Life in the Intensive Care – An inmate’s point of view.
The Inlaks & Budhrani Hospital is a part of the Sadhu Vaswani Mission’s Medical Complex, in Koregaon Park, Pune. It had been inaugurated in the late eighties by Saint Mother Teresa, no less. Therefore it was a fairly young hospital, as hospitals go. Not that it had any bearing on my selection as a go to place in an emergency, for I hadn’t known any of this until much later.
The Intensive Care Unit or ICU at the hospital is where I spent my first three nights and days a guest. It is a huge, state of the art, unit with three or four separate sections – low pressure, high pressure and normal pressure – for highly infectious diseases, transplant patients and others. I later learnt that its walls were made of special materials to ensure that germs do not adhere to the surfaces and also that the ICU is manned only by specialty and super specialty doctors. It also had a full-fledged and fully equipped Code Blue Team to handle any emergency anywhere in the hospital.
What limited view I had from my supine position on the not uncomfortable bed showed only a very large, very brightly lit, spotlessly white room with twenty odd beds and lots of doctors, nurses and other support staff constantly on the move. It was a bee-hive of activity at all times, as patients were being wheeled in and out continually.
It also seemed to me to be windowless and illuminated only by strong LED lights like inside those international airports, so that one could never tell if it was day or night in the outside world. The sense of time was also impaired because there was no clock in my line of sight. So every time someone looked in on me I asked what time it was, so as not to lose my sense of time altogether. The constant activity and bustle also added to the impression of likening the place to an airport. It was impossible to sleep without being sedated, which is what I was, most of the time.
Most patients were hooked up to some machine or other and I was no exception. When I regained full consciousness around nine-thirty in the morning after my admission I found myself lying flat on my back wearing a brown and white striped pyjama suit whose collarless shirt could only be buttoned at the back. My nose and mouth were covered by a transparent plastic oxygen mask. This mask was to remain attached to my face for the next eight days.
There were inverted bottles and fat syringes dangling from a stand next to my bed and multiple tubes emerging from them met, merged and entered my arm through a plastic catheter already inserted and stuck fast with adhesive plaster on the back of my right hand.
There was a blood pressure measuring cuff tightly wrapped around a bit above the elbow of my left arm that seemed to inflate and deflate automatically every ten minutes, or so it seemed, without any human intervention.
There was a small plastic clip, resembling a common clothesline clip, fixed to the top of the index finger of my left hand, constantly measuring the oxygen level in my blood.
Multiple electrodes were stuck all over my upper body with rubber suction caps which were liberally doused with some transparent gooey gel like substance that made a mess of my chest and gave me an icky feeling.
A transparent plastic tube attached to the catheter led out from under my blanket into a plastic bottle & pouch combination hanging from a hook just below the level of my bed. Its capacity about one litre. Some junior nurse would visit the pouch every hour, read off and record the output meticulously on a large chart paper that looked like a printed excel sheet to me. It probably was. Someone else in a green shirt who everyone referred to as ‘Mama’ would come round every few hours and empty the system once the readings had been recorded.
My right arm was swathed in gauze bandage from the wrist to about an inch above and beyond my elbow. The whole forearm was very tender and painful to the touch. I had to wait till the following morning to unravel the mystery of his bandage. A junior nurse came along around six next morning to change it. I saw then that the whole arm was bruised black and blue with thrombosis, and there was a very large and painful lump at its centre. Further gentle inquiries from successive nurses confirmed this bruised arm to be a collateral damage arising out of the desperate life saving efforts of that first night when the doctors were pushing one injection after another with the sole objective of getting the drugs into me as fast as possible, and they were none too gentle about it in their haste. The bruises were further explained by the huge quantity of blood thinners being pushed into me, which caused internal bleeding very easily. The bruises eventually took more than a month and a half to reach near normal status.
