Breathlessness — A Memoir

She comes before my eyes whenever I see someone short of breath.

When I say "she", it's about a fiddling, fine, fourteen year old girl from an obscure place whom I've met once, just once, and who never left me alone ever since.

The evening had been unusually rainy. I was ready to leave from the emergency room after my day's work. This girl came along with her parents, unnoticed but panting heavily, while walking through the usually commotion on the casualty floor. Only her physical distress caught my attention. Even though the triage doctor for the night shift have started on duty, something beyond medical ethics and moral responsibility pinned me back to this little girl. I couldn't stop myself asking the cliché opening statement of physicians, "What brought you here?" Without caring for a reply, I started physically examining the patient. 

"Sir do something, else my child..." Her father's words broke.

This soft tone just didn't seem right for his rough exterior. His strong muscular hands were toughened with callosities all over. His footwear had stains of latex milk. He carried a clumsily folded white towel on his shoulder. Behind him, his wife stood as if sheltered by his shadow.

"We came by the last bus", she said as if appraising me about the situation at hand. Her voice drowned in the rattling sound of the cheap plastic carry bag in her hand. 

"By bus?", I bit on what she offered.

Suddenly there was no further talk. Her words themselves seemed to blame her for her fool hardy decision. Depending upon public transport system to take an extremely sick child to a hospital!

But they had no other choice other than between the bad and the worse. Upon their faces, I saw the helplessness of many a commoner who depended upon public transport to reach the public hospital.

On examination, I learned that the girl have a blood pressure lower than what is required yet she had a puffed up face. She also had engorged veins visible over her neck. She was breathing in heavily as if to pack up her lungs with the whole air from that large room. Still, the extremities of her upper limb were bluish-purple due to lack of oxygenation.

Something was wrong with her heart, my limited medical knowledge told me. Promptly I arranged an oxygen trolley to reach her and to get her chest X-ray and ECG done without delay.

The good thing of being a triage medic is that I can prioritize the most needy ones to first see the consultant doctor over those ones waiting in for long. And I ushered them towards the medicine casualty.

Just a casual look on the X ray, and the doctor diagnosed it as pericardial effusion. Fluid accumulating outside the heart and hampering its pumping action; her heart too was suffocating like her body. Cardiac tamponade, Beck's triad, and more. The doctor within me was startled when impersonate medical terms suddenly attained a human form. "Immediate pericardiocentesis must be done", the doctor was saying.

If not, it's imminent death. He didn't say it though.

I scribbled a label that read "EMERGENCY - VIA CARDIOLOGY" in front of the patient case record and looked around for a reliable hospital attendant. Often the attendants of government hospital work only for the gifts that they demand in return for the service they offer. But in this moment of crisis, I couldn't risk trading her life in the hands of any greedy attendant. I summoned one, shove a fifty rupees note down his pocket, and handed over the patient and well as the case notes to him.

I informed my colleague in medicine female ward to look upon the patient when she is free. Receiving her assurance, I slowly left the place in peace. So much for the day.

The rain was still drizzling. I left the hospital happily, enjoying the showers, and licking the rain drops that ran down my face. After a hot shower and dinner, I drifted off into sleep listening to the wind beating against the window. The rain grew stronger along with the violent storm. The Gulmohar tree outside the house surgeon's quarters uprooted that night, bring down the electric cables along with it.

My tired body didn't care for these distractions anymore. I lay there sound asleep. Except for her visit in my dream—I shook violently on bed, woke up sweating and loud awake. In my dream, I saw her reaching for my arms with her frail hand.

I couldn't decipher at once whether it was a pleasant dream or not.

And It was morning again. I reached the hospital early to review the inpatients and update their case records before the morning clinical rounds starts. Down the hallway, I could see my colleague sitting at the desk in the doctor's room of female ward and hurriedly jotting down something on to the case record in her hand.

"What about the effusion girl?", I enquired.

"At 4 am today morning..."

She didn't wait to complete her words.

How...? There was no possibility.. Why then...? Something was exploding within my brain. I could feel its searing pain flying down my nerves. A stab wound to the chest. Like being locked down in an abysm of despair. Some symptoms that even the doctor in me couldn't explain.

"I'll tell the details after the rounds", her words broke my trance. I took part in the rounds without much interest while my mind was roaming elsewhere. After the rounds, she told me of what she knew.

The girl was taken to cardiology department where the experts drove a tube through her chest. They drained out about quarter to a litre of blood stained fluid from around her heart. Her response to the procedure was instantaneous. She could now breathe and talk like any another child. Because of the overabundance of patients in the cardiology ward, she was later transferred down to medicine ward. At three o' clock in the morning, my colleague was called in to attend to her breathlessness again. 

"What then?", I asked.

"You know the situation of the medical ward, don't you? It may be likened to a slum dwelling or a relief camp. The lives within these walls carry such significance only. Just a mere you or me can't change the situation much."

She continued, "Do you know how much I toiled to shift her back to the cardiology ward, which is hardly a hundred metres away? I took me almost an hour. The ominous hour that snatched away her life. Today morning, technicalities and principalities played odds against me. How many patients have we saved before? But now..."

Her voice trailed off within her sobs.

I couldn't tell her anything.

Some questions doesn't have answers. Answers themselves turn up into questions.

At that moment, someone patted my shoulder and called me, "Sir, can you help? My mother is having breathlessness.."

Again I put my stethoscope around my neck and followed him to his mother, with that fiddling fine girl of fourteen walking before me.