Mr. Kuthappa leaned against the wall adjacent to his bed and sipped the brownish, gold liquid from a tetra pack.
Abstaining from what my eyes were showing “Mr. Kuthappa, what is that” I paced myself towards him, to show my authority, to demand the respect I deserved, to remind him he was the patient and I was the doctor.
But my angry catwalk didn’t seem to intimidate him. Nothing was going to bother him now and we both knew I couldn’t save him with my knowledge or medications. It was too late. His body was completely submerged in the sea of alcohol. He continued sucking through the small hole of the tetra pack waiting to hit the sea bed.
This was also a record new low in my life. An alcoholic drinking right in front of his doctor.
“Oh, this” he let the pack swing between his index and thumb fingers.
“This is what has guided me for the past 25 years. Always there for me in my bad times and good times.” Kuthappa gulped the remaining, squeezed the packet like a toothpaste tube to extract the last few drops.
It was a local liquor brand which treats the middle aged indigents a sneak peek into the alternate universe, a more successful life, where they didn’t suffer from the economic, political and emotional strain they currently faced.
It was their easiest way out of their world.
The tetra pack. 40% flat out local, hard liquor, it contained mixture of methanol (toxic) and ethanol.
And for Kuthappa to smash 500ml of that deadly liquid every day for the past 25 years, it was amazing. I really respected him a lot. I really wanted to know what kept him going for this long.
Grabbing the loose end of his cotton, abstract stained lungi he wiped his mouth and exposed his big, brown cock. Then folded his leg towards his chest and relaxed, his legs wide open now giving the full view.
“Mr. Kuthappa, we have spoken about this, you can’t drink in here. This is a government hospital and you have to obey the rules if you want to stay here. It is a bad influence on the other patients who are admitted here.” My eyes squinted as he scratched the undersurface of his scrotum, stretching the loose wrinkled skin with each stroke. It was so elastic and relaxed. Comforting sight.
“Well look at this place, does it look like a hospital to you. Look at the people admitted here. We are nobody, that’s why we are here. In this dump. You dint care about us, the government don’t give a shit about us. We are abandoned people just thrown away here to die.”
The truth was he was right.
The white fungated paint hanging from the ceilings, highly underappreciated staff personnel, me being the head. Inadequate supply of drugs and medical instruments. And the most proficient architectural design of the building being the stagnant, mosquito breeding drain water, soaking up the outer walls of the hospital.
So in essence this place was a death sentence.
The patient getting admitted here like Mr. Kuthappa already knew their time was done. The hospital helped their disease progress faster with complications or drain out their remaining quest for life, conjuring them to think practically. Death is the ultimate destination of all human kind, no matter who. Doctor or patient.
So as far as I was concerned we were doing a pretty decent job here. Relieve their pain and suffering and guide them philosophically to their deaths.
Didn’t match the Hippocrates oath. But still.
Finally, I replied “well, Mr. Kuthappa, I understand your frustration but this is how it is. You need to get on with the system. Accept it, make yourself accountable instead of complaining about everything. It isn’t very good for me either, but I am trying and keep going.”
Mr. Kuthappa finished digging his pit and inserted his jerky, brown stained index finger deep inside his right nostril as he contemplated my struggle and difficulties.
For a dying man to think about someone else, it showed that he was a very good man. Selfless to say the least.
He was the rock bottom and I was clinging onto the rocks about to get sucked into the bottom.
It was worse for me here. After almost a decade of being a slave to the narcissistic healthcare system, working my way through the ranks, being exploited every day and finally getting the qualifications. I still had no money, no security and no respect.
At this point patient didn’t even care I was their doctor. I was a nobody. They didn’t hate me, they just ignored me.
“I know. Must be hard for you too” Mr. Kuthappa rested his hand over his knee as he flicked the dark green, crust from his nose towards me. Just missed my face.
“You know last month the minister of health got busted for selling the government quota drugs to some of the pharma companies at a cheaper rate. Some kind of distribution shit. Isn’t it pathetic. How ignorant and unethical can you guys be in a system founded by the very bedrock of ethical conduct”
I nodded. He seemed to be up to date with the political scene going on around here. Maye that what he did all day, drink and read newspapers, like most middle aged men in our country.
“Our very own government selling drugs for their personal benefit.”
At least he made money out of it. Better than being a doctor. I thought.
Doesn’t exactly fit the Hippocrates oath. But still.
“That is how much they care about the ill and poor in this country.”
“Doctor, I’m happy I have no family left. My wife died giving birth to my son and him a few days later. So it is ok. I have nothing to worry about. I’m happy that I don’t have my wife and son next to me, taking care of me, crying for me. I wouldn’t want them near me. I don’t deserve their love and care.” He genuinely wasn’t afraid of his future. He had nothing to lose.
Mr. Kuthappa’s life highlighted all that was wrong in the Indian healthcare system.
