Witnessing a trauma patient in a rural hospital

A student’s first-hand account of the treatment of a car accident victim in India

This is the second part of a continuing series of Taran’s Health&Ed essays.

In my third week shadowing doctors at the KV Hospital, a small medical facility in rural India, I witness my first trauma patient. I am standing in the operating room, having just finished observing a series of minor procedures, when an alarm begins to ring. Simultaneously, a large red light begins to flash in the emergency bay, signifying the arrival of an ambulance. A quarter of a minute later, the doors of the adjacent emergency room are thrown open by a pair of nurses, and a patient is wheeled in on a stretcher. Both nurses are shouting. “Get Doctor S!” cries one of them. “Page Doctor M!” cries the other. But there is no need: the two doctors are already standing at the doorway, having hurried over as soon as they heard the alarm.

“Give me the details,” orders Doctor S. The nurse on his right immediately fills him in: “Male, age twenty-two, victim of a violent car accident.” At these words, I shift my attention to the patient, who is mumbling incoherently and turning left and right on the stretcher, as if bothered by an itch in his back.
“He was brought over by an ambulance from the GH Hospital,” continues the nurse. “He suffered his accident three days ago. At GH, his shattered leg was bandaged, and he was given morphine for his pain.”

This information causes Doctor M. to colour up. “And why didn’t he receive more extensive treatment?” he asks, visibly angry.
“The doctors there didn’t have a bed for him,” replies the nurse.

Later, I learned that the young man – I’ll call him Prakash – had spent three days in a hallway of the GH Hospital. He had sustained multiple fractures in his left leg, and required medical attention immediately. However, overcrowding had forced him and several other desperate patients into a makeshift ward – which was nothing more than an empty hallway on an upper floor – where they lay waiting to receive care. Some patients were nursing open wounds, others were coughing into old rags, and still others were bleeding into bandages fashioned out of torn linens. Prakash had been administered morphine six hours after his accident. His left leg, which was entirely shattered in the accident, had been bandaged eight hours later. And then he had been instructed to wait – for what? For whom? For more painkillers? For a nurse? A doctor? He wasn’t told.

And, now, he lies on a stretcher two feet away from me. His eyes dart from person to person in a distracted sort of way, and his movements seem involuntary – it is as if that itch in his back has finally crossed over the threshold of pain. His breathing is irregular, stopping abruptly, then picking up again. “Connect him to an IV,” orders Doctor M, turning to a nurse. “Put him on oxygen. Hook him up to a cardiac monitor.”
But I barely register Doctor M.’s instructions; my attention is fixed on Prakash, who is now clawing at the oxygen mask placed over his mouth. The nurse tightens the mask’s straps to keep it in place, but Prakash succeeds in prying it off. Suddenly he is thrashing in his bed like a fish plucked out of water, screaming and flailing his three good limbs. His upper body lurches up, and falls back down with a thump, which prompts a nurse to rush forward to subdue him.

“Give him an injection of sedative. And for God’s sake, why isn’t he connected to a catheter? Can’t you people do anything without being told?” cries Doctor S. exasperatedly.

A nurse hurries out to grab a syringe of sedative, while another pulls down the patient’s trousers to connect the catheter, a clear bag with tubing used to collect a patient’s urine. She lubricates one end of the tubing and attempts to pass it through Prakash’s urethra, but at that moment he lets out another scream, and she is forced to quickly withdraw the tubing. “Try again,” orders Doctor S. She attempts the procedure a second time, but Prakash screams louder.

Suddenly, he begins to convulse. His whole body is vibrating. His three good limbs are flopping at his sides. He makes no sound; his suffering is restricted to the flopping of limbs and the twitching of neck muscles.

“Where’s the sedative?” shouts Doctor S. “Didn’t I order it a minute ago?” A nurse quickly brings over a syringe filled with clear liquid and administers it through a vein in Prakash’s arm. “Good,” says Doctor S. “He’ll quiet down soon.” The two doctors move closer to the patient, obscuring my view of him. I move around for a better look. I am now standing over Prakash’s right shoulder, staring directly into his eyes. The oxygen mask is still secured over his mouth – I can hear the air rushing through it over the hum and whir of machines and the movements of the two doctors. Prakash’s neck is still twitching, and his eyes are still swiveling in their sockets. We make eye contact several times, but he barely registers my presence; I am merely another person privy to his anguish – perhaps a nurse, perhaps a doctor, perhaps one of those cleaning boys who wipe blood and antiseptic off the emergency room floors.

Prakash’s movements have slowed. His eyes no longer dart restlessly from person to person. His limbs no longer flop at his sides. A nurse loosens the straps of the oxygen mask, and Prakash doesn’t protest. He has resigned himself to the people around him. For the next two minutes his condition remains stable. Then he starts to twitch again. He begins to claw at the oxygen mask on his face, attempting to remove it. Failing twice, he gives up. He begins to shudder, and his eyes begin to quiver. The doctors are muttering to themselves, but I can’t make out what they’re saying.

Suddenly, in one clean motion, Prakash swipes the oxygen mask off his face. He turns over to his right side, and vomits over the floor. A jet of vomit hits my feet before I am able to avoid it. Then Prakash turns over on his back. He looks straight into my eyes, as if to apologize, holding my gaze as steadily as his condition will allow. His eyes flicker and close. He passes out of consciousness.

Hands are pulling me away – hands of nurses, of doctors. I am barely conscious of them; how can I be? I have just witnessed a patient’s agony play out in front of me, a task that no amount of self-preparation could have rendered any easier. To see a casualty first-hand – to be drawn in by the sight of his mangled limb, and by the sounds of his pain – is not an incident that can be easily shrugged off. And what makes it all the more difficult is that you can only stand and watch, unable to do anything but look on in stunned silence.