A Teacher par Excellence

It was in 1986 that this happened. It was my first duty as a 1^st year resident. My senior resident had instructed me, if very serious patients whose prognosis is likely to be poor come, do not admit, refer them off, so that we can keep beds for other patients. He used a word - “scheme off” the patient. Having come from a small rural mission hospital where I never had heard this “scheming off’ and prior to that from a state-run Medical college, which was the final place for all sick people, I never had the previous expertise of scheming off a patient. And adding to this was my poor language skills in Punjabi! As I was wondering what all this meant, a patient with a suspected hemorrhagic cerebrovascular accident was brought in. With very low sensorium and a hemiplegia, the prognosis was poor. The senior resident came and reminded me, try sending the patient off since we do not have many beds for sick patients. The unsaid reason was to reduce the work burden for us, the residents.

I turned to the relative, who happened to be the son, to explain in my broken Punjabi, the poor prognosis, and that they could consider taking him elsewhere. The son looked at me, the young struggling resident, and told me in a simple sentence “do like what you would do to your father”! I had no idea how to proceed now. Would I refer my father off - no way, but could I keep the patient, what would the senior think about me, I needed to impress him on my first duty and my future depended on this! Just then, the senior resident came and asked, what happened. I told, the son wants admission. He smiled at me, and said, you have not mastered the art of sending off, don’t worry, you will soon learn. Admit off into the “Airport beds”. Airport beds were beds set aside for patients who might not survive through the night – a phrase coined by the residents for easy communication. I called, found there was one bed in the Airport bed section admitted and went off to do the rest of the work of admitting the many who were coming in.

After a busy 12-hour shift, early in the morning – 6.00 AM we were to get things ready for the consultant rounds at 8.00 AM. As I was going from bed to bed, checking reports, status, and as I reached the particular airport bed, I found the deeply comatose hemiplegic patient whom we had admitted at night fully awake sitting up and talking with no neurological deficit. I was sure that I had mistaken the patient for some one else. I counter checked the records and confirmed that it was the same patient. The resident came soon, and he too was convinced that there was some mistaken identity issue! Before we could sort this out, the consultant came, and we were forced to present the patient. And as we did, the diagnosis emerged. It was a straight forward patient with Chronic Obstructive Airways Disease with Hypoxic encephalopathy and a false localizing sign, which improved due to Nasal Oxygen administered which was a routine those days for any sick patient.

I learnt many new things and picked up many clinical skills over next three years of my residency from my teachers and senior residents.

But I am thankful that I never managed to master the art of scheming off a patient. All due to that one sentence from the son of the patient – A Teacher Par Excellence - whose simple words still reverberate in my ears, 32 years hence….