Dr A S Bhatia
It was early in the morning on 16th of December 2022, when I was heading towards Rajouri . The air was chilling cold and I had to keep the heating system on in the car. The car was moving at a constant speed taking turns on the curves of black topped road in the Kalidar area. We crossed the holy Kalimata temple and I bowed my head in respect for the Goddess. It was all dark all around with stars twinkling in the sky. The big trees on the road sides looked like huge giants, spreading their arms to entangle you! The sight was frightening and screaming like a scene from Ramsay brother’s horror movie of early eighties and was enough to cause perspiration to a weak hearted person! After few hours of journey, the first rays of sun started falling on the top of surrounding mountains with sunlight getting reflected from the roof tops of small hutments, the whole panoramic view was very refreshing, in contrast to the experience of travelling on a lonely mountainous road through tall trees in the middle of darkest night!
We were having our breakfast in a roadside Dhaba, which was typically of Punjabi style , Aallo prantha with curd and pickle served with a hot cup of tea! “Oh! There has been firing outsides the Alpha Gate in Rajouri” screamed one of the customers sitting there! At the blink of a second I looked towards the screen of TV showing the breaking news. In the next moment the entire atmosphere changed in the Dhaba with expression of fear and anxiousness on the faces of persons sitting there. I looked towards my driver and in the eye to eye language, we decided to leave our breakfast and rush towards Rajouri! I called upon my medical superintendent Dr Mehmood Hussain Bajar along with other senior faculty members of Government Medical College Rajouri and asked them to reach hospital immediately. Just forty kilometers before Rajouri town, the roads were blocked by the protesting local agitating youths . Tyres were burning in the middle of road. I always wonder, whenever there is a protest on the roads, from where the protesting youth get such a large number of old tyres in the shortest possible time! They were not allowing any vehicle to move. I was feeling restless as I wanted to be in my hospital.
Those thirty minutes were the worst for me, all our requests to allow us to go fell on deaf ears! Out of frustration I asked my driver to take the car back so that we could find any diversion. After about five minutes back drive , I noticed a 108 ambulance coming towards us . We signalled it to stop and driver of the ambulance could recognize my car and in the next minute I was sitting along with the driver seat in the ambulance. I left my car and asked the car driver to come to Rajouri as and when the blockage was lifted. The ambulance was not carrying any patient as it was coming from Sunderbani after leaving a patient there. But inspite of that, I put the beep siren of the ambulance on the loudest of volume and thus drove through all the blockades. Indeed, Indian protestors are very kind hearted as they will never stop any ambulance even in worst of situations!
In the hospital, there were two persons brought dead and the third one was in a very critical condition with bullet injuries all over his abdomen and bleeding profusely. The expert team comprising of surgeons, anaesthetists , physician orthopeadician was already there. The patient was going to haemorrhagic shock and even a delay of few minutes could have proved fatal for him! Immediately the patient, who looked very poor and was from outside the UT of Jammu and Kashmir ( Name and identity being withheld) was taken to resuscitation room. Blood was arranged, emergency life saving medicines to maintain blood pressure and circulation were infused with the hope to revive him. The expert work of treating doctors showed positive results and in next two hours his basic parameters showed little improvement. Next important thing was to control his bleeding from the bullet injuries in the abdomen and chest, for which the surgical team led by Doctor Gopal sharma, consultant surgeon, Dr Vikas Kumar , senior resident and Dr Simranpreet junior resident along with Dr Saba wani anaesthetist was given the final nod to go ahead to open the abdomen of the patient! While the entire team of doctors was struggling against the time to save the life of the patient , another big trouble erupted outside the hospital! The crowd led by some aggressive leaders were shouting slogans and started demanding the patient to be airlifted to Jammu! We as a team of doctors were in a shock! Is it possible to shift the bleeding patient even in a chopper! Sure he was to die just outside the hospital or in the chopper itself!
The team members looked towards each other and in a dead of silence, decision was taken to go ahead with the emergency surgery and not to shift the patient!
Everyone in the operation theatre looked anxious as there was extra public pressure. Shifting of the patient could have been the easiest decision to shed off the responsibility and to play the safe game! But the inner conscience did not allow us to do that! And we took the decision against all pressures which was right in the patient’s interest! I as the head of the institution was very well aware of the adverse consequences of this decision, if something went wrong ,the possibility of which was very high, but was the only option to save the patient as shifting at that stage would definitely have led to his death!
The team of surgeons, Anaesthetist, paramedical and other supportive staff of Government medical college Rajouri started their work. There were multiple injuries inside the abdomen and chest , the liver was ruptured , spleen was lacerated and intestines were perforated and lungs were badly damaged. Showing excellent operative skills and meticulous work the surgeons repaired all the injured organs and put a tube in the chest to drain the blood oozing from injured lungs, with the patient still in comatose condition but kept alive by artificial respiration by the highly skilled anaesthetists. While the operation was going on, there were numerous call from different political and social leaders on my mobile to shift the patient to Jammu. I decided to switch off my phone but I resisted my those thoughts! The hard work and excellent post operative care in the surgical ICU was given by the paramedical and nursing staff. The ICU was made bacteria free by stringent infection control measures for which Dr Harleen Kaur , a senior microbiologist and an expert in hospital infection control measures , from GMC Jammu also visited the surgical ICU where the patient was kept. A team comprising of Head of departments of Medicine , Surgery , Orthopaedics, Anaesthesia, chest and TB, Cardiologist along with Dr Gopal and his team and Medical superintendent was formed to monitor the condition of the patient round the clock and a whats app group was also created where regular medical update of patients condition was uploaded. The meticulous planned treatment and follow up showed its results with patient responding to treatment and regained his consciousness in subsequent days.
The patient was discharged on 9th of January 2023, after twenty three days of treatment in the hospital! It was a great feeling to see the patient smiling and leaving the hospital along with his relatives for his native place. In the whole scenario, inspite of the intense public pressure to shift the patient, the administrative department health and medical education and local administration of Rajouri stood by us in our decision to treat the patient at GMC Rajouri and not to airlift in view of the prevailing condition of the patient on the day of firing. With the excellent initiative taken by the Government of India in opening of new Medical colleges at Doda, Kathua, Rajouri and Udhampur in Jammu Division, there is need to create awareness among common masses and local leaders about the specialized services available in these peripheral Medical colleges and measures need to be taken by the management of these new colleges to build a trust among public of the services available in these colleges. This will help in reducing the referral rate of patients and in lowering the extra burden on GMC Jammu. Local political leaders need to understand that their undue interference in planning a treatment for patient care, can even cost the patient his life! So let the medical profession take a final call on the plan of treatment and may it not be the public pressure to decide the mode of treatment. Otherwise as Mirza Ghalib said,’
Mere Paas Se Guzar Ke Mera Haal Tak Na Pucha
Mai Ye Kese Maan Jau Ke Wo Duur Jake Roye
(The author is Principal, Government Medical College Rajouri)
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