#2 Inside India's Covid-19 War: A Doctor on Duty
A doctor in a hospital during Covid, a confession and your vote
Welcome back to EconHistorienne, a newsletter for narrative storytelling and economic history research on Capitalism, Inequality and Globalisation with a focus on India, written and reported by me, Pallavi Singh. Today is Monday and you are reading issue #2 of my newsletter.
Today’s issue takes you inside a gutted neighborhood of Delhi where I followed a doctor for a little over eight weeks and in the process, met people just roughing it out, their sole capitalist function being workers in factories, maids in middle class households, gridlocked drivers on the metropolitan expressways or vegetable vendors, surviving from day to day. What does the doctor see as he meets hundreds of Covid-19 patients at a government hospital where human misery is revealed in the most routine ways and medicine is nothing short of a miracle?
Just so you don’t miss any part of this long piece, you could also read this story on my newsletter page.
Now, I have a confession to make:
Wherever I lie, whatever I do, I see people, not numbers. I may squint, shut my both eyes and roll my glasses to add the extra layer of screen; all I can see floating in the mirror of my mind are PEOPLE and that makes me curious: what’s their story, straight down to the bare basics of their existence, the intimate details of their everyday struggles, the rhythm in their hearts that keeps them going, the thoughts that flood their minds and don’t let them sleep?
Just last week when I introduced this newsletter to an editor I most respect and have had the tremendous fortune of working with in the early years of my career, he remarked: “We don’t ever quit journalism, do we?” I felt very emotional. The first national story I wrote for the newspaper was about a morgue watchman who hadn’t gone home for three days when local trains in Mumbai were bombed in 2006. I was about to board one on my way to work but I just took a taxi that day on impulse and I lived to write about the blasts. Even though narrative stories were always fighting for space in India’s print-dominated news media, my editors always made space for my little stories on ordinary men and women often ignored by mainstream news coverage. So, the first reported piece of EconHistorienne is a tribute to all the editors who nurtured the writer in me and helped me find my voice.
Lastly, the slight change in the dispatch time (I know some of you have noticed!) is deliberate. I think sticking to a day instead of a date works better and I need your help in deciding that. Just use this form to indicate your preference, thank you.
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In Issue #3, I am going back in history to explore this: what the hell do the rich do during a pandemic?
NOW PLAYING: Doctor on Duty. Scroll down to read.
DOCTOR ON DUTY
A doctor at a Delhi hospital playing Russian roulette with death everyday sees new socio-economic inequalities emerging with Covid-19 and that’s not just what keeps him working
Illustration by Ishtha Kapoor.
Sometime in early March, much before the Coronavirus or Covid-19 pandemic exploded and provisions for a national lockdown were announced in India, I learnt of the sense of imminent duty and the accompanying panic that were beginning to permeate the inner fabric of a hospital. I was at the Guru Teg Bahadur (GTB) Hospital in Northeast Delhi to pick up threads on the communal riot that had ravaged the area the previous month. The entrance to the Emergency wing was clogged with a stream of stretchers and ambulances carrying people. At a government run hospital, a teeming crowd is not emblematic of a crisis; it’s often a nod to routine miseries in life. But this day looked different. With the pandemic unfolding across the globe, panic and restlessness had come to mark the daily chorus of healthcare professionals at this hospital. A Covid-19 unit with a handful of beds was being created within the Emergency to treat the suspected patients. A similar pattern was to follow at a few other wards. At the Maternity and Child Health ward, an isolated zone of Coronavirus-only beds with ventilators was in the works. The Personal Protection Equipment (PPE) and the N95 masks were beginning to arrive, and the doctors were getting used to the prospect of walking in them in Delhi’s merciless summer.