My Diagnosis for him is Alcohol addiction exaggerated due to the traumatic loss of mother and child from birth complications. Classic.
He had a huge distended abdomen, pedal edema, shaky hands, and weak drooping nipples on his chest.
Just then, a puff of smoke hit my face and emerging through it was Mr. Kanthappa. Another classic.
Mr. Kanthappa was a coal worker who presented with Obstructive lung disease.
My diagnosis was Chronic smoker, belonging to the low economic strata obliged to work in hazardous conditions to provide for his family.
It was an apt diagnosis considering the social and emotional factors. The government and family both had a major part to play in the diagnosis.
“Mr. Kanthappa, please control your habits, this is a hospital for god’s sake. This isn’t some of your local bars. What you are doing is not only against hospital policy but also against the law. You can smoke openly like this. You have to throw it away.” Beat the previous record low within a few minutes. I had no integrity left as a doctor anymore. This beat everything, the past decade of torture was nothing compared to this moment.
Patent blowing cigarette smoke on my face. There was nothing else to see in this world.
“Well if he can finish one of his, I can finish one of this” he said and let out more smoke. He was in the next bed barely able to sit but still puffing away his cigarette.
I was just one of them now and we were having a conversation about governments and healthcare. The doctor patient line was blurred by the smoke.
“What do you think, Mr. Kanthappa” Mr. kuthappa asked.
“About the whole situation, about how our healthcare systems philosophy is to ignore us and make money from our suffering”
“Yeah, I guess you are right” he said, taking a deep drag. He almost finished his cigarette. Couple more puffs. Really tempted me, but I kept my composure.
Then he threw it out if the window next to his bed and next to the malarial breeding stagnant water.
“Apart from the fact that we are addicted to tobacco and alcohol, we haven’t done anything wrong. So yeah, I agree. It’s not our mistake.” Mr. Kanthappa added.
“Now do you get it” Mr. Kuthappa fired back at me. I was their enemy after all. I was a part of the healthcare system just like them, but on the opposite spectrum. So directly or indirectly I played a part in their miserable lives. Somehow I was the reason. I don’t exactly remember shoving 40 cigarettes down Mr. Kanthappas throat or forcing Mr. Kuthappa cheap liquor. Even if I knew Mr. Kuthappa I would have provided some good quality liquor, I had better standards than him at least.
“Hey why don’t you go to some other place, a fancy hospital, air-condition all over, a comfortable chair and desk and nice money. I would have done that if I were you” Mr. Kanthappa said.
“Yeah, I’m trying for it.”
Doesn’t fit the Hippocrates oath. But still, that was the truth. Money is why most of us joined the profession. Good respectable job, good salary, well settled life. Society misguided us. We just went with the flow.
We were interrupted by a hoarse life sucking cough and sprinkling TB infected water droplets all over us.
It was Mr. Kirthappa.
“Mr. Kirthappa, please cover your mouth before coughing. I have told you many times before. You can spread the disease to other people through your cough. So please be careful and wear the mask, cover your mouth at all times.”
“Wish I knew it before I got infected. I would have dodged all of the coughs which I have inhaled in my life. Very useful tip doctor.”
“At least stop spreading the disease to others.”
He leaned against the rusted bed railings, he was the healthier looking of the three.
Mr. Kirthappa, was a resident of a crowded slum in a big city, a year back TB epidemic had broken out in his slum resulting in infecting thousands.
He was one of the victims not just of TB but of the overpopulation in the country, the low economic strata and the negligence of the government to educate the people.
Mr. Kirthappa was a Tuberculosis patient, on medication for high resistance TB. Relapsed in a year.
“You guys succumbed to your addictions, you had a pat to play for your losses, but me. I didn’t do anything wrong. But still” Mr. Kirthappa argued looking at me.
“That’s what I meant, we have no role to play in this, you didn’t smoke or drink and are still infected. So don’t blame our habits for this. It would have happened anyways” Mr. Kuthappa argued.
“My mistake is that I was born in this country” Mr. Kirthappa started at me before continuing “In a country of excess people, spreading dangerous infections to one another unknowingly so that the government and doctors like you make money out of us and live comfortable lives over our graves”
I knew he wasn’t going to touch me. He respected me very much. Apart from not listening to my instructions and coughing at my face.
Right now, I was surrounded by the three of the deadliest diseases of the country, Tb alone infecting 40% of the population.
I felt very vulnerable. Getting cussed by three dying men.
I couldn’t handle the diseases and the people. It was too complicated. So I decided to leave before I broke new records. Two records were enough for one day.
“I can only say that, I’m glad that I am not one of you. Take care gentlemen” Listening to their miseries was in a happy position. Though I still had to get myself checked for TB.
Didn’t fit the Hippocrates oath. But who gives a damn about the oath anyways except “the court of law”