Medicine ward, RGGGH

5 Nov 2024, Tuesday

Jyothirmayee Swaminathan

Final year medical student, MMC

There are a few moments sprinkled among mundane schedules that catch our hearts: for they are surprising, humbling and unforgettable. Moments that stand out like light capturing crystals embedded in a wall of grey slate glass. Moments that are essentially meetings in a normal day with normal people that leave behind an extraordinary message. I welcome you to experience one such moment with this little piece.

A Sleepy Child

Her skin was too thin and too soft. Like the collagen in them had given up their rigorous vigor to make way for a calm endless sea. It stretched over full green veins curving away like vines over her neck and face. An oxygen mask hung over a mouth which peculiarly held teeth only on the right side. Her grey hair and wizened face stood atop pretty fine boned shoulders, a pretty pink jacket as if picked from a teenager’s wardrobe. She could have as well been a little bird perched on a bed: unable to sleep or lie flat or presently, even breathe. She had the palest black eyes I had ever seen, iris like delicate dark grey glass. She met my eyes everytime I touched her but I saw through them instead of seeing them, leaving me with a feeling that I never truly saw her. They were a window and the scene within was just a shallow shore, only remainders left from a long fight. I suddenly felt a pang of deprivation, there was no twinkle or fight of life, I would never see the story her eyes could tell. The world had lost the story of all that she once was and would never be again.

I held her shoulders with soft pressure, the human contact perhaps rooting me more then her. For even if I had held her with metal straps, she would have slipped away. The singularly most characteristic thing about Rajeswari was that she kept dozing off, her head always starting at the middle of the upright bed to slowly lull away and droop to the corner of the bed in a mere few seconds and back to the middle then slip again. She was exactly like a sleepy child in a bus. Except, she stayed like that the whole day. She was awake but yet asleep, eyes open yet closed, swollen everywhere yet tiny, alive and pleasant compared to all her tube ridden wardmates but yet, life itself held her delicately, one little slip and one could never be too sure and the trouble was: she kept slipping over and over again.

She had edema up till her thighs, swollen legs for so long that the skin on her feet had a rubbery texture, with little bulges that weren’t anatomical. Her feet though soft like the rest of her, barely felt human. And she had a small patch of sweat that never seemed to go away in the hollow above her sternum , accompanied by numerous scattered pulsations and cord like veins. She had a jugular venous pulse that stood up till the line of her jaw: right heart failure and a tense abdomen with ascites. She had a massive scar starting from that patch of sweat disappearing to the neck of her dress, an open heart surgery for a mitral valve replacement. It was the sound of her chest that I remember too well, almost like a song in her lung fields. A long effortful inspiration giving way to the building humdrum of a murmur, there was no audible expiration. Long Inspiration followed by a quick transition from inaudibly gentle to a loud murmur. Repeat. All her heart areas had a drumming palpable systolic murmur which blowed like a drum pushing the steth and my fingers, making them bob with every beat. Her S1 S2 were only slightly audible and the click of the replaced valve lost to that omnipresent beating drum of a murmur. I felt her pulse, counted her breath, diagnosed an unsurprising anemia and debated between a mild jaundice and a muddy sclera.

I listened to her chest, firm soft pressure of my palm supporting her shoulders, stethoscope stuck to her chest with a desperation to decipher the sound of her heart and an urge to cradle her head which was nodding away every few seconds to an uncontrollable sleep like trance. I listened for a long long time, one gentle thumb grazing over the soft skin over her carotid, afraid to press over a vital artery in that delicate creature. I was a student entirely helpless to help her, with only a duty to learn. It would do for me to discern with difficulty: the systole from the transmitted pulsations to her skin than try and get closer to the artery itself. From my shoes, that hurdle in learning was a meagre thing if it would mean even a drop more blood to her brain, even a few molecules of oxygen more. Somewhere within my soul, I understood that she needed every bit of what her body could give her.

That helplessness helped me understand that everytime I wondered if I would ever hear my calling, I was shutting my ears to the whispers: the whispers that called me to stop being a helpless student and equip myself with enough knowledge as quickly as possible to start that sacred duty of saving lives. In the ocean of the biggest government hospital of south India, I knew without a grain of doubt that knowledge: even from a student with zero authority or mastery would make a difference. That sacred knowledge coupled with care and concern: something I had in ample would save lives. I could save lives. One life in this sea of patients. It echoes in my ears and heart as I write it: Yes, Even me. If I could win only one medal, just one prize for all my four years as a student, I would want it to be this: saving a life.

After seeing Rajeswari, I followed my professor to the classroom and my batchmates and I discussed the case with him. I tried to listen intently but I slipped away too, that little bird of a woman slipped into my mind over and over. It was a new gentle beast unfurling in my tummy: I wanted to hug this little sleeping lady, to protect her in any way I could, to let her nodding head rest in peace amd have a lullaby sung to actually put her to sleep. And it surprised me, for while I was fortunate to connect with many of the patients I had met as a student across the years: this fierce urge to care was out of the blue. A new addition. It reminded me of how I felt around children, especially little sick toddlers and babies in our pediatric and pediatric surgery wards. And suddenly, it occurred to me: the guilelessness of the little woman, her blissful unawareness of everything around her, her falling asleep unavoidably like toddlers drooling over the window of the school bus, that blanket of innocence. Her eyes of stories erased could as well be a blank canvas ready to be written. Rajeswari in consciousness and character was a child, and though I hadn’t thought about her like that: her humanity had touched mine with this message and my heart recognized her as a sleepy child long before my mind. It seems that sometimes the hearts talk directly and wait for the brains to go around their winded mountain paths of analysis and memories and reflections to only come back with to that same message. My heart found this sleepy child precious: it was as simple as that.

I must admit to you that I write today with an urgency as I am afraid of what the visit to the ward tomorrow will bring, afraid that the little sleeping child could slip away. Just before I left the ward today, I learnt that her daughters had already been informed that her chances were slim: that any one slip could truly be the final one. For once she slips away, her story now tinged pink in my memory will forever imbibe a drop of watery blank paint. And I wanted to capture my patient thus: A little sleeping child in a pink jacket nodding her head in sleep, perhaps to the rhythm of the murmurs in her heart.

• This topic was modified 1 month, 2 weeks ago by Jyothirmayee Swaminathan.