A general hospital is the frontline of a pandemic outbreak. In India, before the government could stitch together a framework for handling the crisis, the hospitals were already down to the procedural basics – checking for symptoms and treating those symptoms. GTB Hospital, the largest government-run hospital in Northeast District and second only to the Lok Nayak Jai Prakash Hospital in New Delhi, is where some of the earliest batches of patients suspected of the novel Coronavirus infections trickled in, were tested and later sent for quarantine or critical care units depending on the severity of their condition. This was just a lot of action in a hospital where social distancing could be a failed slogan from the start. “GTB is overcrowded any given day of the week. This is a challenge to social distancing. We don’t mean to augment the challenge in anyway, but proximity to patients is a professional hazard. Our only choice, which is our professional duty too, is to walk in here and make them feel well,” Dr Subhash Giri told me, pointing to the impatient queue of patients outside the Medicine Outpatient Department (OPD).
Over the past few weeks, I have obsessively tracked the numbers and rate of spread of the infection globally and tried to understand how this could pan out in India. Within a day of the announcement of the first lockdown, the repercussions for such decisions for a country of India’s size have been visible: migrants thronged bus stops and inter-state transit points to travel back home from the cities, and many walked home with their families, famished and fatigued. Some of them died in road accidents, or died walking just kilometres short of hitting home. Some were run over by speeding trains. Social media and television are ablaze with blinding visuals. Newspapers have all the news - the constraints in the economy, the communalization of infections, the friction between the health ministry and the journalists over sharing of information and data on the pandemic, the doomsday predictions on an impending food riot, the impatient wait for a vaccine, interviews of Coronavirus recovery patients, and daily graphs on the epidemic spread. Essentially, we were bombarded with an information overdose and disturbing visuals. Yet, none of this could tell us what doctors are seeing as they get to work inside the hospitals during these difficult times.
Dr Giri was there, and he could tell. Being a senior doctor in medicine at the hospital, he and the hospital itself were important to the unfolding of the pandemic. Northeast Delhi, constituted as a parliamentary constituency a little over a decade ago in a bid to give political voice to Delhi’s burgeoning migrant population from states such as Uttar Pradesh and Bihar, had barely recovered from the communal riots that singed its social fabric and left 53 people dead. Forty-four of these deaths were reported from GTB Hospital. Erected on a 100-feet wide Tahirpur Road as the most prominent structure in Shahdara, GTB treats 8000 patients in a single day in its various OPDs alone, in what police officials and residents claim to be one of the most communally sensitive areas of Delhi.
Dr Giri started with the overwhelming number of infectious diseases being treated at the hospital on any given day, adding that the nervousness around Covid-19 was unprecedented. “The virus is our hidden enemy. To treat patients of known ailments and infections is one thing; it’s another to head into work not knowing what to expect and where the dangers lurk,” he explained. He and his colleagues had been watching the visuals from Wuhan in China but until that point, the virus was just a morbid fact from a foreign land. “We didn’t feel it coming to our doors until it reached Italy and wreaked havoc. The unrelenting graph of deaths panicked us all,” Dr Giri said. “None of us have dealt with anything like this before.”
Within days of our first meeting, Dr Giri and his team of doctors rushed into the Emergency wing to treat the Covid-19 patient whose case had shaken Delhi, their blue PPE suits wrapped around them like the tidal sea ready to swallow. Gopal Jha, the mohalla clinic doctor from neighboring Maujpur, was all over the television news that kept relaying minute-by-minute updates on the development. The doctor had left a trail of 1200 people behind him for the government to quarantine. At Gopalpur area in Maujpur, Jha’s clinic was one of 450 odd community clinics set up by the Delhi government in 2015 for free delivery of primary health services to the economically weaker sections, most living in unauthorized colonies, underserved urban villages and migrant settlements. From Peeragarhi to Maujpur and beyond, the four-member mohalla clinics in Delhi modelled on the concept of mobile medical vans have sought to bridge the gaps in healthcare delivery for those who cannot afford it and helped reduce footfalls in tertiary care hospitals such as the GTB. Yet, the goals of universal healthcare quickly turned into a hazard for doctors like Jha. Even if he wanted, he couldn’t escape it, a weary government official in the Sub-Divisional Magistrate’s office in Shahdara who didn’t want to be named told me. One small mohalla clinic today covers a population of 10-15,000 people with about hundred visits every day. A sizeable number of patients accessing mohalla clinics are women, and Jha contracted Covid-19 while treating someone who had just arrived in Delhi from Saudi Arabia. In no time, the doctor’s wife, herself a doctor at the mohalla clinic in adjacent Babarpur, tested positive with her teenage daughter. Over the next 24 hours, 5 more fresh cases were reported, taking the total tally of Covid-19 cases in Delhi to 35. This was just the beginning, but the road ahead looked rough. “The exponential growth in infections in other countries and its extremely contagious nature make it a very deadly virus. The war is upon us. We have realized we don’t have the time to think,” Girl told me in late March.
