The patient behind the curtain

As the junior most house surgeon at a Mumbai public hospital in the ’80s one almost sleepwalked through work. But even from that foggy memory some incidents come back in a flash, triggered by current events. This is one of them.

Sanjay Nagral
Oct 16, 2020, Mumbai Mirror

As the junior most house surgeon at a Mumbai public hospital in the ’80s one almost sleepwalked through work. But even from that foggy memory some incidents come back in a flash, triggered by current events. This is one of them.

One night a young woman was admitted to the female surgical ward with burns on her face. This ward was always crowded with many on the floor because for three male wards there was only one female ward. Burns patients were typically kept in a corner behind a curtain. “Many of them say ‘accidental’ but you must suspect ‘homicide’ or ‘suicide’. In any case they don’t survive but make detailed notes,” my senior told me.

This woman looked different. For one she was wearing makeup when brought in. She seemed from the North East and it was difficult for her to talk because of the facial swelling. Her burns were not extensive but very painful. The police arrived for a statement. I had to countersign that she was mentally coherent to do so. After spending few minutes with her, the cop said, “She is a sex worker. She was attacked by one of her clients. Better examine her in detail. They are often sexually assaulted.” My senior ordered an urgent gynaecology call. A junior gynae resident came in a few hours later, examined her and said, “There are injuries to her private parts but nothing major. We see his commonly with sex workers.” While the general surgery, gynaecology and plastic surgery clashed over who should be treating her, she lay in pain and fear. As the junior most person I would dutifully see her twice a day with a certain trepidation. She would mumble to me a bit about her parents in Assam. I was repeatedly warned by seniors: “You better make notes properly. This is a medicolegal case and will come up in courts.”

The cops promised to try and trace her family, but no one turned up. She soon became an object of curiosity. Nurses, ward boys and other patients would peek behind the curtain and talk in hushed tones. I remember someone saying, “See how her bright red lipstick still shows.” The cop would come in daily. Even the dean came one day because it seems journalists were making enquiries. For the first time I saw forensic doctors. They warned us to keep our records in order. She became quieter and quieter. I thought it was the painkillers.

A week later, I had a midnight knock in the resident quarters. A ward boy stood outside with a ‘call book’ on which was scribbled ‘Call over stat. Burn patient gasping’. I rushed to the ward. We didn’t even do a symbolic CPR that was common those days. She was declared dead. Needless to say, we ordered a post mortem and our surgical chief asked us to attend it.

Though my memory is a bit hazy on this, at the post-mortem her abdomen was full of pus. And she had a hole in her intestine as well as the uterus. We had completely missed a bowel injury likely due to a botched-up abortion. The next day the only reprimand was a glare from our chief. Of course, he had never examined her. The beds behind the curtain were the preserve of junior doctors like me. When I look back, I am horrified how we missed the injury. But now I think I know why.

The victim of the Hathras gangrape had a fracture of the cervical spine with damage to the spinal cord due to attempted strangulation. Cervical cord damage is a serious injury. As a surgeon some questions come to mind. How early was the spine injury picked up? Though not guaranteed to work, was surgical decompression of the spine considered as there were signs of cord compression? What was the medical reason for transfer from the Aligarh Hospital with a full-fledged neurosurgery department to Safdarjung in Delhi after 14 days, especially since transfers are hazardous with such injuries? What precautions were taken during the transfer to prevent further damage? And what exactly led to her sudden death?

This is a time of intense discourse around the power structures of class, caste and gender which are complicit in sexual violence in India. Also demands for exemplary punishment to the perpetrators, including reckless calls for public hanging. Victims of sexual violence die due to additional injuries, many of which are treatable. However, they often receive delayed and inadequate care. This is due to the ‘medicolegal’ focus which overwhelms basic, immediate care.

The Hathras victim was transferred to Delhi. Nirbhaya was flown in a private air ambulance to Singapore as she was dying. These are gestures under media and public pressure. The game is often lost in the first few hours when the victim is in a police station or van. Or languishing under threat or shame at home. As we demand justice to the shockingly high number of rape victims, we must also demand that they get urgent basic treatment. The police, media, politicians and optics can wait.