Anatomy of a murder

Kerala Health Minister Veena George pay tributes to Dr Vandana Das, who was stabbed to death by her patient, at AKG Hall in Thiruvananthapuram on Friday. (Sreeram DK)

What followed Kerala doctor Vandana Das’s death is textbook default responses. There was immediate horror and indignation. Also much high-pitched discussion and lament about poor security in hospitals. Some of it is an understandable fallout of doctors feeling insecure

Sanjay Nagral
May 22, 2023, Hindustan Times

Kottarakkara taluk hospital, Kollam, Kerala. Vandana Das, a 22-year-old intern is on duty in the casualty ward. Interns are lowermost in the doctor hierarchy. Sandeep, a crime suspect, is brought in by the police for examination of a leg wound. Vandana is alone at that moment as her colleagues are probably resting. She is about to dress his wound and hence has a trolley with a scissor. It is natural for the accompanying police to step away in such moments.

Kerala Health Minister Veena George pay tributes to Dr Vandana Das, who was stabbed to death by her patient, at AKG Hall in Thiruvananthapuram on Friday. (Sreeram DK)

Sandeep, a primary school teacher, had been nabbed by police after he dialled them after creating a ruckus in his neighbourhood that he felt there was a threat to his life. He was taken to the hospital for examination since he had an injured leg. There are conflicting reports about whether he was under the influence of alcohol. But his behaviour was abnormal. Maybe a troubled family or harassment at work. Who knows whether he was also mistreated in custody. But only a person with a disturbed state of mind picks up a scissor to stab another human being multiple times including in the chest without an obvious motive. Which is what he did to Vandana. For a scissor to puncture someone’s lung needs a certain ferociousness. Sandeep perhaps saw Vandana as a symbol of all he had against the world around him.

In a shockingly thoughtless act, no one thought of putting a tube in Vandana’s chest to let out air and blood. It’s an elementary principle of treating penetrating injuries of the chest. Instead they put her in an ambulance to transfer her to a private hospital in Thiruvananthapuram two hours away. She passed away by the time they reached. The post-mortem has confirmed a deep lung tear. Something not expected in a state like Kerala. This happened in spite of her being a doctor but also maybe because she was a doctor.

Like many others, Vandana had likely worked very hard though multiple gruelling exams for a future which is supposed to guarantee work, income and social mobility. The only child of her parents Mohandas a businessman and Vasanth Kumari a homemaker. A couple like thousands of ordinary parents in India who invest their life savings in their child’s medical education with the hope of a secure and bright future. For whom a child becoming a doctor is a matter of great pride. All this rudely interrupted.

What followed Vandana’s death is textbook default responses. There was immediate horror and indignation all around. Also much high-pitched discussion and lament about poor security in hospitals. Some of it is an understandable fallout of doctors feeling insecure. But a lot is knee-jerk groupthink without nuance, analysis and self-reflection. Veena George, Kerala’s health minister, initially made some comments about Vandana’s inexperience in dealing with the situation, later expressing regret. A bevy of leaders made their way to the parents’ home. The Indian Medical Association called for a strike. And demanded harsh laws for the perpetrators, security and ordinances. Doctors on social media and WhatsApp groups even issued the usual appeals to young students to avoid a medical career in India or migrate abroad. All to a script.

Healthcare inevitably reflects the tensions, violence and brutality in society all over the world. The US has seen gun violence inside hospitals. Hospitals have been bombed in conflict zones. Working in healthcare necessarily involves exposure to the mentally challenged, addicts and criminals. Undertrials sometimes look to doctors to protect them from abuse in custody. And are angry if they don’t.

The usual violence one witnesses in Indian hospitals is very different from the one Vandana faced. Angry patients and their families often notice obvious shortcomings in health care delivery. Mobs and political rabble rousers take advantage of this anger. And often it is junior doctors in casualties and wards who are seen as the face of the system and are targets of the ire.

An angry, provoked or deranged patient or family will not think of a law in the heat of the moment. Perhaps proper triage, privacy and security in high voltage areas like emergency rooms is a way out. The use of counsellors is another. But it is ludicrous to suggest that all doctor patient interactions take place with security personnel. Its like putting policemen every few feet on the road to avoid road rage violence.

Ordinary citizens may be perplexed and horrified by what’s going on. The elite are insulated from this in their gated private sector interactions. The poor are often busy with the exigencies of daily life to really pay much attention. They are familiar with the daily violence on streets and homes and workplaces around. They perceive hospitals as secure places. And are increasingly trying to seek healthcare in what is perceived as more polite and efficient private hospitals often at great personal expense. In any case, they have no choice but to continue to seek whatever healthcare they get wherever.

Vandana and her family deserved better. Both protection and prompt treatment which no ordinance can change. If there is way to collectively apologise to them, we should. But if I daresay even an analysis of what made Sandeep do what he did will help prevent further attacks rather than just indignation, outrage and sterile ordinances. As healthcare workers we should know that even Sandeep needs help.