India’s national capital was in the grips of a health scare by the time March ended, aggravated only by what was to unfold over the next couple of weeks.
At the beginning of a morning shift in early April, the hospital staff hurriedly led patients out of the medical vans and into the hospital. Another batch of patients were being moved to a room reserved for Covid-19 testing. The day was turning out to be gloomy, not just at the hospital but in all of Delhi. As their test results started coming in over the next few days, Delhi’s Covid-19 count kept rising.
This set of patients was brought to the hospital after a religious congregation of the Tablighi Jamaat, a Muslim sect headquartered in Nizamuddin, led to the rapid spread of Covid-19 infections, pushing Delhi’s tally to more than a thousand cases in just a few days. The religious congregation attended by 9000 missionaries nationwide despite government ban on public gatherings eventually resulted in 4,000 confirmed cases, 40,000 people in quarantine and at least 27 deaths. In the third week of April, the Indian government said that the cases linked to the event amounted to a third of all confirmed cases in India. In no time, the disease was communalized with caustic television debates trying to fix the blame on the minority community.
Of the 100 odd men admitted, many called their families to complain about the Delhi Police bringing them to the hospital. Doctors would walk over to them, almost pleading that the quarantine was the only way they could keep themselves from infecting others. Another impatient bunch of patients asked to be released as soon as the samples for Covid-19 tests were collected. “The test confirmations kept them grounded. Several of them struggled with fever, cough or breathlessness, but they kept questioning the need for hospitalization. Even when some of them tested positive for Covid-19, the realization that this could claim their lives had not dawned,” another doctor at the hospital told me requesting anonymity.
There is often a delicate line distinguishing impeccable service from failure and that thin line is patience. Doctors at the GTB appeared too prescient to gauge a standoff before it snowballed into conflict. Just a few days into treating infections linked to the Tablighi Jamaat event, they sensed the restlessness and anger in men over the way their suspected infections were being communalized. “They needed compassion; they needed someone who would not associate their condition with the religion they practised,” another doctor who treated the Tablighi Jamaat patients said without giving out his name. Many of them screamed, broke down, or felt revolted by the hospitalisation and that complicated the work of the medical staff including doctors. “Active social media has educated people and informed them about the Coronavirus. Everyone I see is wearing masks and avoiding hugs. But at this moment, we felt resistance. The procedure being followed in treating Covid-suspect cases was standard, but there was a general feeling of distrust in the government and doctors. They felt that they were brought to the hospital just because they were Muslims. We heard of more severe resistance from other hospitals, but here at GTB, things progressed smoothly,” the doctor recalled, requesting me to not write about this in detail given the sensitivity around the issue.
Dr Giri, who was not part of the team of doctors who treated them, said that all a doctor sees in a patient is illness and how that can be cured, not what religion one belongs to. He insisted, if people could see everything that happens inside a hospital, especially the existence of compassion and empathy uncorrupted by fear retaliation or blame, the toxic recriminations on television and social media over the pandemic would never happen. “In the end, what really matters is that people survive,” his voice rose. “That’s more than a marvel of modern medical science to be still bitter about things that may or may not work,” he added, walking away into the lift where a stretcher with another Covid-19 patient waited to go up.
