Emergency Room

Ali, a third year medical student, completely unaware of his own
ignorance or innocence, whatever you want to call it, stepped out of
his beat up Suzuki and clicked the door shut gingerly.( He didn't want
to give the thing any more grief.) He checked to see that his brand new
stethoscope was in place around his neck and that his pocket Oxford's
Handbook of Medicine where it belonged. Satisfied he strode happily
whistling towards the swinging doors of the Emergency department.

7:00 pm on a miserably hot day that had grudgingly fizzled out from the
baking agony of morning, to a relatively comfortable evening. Ali had
just started third year classes and had been assigned evening duty in
the Emergency department of the dilapidated government hospital
affiliated with his Medical School. This of course made him very happy,
which just goes to show his inexperience. He had a rather cute idea of
himself wading through blood and pain to save someone's life and earn
their undying gratitude. Give him a year and he will be ready to jump
off a bridge at the mention of the word Emergency. A year more and he
will efficiently and emotionlessly break into a run????.towards the
site of action that is, not away from it.

Ali was not a particularly brilliant student. He was not stupid either.
He was just one of those nice, young, unobnoxious people who prefer to
sail through their education without being concerned about grades and
geniuses. He was however extremely proud of the fact that he had landed
himself a place in medical school.

Ten minutes later he found himself in a tiny room with dingy, grey,
peeling walls. This was a nondescript room in the Emergency department,
devoted to the use of medical students and new internees, where they
could deal with the less serious cases such as stitching up cuts and
listening to hypochondriacs. There was something different about the
room today though. There was a sense of panic. The room was full of
people. There were five medical students, two girls and three boys all
in the same stage of inexperience as him. There was one worn out
internee with baggy eyes who snapped at the boys and smiled, or
attempted to do so, at the girls. There was an old woman clad in
brownish grey with a once white, now yellow shawl over her head and
round her shoulders. She held a corner of this over her mouth, her face
blank and emotionless, as she watched the activity. In the middle of
the room was a hard metal table (the kinds that hospitals are
abundantly supplied with) and on the table was the patient, a burn
victim.

Now this would have been o.k., if the patient was someone who had
spilled something hot on a leg, or stuck a finger in a pan of boiling
water. However Ali saw that this patient was far beyond the league of
the nondescript emergency room. A young woman lay on the table
completely undressed. Her skin was black, brown and in places where it
had been burned completely, a horrible, leathery white. Her bladder had
been catheterized and the baggy eyed internee was attempting to place
an intravenous line and finding it extremely difficult. Ali felt very
uncomfortable. He was not used to seeing naked, unconscious females
laid out on tables, especially females that had third degree burns over
their neck, chest, abdomen and legs. He sidled up to another student
and asked for a brief history. The girl looked at him wearily and
declined to answer satisfactorily just saying that the patient was a 22
year old previously healthy woman who had been in a kitchen accident.
She then slapped him in the chest with a pair of gloves and demanded he
make himself useful, she had spent 3 hours in here (though this patient
had come in 15 minutes ago) and was now leaving.

Ali slowly pulled the gloves on thinking he'd ask the internee how he
could help and trying to recall the burned body surface area formula
he'd been taught. What was it, 9\% for the head, 18 for the front of
the chest and abdomen? All he could register was that the woman on the
table was the same age as him and she had golden loops in her ears. Her
chest was moving faster and faster with each breath she took and Ali
was just thinking someone should get an oxygen cylinder when it
stopped. The students stood aghast for a second. Then the internee
punched a boy in the shoulder and ordered him to go get the medical
officer.

Seconds later the Medical Officer an obviously experienced man in a
black leather jacket elbowed his way in. He went up to the table and
borrowing a torch off the baggy eyed, babbling internee, shone it in
the still woman's eyes. He then pulled the stethoscope from his neck,
bunged its ear plugs in the sides of his head and listened to her
chest. Then he dragged the sheet at her feet over her head and shook
his head grimly.

Ali watched frozen for a second as the brownish grey woman in the
corner let the corner of her shawl drop and reveal her expressionless
mouth. The internee put his hand on her arm and offered to lead her
out. Ali turned around and bumbled out of the room in shock.

Hours later he sat in his room replaying the day's events. In his mind
he accompanied the woman into the emergency department, fixed an oxygen
mask to her mouth, slipped a cannula in her wrist, set up an
intravenous line and catheterized her bladder. He then went in search
of the medical officer and asked for his help. However that was not how
it had happened and he couldn't figure out why. He got his answer of
course the next day from the surly internee. When a burn victim with
third degree burns over 70\% of her body comes into a dilapidated,
overflowing, government hospital's Emergency department the staff knows
what to do. Look for someone else to treat. Someone who has a chance.
And there was no available oxygen cylinder.

Ali recognized at last the danger of studying medicine from books
written by people who worked in well equipped, efficient hospitals. He
felt as if every last bit of naivety had been peeled off him and
replaced with a shell of frustration. A feeling he would later come to
realize as false due to the very fact that it would be recurrent.
He had a long way to go and this was just the beginning.