This, then, was my situation in a nutshell when I came to, properly, around nine thirty the next morning. I was still a bit groggy and light headed from the effects of all those injections, tablets, sedatives and the general anesthesia. But I had no feeling of any discomfort. The chest pains of the night before were already a thing of the past, as if it had never happened. I was very glad about that.
In fact, I was mentally feeling so fit and elated (some people might even call me cocky!) that I signaled to a doctor and said that I was feeling somewhat cramped and tired of lying around in the bed and please may I get up and take a walk around a bit? Or may be visit the loo? Or something?
To her immense credit, the young doctor didn’t lose her temper. She simply said “You have had an operation just a few hours ago and you are not permitted to sit up or get off the bed”. “And in any case you have got a catheter fitted, so you don’t really need to visit the toilet.”
That was the end of that conversation. Soon after, the sedatives kicked in once again, and I drifted back to sleep.
But there were also other, earlier, instances of my drifting in and out of consciousness through that first night before I came to my full senses the next day as mentioned above.
I remember waking up once, probably just before they wheeled me into the Cath Lab for the angiography – or maybe inside the Cath Lab itself, I have no idea – to find a man in a light blue collarless half sleeved shirt sitting on my bed and roughly shaving me down under with a dry razor – no water or soap. I was alarmed and I asked him what the hell he was up to.
“ You are going to have an operation” he replied reluctantly.
“But I came here with a heart problem”. I said, my patience highly stretched, “The last time I checked my heart was inside my chest and not down there”.
The guy just gave me a dirty look and went on with the scraping. I would normally have given him a good piece of my mind, and may be a kick also, but right then I was feeling too weak to resist or even to continue the conversation.
Just then a tallish man in a green cloth cap came up to the foot of my bed and asked me without preliminaries “What’s your body weight”? “Seventy three kilos” I replied automatically. I had weighed myself just a few days prior on my bathroom scale. “OK” he said and disappeared. I idly thought this was probably in order to determine the dosage of anesthesia.
I was in a complete daze from the effect of all kinds of drugs inside me and was kind of incurious and not really concerned about what all were going on around me. If they had said they were going to shoot me or hang me or something I would probably not have reacted. I closed my eyes and presumably passed out yet again.
Suddenly someone was calling out “CHATTERJEE”, “CHATTERJEE” “CHATTERJEE” very loudly from somewhere near the foot of my bed. I opened one eye reluctantly to find a portly guy of medium height in a tie and spectacles.
-“You have had an operation”, the man said. “Do you have any chest pain now”?
I opened both my eyes then.
-“No pain”. I replied. “What sort of operation?”
-“How many stents did you put”?
-“Thanks Doctor, What’s your name”?
-“Bhisey”, he said rather tersely, clearly offended that I had had the temerity to ask his name. But I am like that. Never was a respecter of protocols after heart attacks!!
Maybe he had expected me to be clairvoyant. Or maybe he was so famous that no one had asked him his name since his days in medical college. Maybe both. In any case, he made an about turn and marched off before I could utter another word. Quite obviously not in a chatty mood. Funny guy.
I closed my eyes and drifted off to dreamland once again..
*** *** *** *** ***
Routine in the ICU did not vary much for me. The day usually started around five in the morning, give or take fifteen minutes. A junior nurse would come to my bedside and say ”Baba, uthho or Uncle uthho”, as the case may be, and hand me a bowl and a toothbrush with some terrible tasting toothpaste. Anyone trying to brush teeth while still tied up in knots with tubes, electrodes, catheters, blood pressure cuffs, etcetra, etcetra, reclining at an angle of forty-five degrees in a bed with a ten inch diameter stainless steel bowl balanced on the chest would know the feeling. I usually finished in about ten to fifteen seconds, which I considered pretty long under the circumstances. (Not recommended unless attempted under adult supervision !)
