SHOCK AND AWE...

Surgery posting at a medical college in India is always an experience of shock and awe...

Shock at the things OPDs serve up to you, awe at how the patients respond....
Shock at the sheer neglect of their own bodies, awe at what the doctor still manages to do in such cases....
Shock at what gigantic proportions sheer denial can achieve,awe at how the doctor explains it to the patient without sounding accusatory...

A patient comes, along with her daughter.The daughter is welldressed,looks educated, seems sensible. You extend those qualifications to the mother as well. I mean, she is her mother afterall.
'Haanji, kya taqleef hai?' you hear the doctor say.
And the mother uncovers her left forearm. And you can just gawk. Shamelessly, unblinking. For you have never seen something this horrific before.
The skin of the entire left forearm is coming off in large thick flakes, like bits of the bark of a tree. The skin is dark brown, green in some areas, yellow in others,with islands of white separating the layers of flake.
You swallow. And ask the one question that has been hounding you. What you are internally agonizing about. 'Dard hota hai kya?' It seems so foolish...the skin is detached from all underlying tissue...you can see into her arm...there a million different type of infection there...

'Nahen ji, dard to nahen hai...'
And the answer is as pitiful as the arm in front of you. As you imagine what would have happened...

The mother, at home in the village, doing some work in the kitchen garden or the field....a slip of the hand...a gash on the arm...a slight cry of pain, mentally muffled by the attempt at foolish bravery, and to show that she is not weak...a brush at the wound, a cursory attempt to clean it, maybe not even that...ignoring the wound's existence, she carries on working...after all, she has a family to look after...

It doesn't take much for a wound to get infected...or for an infection to spread...

Unfortunately it takes way more than she can manage to come to the doctor...she covers up her wound all the time...maybe taking some superstition-defined concoction...but mostly, just ignoring it, telling herself its just a cut, will get ok...no pain, even if there was any she would ignore it till humanly (or rather womanly) possible...no need to leave the home for that...who will cook when she is gone? and anyway, who will take her to the hospital...No, why bother so many people, it will get ok 'by itself'...

And now, the doctor takes one look at it...looks at some investigation she had before being referred to the tertiary care providing institute you are standing in...'Necrotizing fasciitis hai, lets see kya karna hai...'

You remember the book you read the other day...you know possibly kya karna hai - all the infected tissue has to be removed....and that was going to be a huge amount...and if the visual state of the arm was anything to go by, she would probably lose her arm....

'Abhi tak kya kar rahe the?' asks the doctor, as he fills up her card with recommendations and advice. He is not laying blame - he knows it is nobody's fault. He understood that whole story the moment he saw the arm - and it is pointless to scold her now. She doesn't mind the question, she just smiles.
'Gaon me the, Doctor sa'ab'...she trails off. The doctor nods.

You look on in shock and awe. Shock at what you just saw. A dismal hopeless picture you would think. And awe at how it all ended. With a smile on the face, and hope still strong.

She would lose her arm...and all she would worry about would be who would cook for the family...