Sonali had a focal seizure Saturday morning while I was coming back from taking the children to school. The massis called me and all I could understand was that something was wrong with Sonali. I ran as much as I could, cursing that I didn't get to the gym more often…. and arrived to find her having a right sided convulsion, limp except for the twitching and jerking of the right side of her face, arms and legs. I threw her favorite soft blanket around her and Seema (our Governing Body secretary who walks the girls to school with me in the morning) and I headed out to find a cab. I called Bijoy to come early, but he lives too far away to come instantly. Out on the street there were no cabs, as drivers were probably sleeping off the Puja celebrations of the night before. Then Seema went to find the ambulance, but she took my bag with my wallet. So there I was standing in the midst of Panchabatatala holding a convulsing baby and realizing I no longer knew where Seema was, or when she would come back. I also realized I had no money as it was all with her. I was really afraid — with both the mother me and the doctor me scared Sonali would stop breathing.
The ambulance came — Seema having roused the guys from festival celebration the night before and we rushed off to the hospital. I called ahead to the pediatrician who took care of Rani there. By the time we got to the hospital the seizure was subsiding. We decided to admit her to the PICU and put her on iv's as we didn't know what was going on. Sonali is about three. I have old records showing brain ischemia and asymmetry. She has an odd shaped head, not noticeable with her full head of curls.
The hospital is one of Kolkata's better known places, a private hospital. It cost Rs. 25,000 to admit her, about $500, which will sound like nothing to those living on a dollar or euro economy, but is a great deal of money for someone living on rupee economy. Once in the PICU (Pediatric Intensive Care Unit) the team came to start an IV. That's when I stopped them from re-using a bloody needle and catheter from previous four failed attempts at getting a line into a vein. In this hospital, and according to the doctors this is true throughout Kolkata, needles are re-used in this way. I was shocked, really. I can't imagine being in an intensive care environment for sick children and finding dirty needles being used!
We got through that, but then later a nurse came to put something into the iv. The syringe said Augmentin, but she was pushing fluid in and out. I asked what she was doing, and first she said medicine, then changed it to "saline". The bottom line is that they reuse syringes too. In this process the nurse also let the IV line hang so the open end was touching the bed and I told her this was no longer sterile.
A young doctor I'd met before on Rani's admissions explained that the staff reuses needles and syringes to save money for patients because the patients are poor, and they are charged for needles and syringes and bed pads, etc.
There was also the matter of the toilets and the lack of soap. I saw this on the last admission a few months ago and talked with him about it. He tried to institute change but it didn't last. Actually there is no soap in any of the toilets in the hospital (as I'm told) because it isn't the custom.
I had met the Director of Operations by chance when I was arranging for the C-T scan and called her, thinking she would be aghast at what I'd found (don't laugh too hard at me). She was defensive and said the hospital was wonderful, hadn't I read in the newspapers? Now I clearly had lost my cool and said I didn't care what the papers said, but I'm sure they would love to know about the re-use of needles.
I went back to Sonali's bed and tried to be calm. Another senior doctor there said it's this way everywhere. She said, "we go abroad to train and then come back to these standards." I heard again about how India is a poor country. It's not a poor country but it is a country of poor people. I talked of transferring Sonali but I no longer knew where to go. I wanted to take her in my arms and flee, take her to safety, but there was no place to go. Then I decided I'd stay the night and work as "massi" since visitors weren't allowed but massis were.
There was one scene in the elevator because the guard tried to take me out of the elevator because my card (given to me by emergency room) said Day/Night Visitor but he said that was only for the lobby. I said my baby was upstairs and I wasn't leaving and all the other people started yelling at me and I yelled back that I was sick of this place as they used dirty needles and syringes. I asked if they knew that! One man, particularly nasty said, "well, anyone can make a mistake!" My readers have to understand that when doctors "make a mistake" in West Bengal they are likely to be beaten up by the patient's family.
I had called Seema earlier to come and help me decide where we could move Sonali if we had to, so she was in the vicinity, thinking all was well since I had gone back up to see Sonali. I called her and said I was in the corner of the elevator refusing to leave. The hospital had also started posting men in black uniforms and black turbans, looking like bar bouncers or the body guards of gangsters, and I wasn't going to be bounced. Seema came and pushed herself onto the elevator and did a lot of just patting people and telling them to take us up to the PICU — did the, "she's a doctor from America and she is upset about the dirty needles."
