The Healing
His eyes suddenly fluttered open. It was the incessant ring of the telephone on his beside table that brought him awake. He picked up the phone and listened. “O.K. I’ll be there in a few moments,” he said. He waited fro a while for his heartbeat to settle down: sudden ring of the doorbell or the telephone always gave him wild palpitations. Then he swung his legs off the bed. He looked at his watch. It was already past 11 p.m. Quickly he pulled on his white coat, put his stethoscope in his pocket and set off for the hospital ward with an electric flashlight. The patient, a stout and a rather short man with long black hair plastered to his forehead, lay comatose in bed. The nurse had a bottle of intravenous fluid hooked up already.
With practiced thoroughness and speed the medical officer assessed the patient. He listened to the brief narration of the events preceding the illness that brought the patient to the hospital.
“He was alright till yesterday, but from this morning he said that he was feeling sick,” reported his anxious wife. “Then about three hours ago,” she continued, “he complained of headache, he vomited several times and said that he had a pain in the stomach. Then we noticed that he was getting very sleepy. He started to talk as if he was confused or as if he was out of his mind sometimes.”
“Is he taking any medicines?”
“I don’t know what it is, but he takes some tablets regularly,” reported the wife. “I think he said that it was for some sugar problem.” Immediately he knew what he had to look for. Yes, the unmistakable signs: soft and sunken eyes, unconsciousness with deep and labored breathing, rapid and barely palpable pulse and falling blood pressure. And that unmistakable fruity odor!
“Diabetic ketoacidosis,” he murmured more to convince himself than anyone else. He completed his examinations, checked the bottle of fluid attached to the patient’s left arm and adjusted the volume of the drip. Then he retired to the duty room to fill in the case sheet. While he was half way through writing his notes, the nurse on duty came to inform him that he was wanted on the phone.
“Hello.”
“Doctor, how is the patient?” For a few seconds he was taken aback. He wasn’t sure who was calling. It isn’t normal Bhutanese habit to introduce oneself on the phone. Then it hit him: of course he knew the voice.
“Sir, which one are you referring to,” he blurred out as he almost got out of the chair in deference to the voice on the phone. Although the voice was far away, he could almost imagine the warm breath on his ear.
“O, I received a call just now that he has been admitted a few minutes ago. I would like to know what his condition is.”
“O! O, that patient. Yes, yes. Sir, I think he will be okay; he has diabetic ketoacidosis and I’m just writing out the instructions for the treatment.”
“Doctor, please do everything possible. We can’t have him die there, can we?” The calm and distant voice had a sinister ring. The concern was genuine; the threat unmistakable. The voice then went on to explain who that patient was.
“Yes Sir. I’ll do my best, Sir,” he replied mechanically.
“Doctor, please keep me informed, will you?”
“Sir. Yes sir. Of course I’ll do that sir.”
He decided that it was not going to be sufficient to leave the treatment to the nurses; he will have to stay in the ward to ensure that nothing went wrong. The hospital had neither the facility for measuring blood sodium and potassium nor a machine for blood gas analysis. They had only dipsticks to estimate blood sugar. He knew that he had only his clinical knowledge and experience to rely on. But he was determined to fight it out.
He started oxygen, readjusted the flow rate of the drip, and sat besides the patient. From time to time he measured the blood pressure and pulse rate, palpated the patient’s abdomen and searched for signs of deterioration or improvement. All necessary medications were already initiated. As he sat on his lonely vigil besides this patient, the doctor stole occasional catnaps. By the break of the dawn, he had a stiff neck from the back of the wooden chair on which he stole precious moments of sleep. After stretching himself, he mad a hurried check: no change in the condition.
A quick shower and a hurried breakfast. He was back in the ward. His colleague was on leave, so he was all by himself to run the hospital. But that was normal. It happened quite regularly given the acute shortage of doctors in hospital in general.
The day wore on without anything dramatic. Somehow he felt confident that the patient would come through. After completing his morning rounds, he went to the outpatient’s department to dispose off the daily visitors.
After a quick lunch, he resumed his vigil besides the bed again. He wanted to be sure that nothing was left to chance. Towards evening, one of the relatives wanted the doctor’s permission.
“What for?” he asked.
“We want to go and consult a Lama.”
“O.K. No problem. Go ahead.”
Just as dusk enveloped the hospital in its silent darkness, two miles away from the hospital, in a small traditional house, an elderly lama was preparing for his dinner. He was almost bald, a few graying unkempt strands on the sides of his head made him look as if he had just risen from bed. His corpulent form lay reclined on a pile of pillows behind him, his thick legs, half curled beneath him in the traditional manner. On his right was a small choktse, a low wooden stand, on which a large enameled mug stood, half filled with ara heated with butter and eggs. The strong and hot local brew had already suffused his face with a florid turgidity. And he breathed noisily as he sucked air hungrily into his rotund chest. And on his left, on another choktse, were a pile of religious book, a small brass bell, and a brass container with white rice and two incense sticks stuck in the rice. From the incense sticks slow, curling scented trails of thin smoke rose lazily towards a smoke blackened wooden ceiling. A woman in her late thirties entered. She did not look at him, but silently arranged the pillows behind him and moved the choktse from his right to the center. He took a long, slow drag at the contents of the mug. He sighed contently.