In the weeks since I first visited the hospital, I have seen the maddening rush, the overburdened infrastructure to treat a wide range of diseases and trauma, and the efficiency of its doctors treating hundreds of patients every day. At the police station housed inside the hospital’s Emergency wing, its officer in charge Gyanendra who prefers using his first name, with grievous violence and trauma related cases mapped into thick registers on his work desk, convinced a nervous me, completely shattered by a wailing woman with third degree burns, that the doctors at the hospital were way more experienced than the ones I would find in a private hospital. Once, waiting for Dr Giri at the OPD, I spoke to a woman whose child born with a chest abnormality was growing up healthy after medication at the hospital. At least once, I met a young girl visiting the hospital for appendicitis diagnosis, who was saved from rash decisions over the necessity of invasive procedures by its doctors who said no matter what anyone said, she didn’t have the condition. People like her, with distrust in private hospitals and fear of being manipulated for money, turned to the GTB Hospital and came back cured, feeling relieved about the free and effective healthcare services.
Dr Giri with his team at the hospital’s Critical Care Unit examining a Covid-19 patient.
Northeast Delhi is a settlement of multitudes used to extreme endurance in the face of crippling disease. In its dense pockets such as Maujpur and Babarpur, a little less than five kilometers away from GTB, the hospital’s core patient population lives. Some work in hazardous conditions or engage in excruciating work just to stay afloat and feed their families. For most of this population, an hour at a hospital equals a day’s wages. Some of the most violent areas in Delhi notorious for murder, rape, riots and kidnappings — Seemapuri, Bhajanpura and Jafrabad — are here too, where young men picked up locally made pistols in the middle of a riot and ended up on the front pages of newspapers. This marked them truants for life in the police charge sheets and overnight, they became enemies of the state unless proven otherwise, but that could takes years in a court of law. Learning to walk on crutches after the riots left the area devastated, the outbreak of a pandemic sent people in the district limping for cover. Only when they couldn’t bear the hurt, they arrived at the hospital.
A sexagenarian arrived with symptoms of Pneumonia and a long history of Diabetes and Hypertension. His condition worsened in less than 24 hours. The diagnosis of Covid-19 was delayed because he came to the hospital late. “When he arrived at the hospital, he was exhibiting symptoms of acute respiratory distress. We put him on the ventilator immediately,” Dr Giri said. In less than a day, he passed away. “We barely had any time to work on him. People are too terrified of being diagnosed with Covid-19 and their fear is stopping them from reaching a hospital before it’s too late. That’s costing lives,” he said. Globally, a high mortality rate for Covid-19 patients on ventilators has been widely reported. In Dr Giri’s experience too, the probability of survival on a ventilator could be very low, which is why he insisted that early reporting and detection could save lives.
Late reporting coupled with other underlying diseases endangered the life of another patient earlier this month. Once the woman, who came to the hospital for Diabetes related complications, tested positive for Covid-19, her health quickly deteriorated. Tests revealed a Pneumonia patch on the lungs. The woman in her mid-50s was moved to the Critical Care Unit (CCU) where she quickly slipped into a coma. Still admitted at the hospital, she is at risk of brain injury. “We are closely monitoring her,” he said, sounding upset. Dr Giri, who I have spoken to several times in the past month in person and on phone, is exceptionally cheerful and easy going but on the day this happened, he sounded tired. For a brief period in recent weeks, his workout regimen bore the brunt of his willful neglect until one day last week, he was back at the gym and the sadness began to dissipate.