I decided then that I had to stay the night with Sonali and play the massi role. The PICU had said they had to have someone with her as they couldn't manage her, so I became the one, to their dismay. I came back to Shishur Sevay to say hi to the kids and tell them Sonali was doing well, and to have something to eat as I hadn't eaten all day. The girls packed a bag for me… picked out a sari, blouse, made sure I had comb, tooth brush… towel and I went back. But I told Ganga I'd be out for the night taking care of Sonali. I have to tell her or she gets very upset. Meanwhile Bornali was already upset that Sonali wasn't there. She keeps track.
The part that was nice was spending the night with Sonali as I don't usually spend a lot of time with her alone. To everyone's shock I was able to feed her, change her diapers, etc. I sang songs to her, stretched out next to her — they allowed that. The doctor came late at night so we had a chance to talk for a while. Like everyone else, she just says that's how it is here. But we also talked about soap and I suggested dispensers since bars walk away. That part was surreal, talking about dispensers….
In the evening the nurse brought me a blue gown to put over my sari. I asked why and she said because i'd be sleeping there and in contact with the baby. This is true and good, but I asked why only in night. Actually I'd never seen a blue gown on anyone! She said in the day the massi didn't have contact with the baby so she didn't need a gown. This is nuts! In the day the massi carried Sonali, fed her, sat on bed with her. I wore the gown and insisted the massi wear one when she came in the morning. I asked about the child in the other bed and the nurse said the mother didn't touch the child so she didn't need a gown.
This hospital has a School of Nursing. These nurses and students are from their School of Nursing. They were working as they had been taught. I was clear these were lapses in teaching, not intent of any of the staff there.
In the morning Sonali was clearly ready to go home. The nurse asked if she should give her a bed bath and I said fine. Then she asked me for the soap and powder to bathe her but of course I didn't know I had to bring it. After the plain water bath i went to change my sari, brush my teeth, etc. The bathroom and toilets were flooded but there was a small container of soap! I had to take the top off the toilet and fill it with water from a mug so it would flush. But at least I could wash my hands.
I drew the curtains around Sonali's bed and put on my sari…. engaging in what I call the Zen of Sari. It means you have to relax in order not to get into a battle with six yards of material that wants to go on it's own, not where I want to fold it. But, once done, my sari was much admired.
I told the staff that my arguments were with the administration, with the head of their nursing school, in the hospital…. and that these were policy issues, re-use of needles, soap for toilets… The junior doctors I talked to were upset that they are constantly compromising their standards. They want to leave India because they can't stand what is happening to them, the lowering of their standards.
I have a thing about handwashing, which is to say it's big in my head. I still see images, drawings, of women dying of puerperal fever and Semmelweiss ridiculed for wanting to disinfect the hands of doctors. I love building toilets. In one orphanage here in Kolkata I put in a septic chamber and toilets for girls in the dormitory rooms. I've built a few toilets in villages. At heart maybe I'm a "barefoot doctor." My idols were Albert Schweitzer and Tom Dooley.
Soap is so simple. It's so cheap.
By noon Sunday we were ready to go home, and I made my way through the bill department and the pharmacy. Seema called to see if I needed help and I said I thought I could get through the process without making a scene. Actually, when I was standing in line at billing a huge fight broke out with men screaming at each other! I waited…. I'm fine waiting.
Bijoy had brought a massi in case Sonali was staying, and I wanted to leave for a bit. Instead we were packing to leave. We were at Sonali's bedside and I so much wanted to carry her. I didn't want to always be "white lady carrying bags." But this young woman really wanted to be the one carrying her out so I let her take Sonali and I followed with all the "stuff."
Sonali got a huge reception at home, with girls arguing over who would hold hold her and feed her. She seemed happy with the attention. Bornali laughed; Ganga just looked relieved to see me and didn't want me to put her down. Rani seemed fine when I was away, but seeing me got her started… crying, screaming… hitting her head. So I spent time with her, immitating her sounds, clapping my hand in rhythm to her clapping. This went on. She was happy and calm.
…Which reminds me, Kasturi, a close friend of mine and of Shishur Sevay has posted pictures and a note and poem about Rani. http://ashajournal.blogspot.com/2008/10/i-met-rani-in-june.html It is really beautiful. My dream is for my children to have voice, to not be orphans to the world. Kasturi has given Rani voice, even as Rani works so hard to create her own voice of communication. This is what they all work on. Voice is connection. We all search for connections. Our connections are part of how we know ourselves, how we build sense of self, identity, and dignity. Washing and grooming are part of who we are, what and who we carry with us….
Sonali and her massi in Bed I of PICU. (Blue gown per my instructions)
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