ACTORS

Contrary to what people might believe, surgical wards are relatively quiet and clean. Occasionally you’ll hear someone screaming in the silence, but only momentarily. Its clean because no matter how dirty the wound, the thick white bandaging makes it look as nice as wrapped candy. You’ll be surprised if you see how dirty the wounds are when people come to us in the emergency and how neat they look (or are made to look) after a day or two in our ward. That’s why many of our patients love being in the ward, especially the ones who are destitute, or don’t get any attention at home. Not to forget the attraction of three square meals a day-free. And so, when the time comes to pack up and go home all fixed up, they become actors.

The first time I met a serious actor, it was the Mother of a 25 year old girl with cancer of the Rectum (almost the last part of the Gut).  We had diagnosed that the Cancer had spread so much that surgery at that stage wouldn’t have been feasible. She needed radiotherapy, which isn’t available at our hospital, so the patient had to be referred to a center which had this facility. For some reason the Mother of this patient believed we were making an excuse to get rid of the patient (a common perception among many patients in government hospitals). She liked the standard of care we had given her daughter. She liked the cleanliness we maintained and the helpful attitude of our nursing staff. She kept asking for us to treat her ourselves. But it wasn’t possible. This girl needed radiotherapy. So she started to butter me up. She kept referring to me as her son. She kept telling me how much I resembled her son. She said she had gotten us fruits, she asked for my shirt size and when I refused to co-operate, she kept pulling on my cheek and grabbing my chin to draw my attention, like they do to little children! That’s when I lost it. “Firstly”, I told her, “I’m not your son. Second, unless you can spend a few million and buy the radiotherapy machine for this hospital, you are wasting your daughter’s precious time by staying here. So go get her some help and stop stalling”. You should’ve seen the frown on her face when she left.

Probably the best actor I’ve met so far was a 30 year old man who had suffered an assault at his home. He had been beaten by a bunch of guys with fists and slaps and had landed in our hospital with the police. He had no severe external injuries. But he complained that his head and chest were paining. Although we were quite confident in our clinical diagnosis, this was a Medico-Legal case. That meant that it could go to court and we might be asked to testify. So we left no stone unturned. We got a CT scan of the head and an X-ray of the chest and as we expected, he had no internal injuries either and was good to go. But he wouldn’t. He just lay in bed with his head down and pretended not to be able to sit up. His voice was normal and he seemed fine, but when I made him sit up he just fell back on the bed. It was too obviously, fake. We gave him some time. But he wouldn’t move. So my senior told me a little trick he used during his PG days. I went and told him that we needed to place a Ryle’s tube into his stomach. This is a plastic tube that goes through the nose, then through the throat and into the stomach. It’s perfectly safe and very useful in patients with intestinal obstruction, but it’s very discomforting for the patient during insertion. He was so stubborn in his efforts though, that he agreed. He actually bore the discomfort of the tube and had it inserted. Seeing all this, his relatives asked to speak with me in private. They told me that the reason why he wasn’t ready to leave was because if he went home, the guys who beat him up might just do it again. He was scared. But staying in the hospital was no solution. He wasn’t ready to tell the police the truth either. He had to go home sometime.

We decided to get him a psychiatric consultation, but just before we did, one our most senior residents joined us during the duty change. When we explained what was happening to him, he went and saw the patient immediately. He asked the patient about his complaints. He looked and sounded very sincere and serious about the patient’s condition. Then he had his attendants pick him up and make him stand. It’ll be interesting to know that a man cannot voluntarily fall from a standing position with the intention to hurt himself. The body reflexly protects itself. He acted as if he was wobbling of course, and my boss was acting as if he was encouraging a disoriented man to walk. In the end, the man walked a good distance and back and told us that his aches had mysteriously disappeared, that his head wasn’t turning and that it was all because of the Ryle’s tube (that had practically done nothing) that we had placed in him. We took out the tube and he left voluntarily. I silently gave him (and my boss) a standing ovation for the entire performance.

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