The forgotten nine...

A casual conversation with the husband and the curt reply revealed many things. The issue was around can the patient stay for a few days more in the hospital. The immediate response was, sorry we have run out of money, we must take her home. I called the husband aside and told that, whatever the hospital expenses we will take care of, take care of only the drugs. He was not keen.

The patient was his wife. She had a Cardiac illness – a valve narrowed, which she did not know about. She was brought with a stroke and in the hospital, the underlying heart disease was diagnosed. They never had any check-up prior to this though she was symptomatic. Subsequently, she went into severe cardiac failure, and had to be on ventilator for few days. Back in the ward, she developed pneumonia and had to go back to intensive care for another few days. Throughout all these ups and downs, the husband was with her. At one point of time, some of us discussed and thought of explaining to the husband, the futility of holding on to her, since he had told us that they will not be able to afford a curative cardiac surgery. And an attempt was made, but he was clear, do all what is possible to save her life. I discussed the same with our team, I hope he understands that she will be bed ridden and would not fully recover. He seemed to have understood the same, but was clear that all possible support be given. We continued treatment and she slowly came out. She was still of tube feeds and mostly bed ridden but conscious and alert. She started recognizing her family members. We felt a few more days of active care, she would improve, of course with some residual deficits. And we were keen for her to be cared for a few days more.

The refusal to keep her despite the offer of full free treatment at the same time being so caring surprised me. I probed, why not, it will be free treatment. He looked at me straight in the face and said, yes sir, but what about my children and their food. Unless I go back to village and work I cannot feed them. There is no one else to care for her here. I will take her home, and along with my kids, we will feed her, clean and do the needful.

It was not the hospitalization issue but the support system he did not have that prevented continuation of care. I left the bed side asking myself – could we have offered something more?

I went from there to OPD after completing rounds. In the OPD was another similar but different patient. She also had in the past the same illness, but had been to one of the premier private institutes a few years back and had got the corrective surgery done. Now she struggles with dry cough for which she comes to us. She goes regularly to the centre where she was operated on. We discussed with the family, the need for her to go to yet another better centre to sort her cough issue out, and they had no issues. Any time, just let us know we will go and get the same sorted out. Money support systems etc. were not an issue for them, they had all what was required, where ever it was needed to go.

From there I moved into the Ultrasound room. An elderly man with abdominal pain for three months. All the children were migrant workers and they had come home for festival and found him not doing well. An ultrasound revealed late stage liver cell malignancy with secondary’s all over. Explaining to the family the lack of any possibility of cure and the need for palliative care, they were quick to decide. Yes, we will take him home and care. The issue, they cannot even think of going anywhere else. They had no money nor support systems to care.

As I walked out of the Ultrasound room, I saw this 25-year-old man whom we had discharged the same day. 6 months of numbness of both legs, he had gone on to develop multiple ulcers in legs and has had extensive late stage active Leprosy. I asked him - the treatment is so cheap and available in government, why did you not get treatment? He said, we did not know where to go. It took 6 months and loss of much function of his body before his disease could be diagnosed.

For every one person who, at the drop of a hat fly off to get the latest hospitality cum health care “ivory towers”, there will be nine who can not access anything other than basic primary health care. Who thinks about the nine? It the one for which everyone is setting up their ivory towers and the powers that be actively supporting them. Who will talk for the 9, who have none to talk for…