His challenge isn’t just the Covid-positive patients with other complications; it hasn’t escaped his notice that an overwhelming number of Covid-positive cases in India are asymptomatic. Several times, overcome with a doctor’s unfailing gut, he walked over to the OPD suspecting the asymptomatic cases in regular patients of renal failure, respiratory ailments and other chronic diseases. “I am most perplexed by the ones not exhibiting any symptoms at all. They may all be crashing from inside but on the outside, there is just the pale expression that comes with a non-threatened state of being,” he frowned. In Covid-related deaths, most victims worldwide are older patients. India is a young nation with 65 percent of its population under the age of 35. “Not testing asymptomatic cases helps build a chain of infection which doesn’t get discovered until the next one shows symptoms,” Dr Giri says. “However, high rate of viral and other infectious diseases in India has built high immunity in its population, which could explain why we have more asymptomatic diseases It may indicate that Covid-19-positive people with no symptoms of the disease may be fighting the infection better thereby suppressing symptoms. Yet, such patients are still contagious to others,” he said.
Much before the novel Coronavirus knocked on its doors, the population of Northeast Delhi has battled poverty, malnutrition, poor sanitation and subhuman living conditions. Most of the hospital’s patient pool, overworked or underemployed, other factors accounted for, deals with seasonal flus and other infections just the way Delhi’s rich would deal with a heart attack and Cancer. “All of these ailments, in their respective populations, have the potential to claim lives,” Dr Giri explained.
Dukhi Mandal, for example, felt she could die the morning she arrived at GTB Hospital. In the hallway next to the Emergency ward, Mandal whose first name means “sorrow” in Hindi could barely walk as she arrived with nagging pain in her head. Weak from a fainting episode that occurred earlier in the day when she barely survived hitting the kerosene stove at home, her husband Debu escorted her into a small room where a bunch of young doctors sat around a table. A window with broken glass opened into the mayhem outdoors. A white basin and a narrow examination table appeared from behind the pale blue curtain. A man’s feet on the table trembled just as one of the doctors’ cellphone started buzzing. They watched as the staff moved the patient from the table onto the chair next to the junior doctors. One of the doctors said, “That’s better.” Dukhi settled down in the chair next to him and turned to look at me with probing eyes as I stood huddled in a corner near the door, trying to peer inside. “She looks anemic,” one of the junior doctors remarked, examining her eyes, and began to ask questions. She wasn’t sure how old she was, but possibly in her thirties, she said. She had four children and her husband was a seasonal construction laborer. Her salary as a maid in a middle-class household in Karkardooma bought the ration for the family and paid the rent. Within minutes, the prescription listed a series of tests to be done including a CT scan and a test for Tuberculosis (TB). The doctors then joined their heads and muttered to each other, and the junior doctor added a few more tests. At the medicine counter outside the hospital main building, Dukhi and her husband arrived to join the queue for free medicines. Among the major chunk of medicines handed to her after nearly an hour in the queue, there was a three-month course of pills to fix iron deficiencies. What she didn’t tell the doctors but was visibly one of the reasons for her distress remained untreated: her husband’s addiction with alcohol. Standing in the queue for the medicines, Debu Mandal hurled choicest of abuses at Dukhi for missing work that day even as he struggled to stand straight, his drunkenness sending him into a delirium.
India is not new to viral infections or other infectious diseases such as TB. Many decades before India became independent, communicable diseases from Smallpox, Leprosy to TB claimed thousands of lives in India and were consistently linked to poverty, low socio economic status of patients, rapid urbanization, migration and proliferation of slums. Modern medicine has reduced the burden of these diseases for the likes of Dukhi, but economic prosperity in India post reforms in 1991 has spawned another set of fresh challenges — rapid rise in non-communicable diseases such as Diabetes and Blood Pressure related ailments.
After a long day navigating the adjoining pockets in its neighborhood sometime before the first lockdown was announced, the hospital’s narrow, overcrowded entrance propelled me towards a quieter, circuitous route to reach the Emergency. A long way inside Gate no 1 of the University College of Medical Sciences to which the hospital is attached, the morgue and the multistoried Diabetes wing, situated at least half a few hundred metres apart, throbbed with people. If a mortuary is the final destination in the journey of human life, the Diabetes wing may tell you how to get there and if you are strapped for money, it’s also an expensive route to take. Talk to any doctor with his head into epidemiological research in India and he would tell you that the diseases too have a class divide: if you are poor, you are more likely to die of infectious diseases and if you are rich, your lifestyle will curate a varied bouquet of diseases for you to die from if you take your indulgences too far. The new insights emerging from medical science research confirm: economic prosperity has moved alongside a spurt in lifestyle diseases especially in the high and higher-middle income level groups in India. In numeric terms, cardiovascular diseases, respiratory diseases and Diabetes kill more than four million Indians in a year prematurely, occurring among Indians aged 30–70 years.