“Dinner is ready if you would like to eat,” she informed him softly.
He surveyed his wife with languid eyes. There was no smile, but a distant longing in his misty gaze as he looked at her standing in front of him. He did not speak. He nodded almost imperceptibly and she moved out of the room like a shadow.
After what seemed like an hour, he had consumed an entire plate of red rice, two slices of pork fat, a bowl of eggs scrambled in fresh butter, and his favorite curry of blanched chilies laced with thick cheese. As she was clearing the plates, he instructed her that when they have eaten, she was to bring some rice, curry and two pieces of meat. She looked at him inquiringly.
“There is a patient in the hospital who is very sick. Some evil and hungry spirits possess him. I must make an offering to appease them.”
When the rice, curry and the two pieces of meat were spread in front of him, he separated the rice into two equal halves on the same plate, like two ridges facing each other. Then he placed one piece each of meat on the portions of rice. He put a little of the chili curry besides the pieces of meat and then sprinkled holy water over them. A glass of water was also put besides the plate. He also asked for some glowing coals, on which he put incense powder. As the smoke from the incense rose, he took some rice from the brass bowl and as he muttered his prayers, he threw the rice over the plate of offerings repeatedly. He performed a rapid ritual of clapping, folding and unfolding of his hands, intermittently broken by the ringing of his drilbu, a small resonant religious bell. Then he sprinkled the offering with ara, threw some more of the rice from the brass bowl. Finally, he asked the offering to be scattered to the winds and the darkness.
At the same time, in the hospital, the patient was thrashing about restlessly. He was muttering incoherently. The doctor checked again, anxiety written all over his face. All vitals normal. Ensuring adequate hydration was simple, but he was worried that without the means to measure, the administration of potassium was risky. But he had to take the risk, because without it, the patient would certainly die. He redoubled his efforts: checked the treatment chart to ensure that the fluid input was compatible with the state of hydration and the urine output. He made sure that the dose of insulin injection and its timing was right. It did not matter to him if he had to spend another night in the ward, sitting besides this patient. He was determined to win this battle.
A little after 5am the next morning the patient regained consciousness. From then on, the progress was rapid. By noon, the patient was able to take thin rice gruel; in fact, he took almost three cups of it. All the tiredness and worry in his body disappeared, and the doctor walked around the ward with a playful buoyancy of spirit.
The following morning the patient was sitting up in bed, much better now. The doctor gave a thorough check and declared him out of danger.
“Do you think, doctor, that this will happen again.”
“Well, it depends on you entirely. Yes, if you discontinue with your drugs and you don’t control your diet, same thing can happen again.”
“Yeah. I must be more careful from now onwards.”
“That’s right. If you do that I don’t think that there is any danger,” advised the doctor as he stood at the bedside, with his left hand resting on the head of the patient’s bed.
“Cheche, can you please give me my bag,” said the patient, turning to his wife who till now was sitting besides the bed very quietly. She pulled a small black leather bag from the drawer beside the bed. He rummaged through it.
“What are you looking for?” she asked. In response he pulled out a packet of brand new hundred ngultrum bank notes.
“After this I feel that I must make a small offering in gratitude,” he said, looking at the doctor meaningfully.
The doctor straightened. It wasn’t common in hospitals in Bhutan for patients to make such offerings to their treating doctors. Health services are free; all cost born by the government. The patients normally pay nothing. In fact, it was understood that the doctors were meant to work as they are paid by the government to do just that. Of course, when he was in some of the remote health facilities, the rural folks came with eggs, sometimes with balls of fresh cottage cheese or even vegetables. He never demanded such things, but he accepted them as it seemed to please them. Looking at the bundle of notes, his heart raced a little. “Ten thousand ngultrums – more than a month’s pay,” he thought.
The patient held the bundle of notes over this forehead. His eyes were closed as his lips moved in silent prayer. He spent quite a while praying. Then he turned to his wife and said, “Cheche, I’d like you to go and make this humble offering to the lama. Without his blessings, I don’t think that I would have made it this time. Please tell him that this is a small token of my gratitude for saving my life.” Then he turned to the doctor, but the doctor was already busy examining, with his stethoscope, the chest of the patient on the adjacent bed.
The patient on that bed was a little surprised at the sudden attention that he received. His chest was fine. He was waiting only for his leprous ulcer of the foot to heal.
By: Dr. Pem Namgyal