Brushing would be followed in quick succession by someone taking my temperature, someone else manually measuring my blood pressure. Yet someone else would then turn up offering a few tablets and some liquid medicines. This would usually be followed by a few injections – one of them around the navel area (blood thinner, she explained)- and the others would be pushed directly into the plastic saline bottle hanging next to my bed and connected by a tube to the back of my right hand.
Soon after, the ‘Mama’ in his green shirt and a young junior nurse would turn up for some serious work on my body. They would first pull up the screen around me for privacy and remove my diaper, clean me up with special wipes, remove my clothes and give me a sponging with a hot and damp towel, literally manhandling me by turning me over every which way as if I was just a full sized doll and not a human being. I totally lost my sense of shame or embarrassment after the thorough mauling of the first day.
These people were real experts, I will grant as much. They avoided causing any hurt and were duly respectful at all times, asking me solicitously from time to time “Uncle aap thhik ho naa”? Sponging done, they would put a fresh set of brown and white striped hospital uniform on me and once again by some very dexterous handling of my body with all the connected tubes and bottles, electrodes, oxygen mask, catheter and everything else, manage to replace the bed-sheet from under me with a fresh one, change the draw-sheet for the blanket, change the pillow case and tuck me back in nicely, pull back the screen around my bed and move on to the next patient. After years of practice, they had the routine pat and the entire exercise was generally over in less than ten minutes flat, or less.
*** *** *** *** ***
A man from the canteen would arrive around seven o’clock with the tea, served in a stainless steel tumbler. It was very weak lukewarm liquid with just a hint of tea, lots of watery milk and a touch of sugar. I didn’t bother with it from the second day onwards.
Breakfast followed around eight or eight thirty. I was quite nice actually, though vegetarian, as per hospital policy. Sometimes it had Uppma or poha, some fruit and a glass of hot milk. At other times bread/butter/jam , fruit and milk. The butter was not really butter, of course, but it did its duty as a bread softener just the way butter was supposed to do.
I did not eat or drink much during my long stay at the hospital, due to a reason that had nothing to do with the state of my heart or the quality of hospital food.
Actually, I had had a complete set of new dental crowns fitted on the very morning of the night of my heart attack. They were only temporary and not very well fitted. There were some sharp edges and points inside my mouth that hurt and injured my tongue each time I tried to drink or eat anything. I was supposed to return to the dentist on the following day to get any inconveniences sorted out, but unfortunately had ended up in the Intensive Care instead, with all the inconveniences intact.
So, since eating or drinking was so very painful, I simply gave up trying altogether after the first day. As a result, I returned home six kilos lighter and looking like a model for jeans and such for senior citizens, figuratively speaking!
*** *** *** *** ***
The doctors would start their rounds around nine or thereabouts. There was no fixed time really. The junior doctors trickled in first in ones and twos, in half sleeved white coats worn over full sleeved shirts. The symbol stethoscope proudly hanging around their necks. They probed and prodded their assigned patients, sometimes asked questions and took notes. The examination mostly remained confined to checking of the blood pressure, even though it might have been checked an hour ago by the junior nurses. In some cases they also checked out the chest and the back. Generally, examination was over in a minute or two. Then came the resident doctor in charge , asking similar questions but not really physically touching anyone.
The big guns moved in an hour or so later. These were the senior doctors – the MD, MRCP, FRCS and other specialist types. They barely spoke to the patients except saying things like “How are you this morning”? “Good”? “Good. Good” in a patently false and hearty voice. They looked at the patient files and the charts, listened to reports from the junior doctors and scribbled in the files before moving on. I was really surprised to discover later how quick and intelligent they really had been – assessing a patient in less than a minute and unerringly prescribing a proper course of treatment or changing and improving an existing treatment plan without batting an eyelid.
But the real surprise came on my last day at the hospital when I received the bill in hand – for every visit, every touch, every feel and every pass by every doctor had been as meticulously recorded in the files as my hourly blood pressure, body temperature and urine output. And billed accordingly, based on my room classification.
That is when I almost had another heart attack !