Yet, the Coronavirus crisis has completely turned on its head the one thing that had seemed to work for affluent people: money. In this pandemic, until an effective vaccine is developed, how longer you survive depends on your age and absence of pre-existing diseases, not the money that could pay for expensive healthcare services and surgeries. “India faces a triple burden of health to deal with - infectious diseases, non-communicable diseases and injuries. Covid-19 will only worsen this,” Dr Giri says. What could also worsen the health inequalities is the unintended consequences of healthcare delivery during a pandemic and the socio-economic profile of patients. A few weeks ago, the Dialysis Unit at the hospital where patients with chronic kidney ailments receive treatment was opened middle of the night to treat a high-profile patient. For the next two weeks, the medical staff involved in the procedure were sent into quarantine, a peon disclosed to me during a conversation requesting not to be named. Being named would cost him his job, he said, and I tried broaching the issue with other staff at the hospital. Everyone seemed to skip these details while speaking to me including Dr Giri and I was just left with the question the peon asked me: “We have hundreds of patients coming here for dialysis so when the medical staff in the ward were self-isolating, can you imagine what happened to patients?” No one knows, or at least they said so, but the red tape in government hospitals has a way of inconveniencing the patients in disturbing ways, that was loud and clear.
Speaking to Dr Giri for several weeks now, I knew he would look at the brighter side and not miss the rose for the thorns. This takes an exceptional perspective to focus on the inequalities bridged and not be defined by the gaps that remain, but Dr Giri would any day do that. “There are limitations everywhere, but we know that the government is doing its best. In the end, you know that you may not change the system, but you try your best to do your work,” he said.
He has been working as a doctor for 26 years. GTB’s patients exemplify the health inequalities researchers and international health organizations worry about but what informs Dr Giri’s sensibility as a doctor heavily derives from his humble beginnings in life. Dr Giri, 57, grew up in Uncha Siwana in Haryana’s Karnal district and attended the only government run middle school in the village. For high school, he travelled to Madhuban four kilometres away from Uncha Siwana to attend the government run school in the village. His mother died while he was growing up and his father was a land-owning farmer. He was a bright child in a family where no one had gone to college before him. He loved science and Einstein, but he was also playful and loved hockey and running around with other children in the neighborhood until the day his brother’s accident happened. He survived but being a witness to how doctors treated his brother, Dr Giri saw the divine in a doctor’s hands and started looking up to a doctor’s work with utmost seriousness and responsibility. He went on to study Bachelor of Medicine, and Bachelor of Surgery at Pandit BD Sharma Post Graduate Institute of Medical Sciences in Rohtak and graduated with a doctorate in medicine in 1994, followed by a Master of Business Administration from Faculty of Management Studies at Delhi University. “I was good in surgical procedures and being a second topper at the university, I could have gotten into any specialization but I opted for medicine because study of medicine needs a lot of knowledge and analytical abilities to reach a diagnosis. Many of the diseases remain mysteries and medicine can solve that,” he told me.
