The Rich man and Lazarus

The man had some mild chest pain. He was accompanied by about 15 people, all walking around trying to show their importance and prominence. The Junior Doctor got the ECG done which was inconclusive. She send the ECG to me and I over phone asked her to shift the man to ICU and then get a repeat ECG and some blood tests. It was about 12 mid AM at night when all this was going on. Since a repeat ECG would any way come to me, I thought instead of it being sent, I could go to ICU and be there, see the ECG settle in the patient and come back. Which was not what the JD wanted, I did not know that the relatives had been pushing her to call the consultant and was trying to make life tough for her. She was not too keen to disturb me. Walking into ICU, a group followed me in. Questions followed. What about repeat ECG. What about blood test? Then dropping some names of prominent people and places where he has been treated etc. ECG, Blood tests all being inconclusive, morning itself they were off, taking the patient to may be a higher center after all the night drama.

When all this was going on – no one noticed that near the gate there was an old man fighting for his breath. There was his wife and son along with him, and since they were not sure what to do at four in the morning, they were waiting by the gate of causality. Some staff noticed and brought him in. In severe heart failure, gasping for breath for few hours. We were all there trying to save his life. The family watched with fear and anticipation. They had just 200 Rs in their hand and someone was to come later with money, which was why they were waiting. He was admitted and was in the ICU for 5 days and later in the ward, but succumbed to his illness, despite all what was done. Knowing that they were poor, the nurses had found out how much they can pay, and that was asked to be paid and the rest was written off. Throughout these five days, never was there a question to us from the family on his status. They were waiting in anticipation and faith. We had to call them daily and talk to them. They accepted the facts as it was.

For every one rich man, there are about 10 Lazarus in and around in the community. But the majority of the Lazarus’ of today seldom reach the gates of institutions of health care. They have their apprehensions and fears, their inability to navigate the system, their innate fear of the big structures and other barriers which we do not even understand. But the rich men of today, have all the information they need. They have the arrogance, the push and pull to navigate the system and also use the system to their advantage and then move on to the next system to get what they want from the many systems which are waiting with open doors to cater to them.

It is not a new story. I talked with on old missionary doctor who worked in this hospital in the 70s. He told me, patients would come to the counter and inform – want to see the “Bada Saab” or “Chotta Saab”. What was left would come to him, and he was known as the “Jo kuch doctor”. Anyone who did not have a choice (Jo kuch) would land up on his desk. Mostly the poor who did not know who was Bada or Chotta!

How does one function in this kind of milieu? Where the rich men are stuttering around trying to push their way through, and the poor are waiting in the sidelines, not knowing how to navigate the system. Where the rich men with their arrogance tries to push the Lazarus’ away.

How does one empower the poor to navigate the systems with dignity? How can one create systems which are easy for the poor to navigate? How does one make structures which are primarily poor friendly?

At the same time how does one love the Lazarus’ and respect the arrogant rich men, or respect the Lazarus’ and love the rich men too – because both carry the Imago Dei….

Are not the rich poor in their attitudes and faith and the poor rich in their simplicity, and faith? So who are the poor and the rich?

Questions health care systems have to grapple with on an ongoing basis….