank had a blood in return for blood policy too. But, by then a lot of private blood banks had come up around the city, which sold blood units for money. It was always the patient’s job to arrange for blood guided by the treating physician, and affording patients’ relatives preferred to pay for the blood with money rather than replace it. Also we had no equipment available for emergency auto-transfusions. Consequentially the pool in our blood bank often dried up and we would arrange for blood donation camps. Mostly students took part in those camps and the stocks would be replenished only to be diminished soon. There was also a birthday donor’s club. Students were encouraged to donate blood on their birthdays every year.
Then bizarre policy was issued by our blood bank, which stipulated that blood replaced will have to be of the same blood group as the one issued.

I agree that it was an attempt by the management to store up on the rarer blood groups. But it took a toll on patients. Ones who lived in the city could manage to bring dozens of friends and relatives to get their blood groups checked out and the matching people would donate. But the ones who came from villages and far away places did not have enough donors and had to suffer a lot. This problem became apparent to us during our clinical rotations in the surgical disciplines. To combat the situation, my friends and I came up with the ‘Unofficial blood donors’ Registry’.

We collected the donor cards from as many students as possible and processed the information to make a database consisting of the donor’s name, blood group, dates of donation and expiry of the cards validity and contact numbers. Initially we had planned to retain the cards with us, but people were not willing to part with their precious cards without knowing to exactly what use it would be put to, so we returned the cards back to their owners. Initially it seemed like a very tough task. But I was the prefect of the girl’s hostel that year and exercised all my power to convince people to register their donor card. By the end of the month, we roughly had 60-70 donor card registered with us and the numbers improved as word spread. The idea was that a resident who felt that any of his patient would not be able to arrange for the required blood in time for the surgery or whatever the indication was, would approach us and we would direct him to the people in possession of the cards of blood groups needed. It seems like a tedious approach but it worked out great. The blood bank was a bit reluctant to part with blood units in return for donor cards. But the advantage was that the cards could be exchanged in any of the government blood banks, wherever a blood group, if rare, was available.

We tried to keep the matter as silent as possible, for we were not sure how the management would react. But something that huge could not be hidden for long. Though we were never condoned by the management, officially or unofficially, a few of our teacher’s lauded our effort, unofficially. Of course, there were numerous problems in the endeavor. Quite often cards would expire before being used, and we had to be very judicious as to whom we were giving the cards, for lazy residents had tried to con us on behalf of their patients a few times, and it took a chunk, albeit small out of our study time. We managed the registry for three years, till we were in school. After graduation, we passed it on to the junior class. Last I heard it is still running strongly.

And in final year of med school, when one of my friends met with a near fatal accident, needing a half a dozen major surgeries, we had all the necessary blood units at hand. Guess what goes around does come around.

Over the past seven years, I have donated blood about ten to eleven times. I had to stop doing so a couple years back after an HIV scare, when I sustained a needle prick from an HIV positive patient. That is a story for another day, but for the record, I took the post exposure prophylaxis and have not seroconverted. I can donate blood again, and plan to do so on my mom’s birthday coming up in a couple of months.