He particularly loves that his specialisation involves getting down to making lives of those better who cannot afford fees of private medical practitioners in private hospitals. “It’s a joy,” he said, “to see smiles on the faces of these people after their pain has gone and their bodies have healed.” Medicine for Dr Giri has been a way of bridging the health inequalities and the recovery of patients is his ultimate reward. The range of health conditions he treats as a doctor is extensive and varied. “Medicine is the largest specialisation in medical branch. Maximum number of patients coming to hospital in OPD and emergency are from the specialty of medicine. It includes a variety of diseases starting from infections, cardiac, neurological, gastro, autoimmunity, nephro, endocrine, lung conditions and many more,” Dr Giri says. Over the course of his long career, he has treated patients with this range of diseases, often all in a day’s job. He leads a team of 25 odd resident doctors at GTB Hospital who attend to more than 200 patients in a day.
At Dr Ram Manohar Lohia Hospital (RML) in Connaught Place where he started working after his MD in 1994, he was a Registrar in Medicine with impeccable education credentials and his work as a doctor was getting better with experience. Three years at RML and another year at St Stephen’s Hospital in Tis Hazari prepared him for what was to come at GTB Hospital where he joined in 1999. In decades that have passed since, his ability to diagnose and treat draws from the wealth of experience accumulated by doing what truly matters: getting to heal those for whom dying is easier than living.
Dr Giri at work.
It’s been eight weeks since I met Dr Giri for the first time and our conversations have now moved to WhatsApp calls and texts. In several hours of conversations over the last fortnight, I am weaving a mental picture of his daily observations. There are now more patients walking into the hospital with symptoms of breathlessness and of the 2500 odd samples sent for Covid-19 by the hospital, about 100 have come back positive. This is different from the early days of my visits at the hospital when the sense of panic wasn’t validated by the numbers on the ground.
With increasing numbers, it’s not just the Emergency wing where Covid-19 patients first report to the hospital. In recent weeks, several patients walking in for regular check-ups and routine surgeries also exhibited symptoms of Covid-19 and were found to be positive after testing. A handful of doctors and medical staff tested positive too, something Dr Giri felt was inevitable. “When I walk into work, I don’t know who may be afflicted. In early days, I would only wear the mask and examine patients and how safe was that against Covid?” he asked me. Being at the hospital is playing Russian roulette with death but Dr Giri reasoned, in acceptance lies peace and courage. “You begin to face the enemy only when you accept that there is enemy,” he said. “In any case, we are used to working here. We can cope with this.” More PPEs and masks have now arrived at the hospital and more ventilators are on the way, he informed me earlier this week, and everyone is walking around looking like a space cadet let loose in a dystopian world, he then joked, in a moment of expansive humour.
Unlike many of us who may often have starkly different self-image in our minds about our work, Dr Giri has managed to be realistic about himself. His nights are often interrupted by calls from the hospital but he downplays it, often referring to the work put in by his team of doctors at the hospital as exceptional. “At any given opportunity, I know that my team will go beyond the call of duty and serve our patients without a care in the world about themselves,” he told me.
Not once has he told me he is exhausted, even in the middle of a long day of work when he attends calls from the hospital 24/7 or when I have sent him questions late into the night or when he is back home and rested, constantly probing, seeking details, throwing details at him gathered from numerous conversations with my sources at the hospital. At his age, he walks fast like a teenager jumping in his feet, looks about two decades younger with his slender physique and almost 6 feet tall frame, and doesn’t wear glasses. He doesn’t smoke and he isn’t extravagant, healthy habits that he wants to keep from the days he was just a small boy growing up in a little-known village in Haryana. His WhatsApp Display Pictures perhaps reflect the flamboyant side of him more than he likes to reveal in a hospital: from a dull passport shot of his smiling face to a more youthful him riding a horse in polo boots and helmet, and sometimes, shots of him flexing his muscles at the gym. At the parties organised by senior residents, he is always invited for his jolly demeanour and his sense of humour. “I never decline these invitations. I let my hair down and I enjoy the moment,” Dr Giri told me one evening last week. During our conversation, his phone rang several times. My mind wandered, he hadn’t mentioned his family even once in all these weeks. I asked how they are coping with his work at the hospital during the pandemic and he just ignored my question. I didn’t probe any further but he told me what he does in the evenings he gets back home early. “I catch up on news and watche the National Geographic, Discovery and Animal Planet. I love nature and animals,” he said.
