February 06, 2010

The Sacrifice

She folds her hands together in greeting. "Doctorji, namaste." There really is no fear. How can there be fear where there is such profound ignorance? I rub my eyes. It's two at night, I haven't slept for three, and I just want to finish this and go. But she speaks Hindi, and my knowledge of our national language is far from fluent. I rely on hand gestures. "Your breast", I say and point crudely. "It's cancer. We are taking it off. No nipple, no areola. Nothing but a long scar will be left after the surgery". She nods, but I don't think she actually gets it. They usuallly don't. She smiles, without too much comprehension. "Nothing"? "No", I reply, more impatiently than I mean to sound. "Nothing. It will be flat. You will have decreased sensation over there." She smiles a little more and shrugs. Okay. I fling the consent form in her face. "Sign here." "I don't know how to write Doctorji". I curse her in my head as I have to make one more trip down the hall to get the ink necessary for her to make a thumb impression on the paper. I pull it from her almost before she's done and shove it into her chart. The fatigue is numbing. "Surgery is tomorrow. I don't know when. There are lots of surgeries tomorrow. Don't worry, it's all good."

I go to my room and collapse on my unmade bed, fully clothed. It is a clear night. I can faintly hear the sounds of people wailing outside the Emergency department. Someone probably got run over. Or hung themselves. Or just got old and died. Or is in the process of dying as I lie here. I don't know. I just don't know anything anymore.

The next day she is wheeled in first. She eagerly looks for me among the gowned cutters. I give her a cool wave. The anesthetist puts a mask on her face and she is conscious no more. We paint with povidone iodine and drape her in sterile sheets, till only her left breast is left exposed, glistening under the wet brown solution.
Wannabe gods of human body parts
Her breast we bring, a sacred offering
To the hallowed altar, the operating theater

The senior surgeon marks the breast precisely so that the incision and final sutures are as neat as possible. He draws two curved lines that meet around her areola. It's called a skin ellipse. The whole thing looks like an eye. It really does. Her nipple is like a pupil, the areola like her cornea, and the lines outline the whites. The eye of the breast. It's a vivid, startling picture. Starting, he says to the anesthetist, and makes a unwavering cut on one of the lines. Blood gushes out. The eye is crying. The eye is crying blood. We wipe it with sterile gauze and proceed. Please don't cry. Please don't cry, you're a grown woman. I hope no one can see the tears. I don't want to be labeled a sissy.

The breast is brought out a one big chunk, already cold and lifeless, put in a plastic bag and sent off to Pathology. We wake her up, transfer her to a trolley and send her back to the ward. On the fifth post-operative day, I'll have to take off the dressing. She'll see her new chest. I know what the scene will be like. I dread fifth post-op days more than anything else. It spoils every morning, it gives me heartburn, it makes me a mean, angry person.

It's the fifth day. I forget to brush my teeth. I don't have breakfast. I rehearse the conversation over and over. I think of how kind and understanding I will be today. But as I walk into the ward, numbness, routine and self-preservation take over. I trip in my hurry and almost land on top of her. "Maaji I'm sorry I'm sorry. Today we are removing the dressing. There is no breast. Okay?" She nods. "I have pain there", she says. I roll my eyes. "Yes, I know. There will be pain, it was a surgery, no? Okay, now do you want to see"? She hesitates. Come on, come on, I have more patients waiting. I have so much shit to do. Oh God, how can I be such a bitch? "Do you want to see Maaji", I ask again, hoping I sound more compassionate. She closes her eyes and nods. I pull the dressing off. See now. She looks. Then she closes her eyes again. Two tears trickle down slowly.

I'm in a fix. Do I immediately start to paint and dress it again or do I counsel or something? I hate counseling, man. It sucks. I have no idea what she feels like. In her place, I would go berserk and wail and bring a few psychiatrists down. But she's just lying there softly crying. I gently start to paint over the sutures. She is looking at my face. I refuse to meet her eyes. I paint with utmost concentration and put the gauze. Okay, see you in the evening, I say brightly, still looking only at her chest. I can't look at her. I won't. I'll start crying too and that is just too unprofessional.

I turn away before she can see my tears forming. Before I can leave though, I feel her grip on my elbow. "It's okay, don't feel so bad", she says slowly so I can understand her Hindi. "You cut my breast off to save my life. I know you are worried about me and how I feel. But I'll be fine. You have a very good heart Doctorji, I know you care. Thank you." The tears fell then, but I still did not look back at her. I squeeze her lingering arm and push it away with as much tenderness as I can afford. I run to the Doctor's room and howl and howl and howl till all the ward nurses come around in alarm. "I can't", I say. "I can't. It's too much." "It always is", says one of them. "It will always be like this from now on. You are not a student anymore." She holds me till I calm down. Then she leaves. She has a lot of work. So do I. There is blood to be taken and notes to be made and more consent forms and more dressing coming at me. Another day has just begun. I know I'm going to face it like I do with everything, with too much emotional involvement and self-loathing and extreme paranoia. Maybe I'll still get through this year with all the baggage. Maybe it'll make me a better doctor. Who knows?

6 comments:

sur said...

I think you will..have been reading your posts since quite some time, but its first time i can realize that you are a doctor..not sure if i can say i understand, but whatever i say..it will remain a tough life..it always is..

Psmith said...

that is the most powerful thing Ive read in years.


keep up the good work....thank god for people like you.

we engineers.....I guess we make a difference too....but never in the immediate, intense, powerful way in which doctors do.

Id like to say I feel your pain, but I guess I cant. while reading that, I came pretty close though.

Kid Dork said...

This left me stunned. A powerful, wonderful piece, Crow.

Just a stunning piece of work--you're breaking my heart.

Pranab said...

Crow,

Being an intern as well, I understand! But you did what you had to do. Was there any way around? And well, we need that shield of indifference up and about so that every distressing patient encounter does not turn into a nightmare!

Orpah Daruwala said...

i'm so moved...

vjcvjcvjc said...

good job dude...

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