I work in India. I work in rural healthcare. Like 60 km out of the nearest large city and 40 Km from a small town.

Every Tuesday and once every 6 weeks on a Sunday I have “the long shift”. It starts at 8 AM and ends at 8 PM the next day. During this time we have to man the Outpatient and the casualty.

Most of my work is fevers, coughs and headaches. India though has the maddest things out there. From the “hilarious” to the “absolutely tragic”.

We are understaffed and overworked and really underprivileged. People don’t quite believe me when I tell them that sometimes we run out of electricity… Note, it’s a tropical country without air conditioning. Work is in an oven…

So these are my “hard” stories.

A child came in. Unconscious and not breathing. We start CPR as we connect up the leads for the ECG machine. At this point the power cuts out. It’s pitch dark. We read the ECG… non shockable. We try everything but the child is declared dead. 14 years old… the mother says he was studying for an exam and she found him unconscious by his table. We send away for an autopsy (as we had no idea what just happened). Turns out the wiring in his house was faulty. We found out when his sister died the same way. She used the table, and as it was hot turned on the AC which was touching the metal table that she was working on. He was electrocuted. This happened 3 days after he died and was cremated (Indians tend to not wait around). “I do my dressing every day”. “Oh?” I said as I stared at the yellowing bandage. My heart sank, the smell was intolerable. Could I fob the dressing off on someone else? My aid comes in the form of another new house officer. But he returns 5 minutes later. He’s faint and hyperventilating. There is no other option. It’s me. I drew the short straw. The sterile dressing room is permeated with the odour of rotten meat. This was the first case of myasis I have seen. Maggot infested foot. The odour is intolerable. I can feel my eyes water, lucky I hadn’t had breakfast. I clean and scrub and debride. A toe has to be removed which is fine since it’s nearly falling off anyways. I scrub and clean till the maggots are dead and pink tissue is seen. Nearly half his foot has just been eaten away. We admit him. From then on, it’s just me doing his foot. This man has no one in the world. Not one person came to see him. It came in a bottle of coke. This dark liquid. It looked like flat coke. But it wasn’t. It was carbolic acid. Indians have a bad habit of voiding child proof caps on bottles of bleach and storing them in soft drink bottles. The child died in pain. After all, what do you expect if you leave a coke coloured liquid in a coke coloured bottle around a 4 year old. Another coke bottle. Another dark liquid. I had a sniff, the heady mix of eucalyptus oil permeates the air. The parents are angry at my suggestion. How dare I insult their doctor. Surely a mere house surgeon doesn’t know as much as this doctor. We try to save the child but it’s of no use. Now we are blamed for the death of the child. How do you explain to people that eucalyptus oil is a poison? And how do you explain to them that no real doctor gives out medicines in old coke bottles. There were so many things in that bottle that we still don’t know what killed that child. The “doctor” is still practising. I go to work on shitty bicycle. He drives a BMW. He’s a doctor of “traditional medicine”. “We were waiting for you”. My auto ride back to my little room in the village is cut short. He stops in front of a house. A man is lying on the floor. It’s dark. 8PM in a village with little no light. I see burns on his arms and legs. Suicide attempt, well success. Indians love a dramatic suicide. It’s our culture. See you slighted me so much that I shall dramatically kill myself so you feel guilty. That will teach you! This 17 year old lad set himself on fire using kerosene. They then left him on the floor. They didn’t know what to do. No one would touch him. In the end I picked him up and carried him to the hospital I worked in the autorickshaw. He had over 90% burns. The prognosis was grim. We had to cut to femoral veins to get access. He is in profuse shock. We explain to the family what happened. We are blamed again. He was fine and lucid on the street. Our IV fluids are killing him. We do CPR at the parent’s request but there is nothing left. He’s a dead man. We don’t have the technology to save a 95% burn even if he wasn’t left to lie on the road. All I provided was a less painful death. The auto driver refuses to take me home. Now half a street blames me for killing their kid, not the fact he was set on fire. I walk the 6 Km home. It’s the day my long shift ended. It’s been 40 hours since I had any sleep. It took me an hour and a half to walk home. They took the body to a larger hospital demanding an autopsy. They apologised a month later in drips and drabs. The autopsy stated that he had 4th degree burns. Death was inevitable. “I am a demon” she said “look, I cannot be killed even by electricity”. She shows me her thumb with pride. It’s black. Charred and bone is sticking out. I drew the short straw. I showed up first, I got stuck with the patient. Everyone else in the labour ward (I was on Obs/Gynae rotation) was running around with other cases but this one was mine. Post Partum Psychosis. Her altered state created by the belief that mental illness was a product of demons rather than something that occurs. She had been brought in for a well baby check up, left the baby with the nurse and promptly tried to kill herself by putting her finger in the light socket. We kept her for one night. We kept her medicated. Her family took her away the next day. They took her to see an exorcist (no seriously). A week later we see her again. This time she’s in our morgue. The baby is dead too.

I figure these are some pretty shitty stories. It’s not all gloom and doom here. So I give you the silliest story ever.

A panicking mother brings her child in. She says the boy was bitten by a snake. The child is crying refusing any injections. We ask if she knew what snake it was. She says her husband’s outside with the snake if we wanted to go have a look. So we figured we may as well know. This is the correct procedure after all… Turns out the father didn’t kill the snake. He just grabbed a jute sack and nudged it inside. So we figure that we should have a look. We kill the snake by beating the bag with a heavy stick pretty hard. Like the security guard was really going at it with a stick. We then open the bag and throw out this long black bloodied dead sn… wait a minute… this is a bicycle inner tube.

Turns out the child wasn’t bitten. Late at night he was running about and tripped and fell over a bicycle inner tube. The parents saw a black shape in the dark and thought it was a snake…

Cue lots of patients staring at two doctors and a security guard kicking the almighty crap out of a sack and dumping out a bicycle inner tube and staring at it before exploding into laughter…