In a world where people appear everywhere wearing masks and human interactions could turn into potent recipes for fatalities, did he remember any patient that gave him a visual portrait of second chances in life, I asked. Dr Giri paused and then, the incident came back to him. A young girl in her teens, who was studying at Delhi university at the time, was admitted with a severe case of poisoning. Being a government hospital, GTB treats a sizeable number of officers and staff serving in various Delhi government departments and this girl came from one of these families. Dr Giri’s team was doing its best to revive the girl. The prognosis was negative, though, he said. He didn’t expect the girl to survive. But she did, recovering from ventilator support in days. She lived. A few weeks later when she came in again for a review, Dr Giri told her, God’s miracle and a little help from doctors, may be, worked, but remember to pay this back to the next person you meet who needs your help. When human bodies defy odds to hold on to life, that is when we know what second chances look like, he told me, philosophising his take on second chances, and “that picture is a source of joy that outlives the sorrow.”
But, of many lives that don’t make it, the feeling of heaviness intensifies, the questions over what works and what doesn’t remain, and the mind is numb with those unsolved riddles. The human body is at once a mystery and a miracle, whichever way it plays with the disease. For morose endings, he has empathy but for those still walking in to get better, he has hope that often transforms into an emotional bond with the patient. “In the hospital, my patient is my responsibility, the sum total of what I stand for, why I am here, of all the places, at all the times I am needed,” Dr Giri explained. Dispensing correct information and education about the novel Coronavirus infection is an important part of a doctor’s job in times of a pandemic, he told me. “The main misconception people have when they go for Covid testing is that they think once they have it, they will die. It also puts their relatives in a shock because they immediately realise, they have been exposed to risk,” he said. The chain of what follows is by now universal knowledge. One positive Covid-19 person means a chain in hundreds, drawn meticulously by the police through interrogating everyone the person has met, and asking all of them to quarantine. “But the real trauma is not following rules on quarantine; the real trauma piercing the heart of such patients is the time away from people they love,” he said.
Dr Giri’s understanding of his work translates into compassion for his patients and sense of duty but there is more. I came close to understanding this when Dr Giri, who has an innate grasp of human emotions and is often able to locate these in India’s socio-cultural contexts, narrated to me the trauma and confusion that follows a Covid-19 death with examples from across the world. The Covid-19 crisis has unmasked devastating stories on the abandoned and lonely deaths globally, often explained by the highly infectious nature of the disease. In Italy, several Covid-19-infected patients faced death alone; in Iran, corpses piled up in morgues, many unclaimed; and in Spain, the government admitted that old people were abandoned to die. Laying bare all the details, Dr Giri said it’s been different in India in his experience, at least so far. “We are a socially cohesive society. We are emotional about relationships. Relatives mourn deaths, grieve the loss and take the bodies for the last rites,” he says.
As Dr Giri was saying this, the rituals relayed to me last month of my grandfather’s Hindu funeral over WhatsApp floated in my memory. In times of Covid-19, I realized, life, just like death, has no future. But in a culturally and religiously diverse nation, death ties even the non-believers to rituals, to the rites of passage that many believe will smoothen the journey of those who are passing over into the unknown, the “other” world.
Once at the hospital, Dr Giri’s belief in India’s cultural exceptionalism in honouring the dead was challenged. After a patient died, his relatives left the hospital and doctors wondered if they had abandoned the corpse. “This hadn’t happened before,” he remembered. For every unclaimed corpse, police makes arrangements for disposal. The doctors had already requested the hospital administration for more storage cabinets in case corpses were left at the hospital. “We were thinking if the police should be asked to intervene now,” he says. The relatives of the deceased patient returned the next morning and took away the corpse for funeral.
But what if the final act of abandonment that he hasn’t yet seen happens one day? “Many of my patients, in life or death, have nothing, no one to call their own. They are ours, ours, ours,” he said softly, again and again and again.
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