Middle of the night scenes at Sion Hospital

Posted: September 12, 2004 in Uncategorized

It was the Janmashtami day – a holiday for me. At around 11:30 pm, I got a call from AD, one of our senior employees. He was speaking from a private nursing home, where his mother had been admitted earlier that day. The doctor there had informed him that he should take his mother to Sion Hospital. That was because she had not passed urine since afternoon, and perhaps she may need to be put on dialysis, which facility was not available at that private hospital. AD and his mother have both been very wary about going to a public hospital like Sion Hospital, so it was not something that they wanted to do (will put more about AD and his hard life, later in another posting). So he called me to ask what he should do. At 11:30 pm, if a doctor in the private hospital recommends that a patient be moved to a large hospital, I presumed that it would be with good reason, and I conveyed my opinion that he must follow that advise. As he and his brother were alone, I offered to go to the hospital and see if I could help them. He was happy to have me go there, and which I did.

Thus, it was around midnight that I found myself, at the casualty department of the Sion Hospital, one of the largest public hospitals in Mumbai. And I was there from then till about 4:30 am that morning. And what I saw during this time, and what I experienced is what I intend to share here.

As mentioned earlier, it was Janmashtami day and there are these large number of groups who go out to do the pyramid structures for breaking the matki. And that causes several injuries. Either that, or perhaps there is anyway, an average large load of patients at a hospital like Sion. But the fact was that there were just so many patients who kept coming in, at the hospital.

There is this one doctor at the gate of the casualty department. He was late thirtyish in age. And over the next 2-3 hours that I kept seeing him, he did not rest for a moment. He was on his feet, running around, rushing from here and there, and trying to ensure that he kept the incoming patients moving in. He was wasting no time, and his energy levels had to be seen to be believed. He was the most surprising vision for me. He was alone at that desk there.

Inside the casualty department, there was a serious resource crunch, of many kinds. The phone there did not work too well. Had to be banged every now and then, to work. This was the phone that was being used to call interns and registrar doctors, amongst other things. It took an extra effort each time, to be used. They ran out of specific forms that they use for some purposes. They started to use ordinary plain paper instead. When doctors were given these legal sized plain papers, they (I saw more than 3 doctors follow this procedure) folded the paper in a particular way, used scissors and cut the sheets. At least 1 minute wasted each time they had to do this. I had no idea why the doctors needed to do such basic stuff. And why they took so much effort with the scissors and all! Then they needed to use a carbon paper. There was this one very used and abused carbon paper sheet that kept going around. Before using the carbon, they had to pin the sheets together. And do you think the pins were easy to find at the pin cushion?? Of course not. The pin was always hard to find, and docs had to keep searching for these. Staplers or stapler pins, of course, were just not around. It was so crazy that doctors had to waste so much time, in such dumb things.

All kinds of patients came in. Few men who had taken bit too much of illicit liquor, and whose wives had brought them in. There were others who had been injured in the janmashtami celebrations. Few small kids. Even one pregnant woman who actually delivered right outside the casualty ward. The common thread running through was one of poverty. The doctors had to keep mentioning approximate cost of the medications or the treatment (the actual medical costs are extremely subsidised here; also medicines bought at the local store are a lot cheaper than those outside), which was causing great deal of discomfort with the people who came with the patients. Many times, the numbers appeared just too large (as 2000/- CT scan cost is very subsidised, but it could well be the month’s salary for the person concerned, and it would go off, in one shot!) to be affordable! There were persons who were just neighbours, people from the same village staying together in some hutment in Mumbai, but not really relatives. And for such an accompanying person, to arrange larger amounts of cash, was asking for too much. Considering that he was also in the very struggling stage himself. There were at least two such cases.

The plight of the individuals, especially with regards to the finanical burden was unimaginable, and really shocking.

Coming back to the casualty ward, they did not have water fountains handy. A patient’s attendant had to walk a while and get water for the patient! Ward boys were few and when they went off with a patient, say to take the patient to the ICU, then the ward boy would disappear for a while and no one would be around. If a patient had to be moved from a bed to the stretcher, it had to be done by the patient’s relatives, as such. There was no “bai” at that time. So when AD’s mother attempted to pass urine, it was left to AD to pick up the pot from the corner and give it to her. No one else to help him. And the stretchers were also disappearing and hard to find. Essentially everywhere time would be wasted to arrange all these!

The casualty ward was air conditioned and quite cool, at least.

Being a big hospital, things are all over the place and take time to get done. Like the window for paying the small fees that they charge, is away, and not well labelled. Hard to find it at that time of night. The sonography unit was on first floor. The ward assigned to AD’s mother was far away from there. Just so much time was wasted in going from one place to another.

In the ward, there were large number of patients. There were also stray dogs and kittens, INSIDE the ward! It took so much time for the doctor to get to the casualy ward, even after we had got the patient in there.

At 3 am, she passed away. We waited for a while to see if they would do the formalities quickly. At 4:30 am, I realised that a post morte=m was inevitable and would take some time. I left from there at that time, then. As it turns out, with all the paper work and formality, by the time they were able to get the body, it was about 10 am the day after! Almost 31 hours after the patient expired.

All in all, it was shocking, apalling, and scary as well.. !

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Comments
  1. RPM says:

    It is quite an unfortunate thing. Do you think AD’s mother had a chance if there was more time, or more efficiency in the operations there, or at least in this case, time was not the problem?

  2. SPM says:

    I do not know really. I used to get brief information about the case from AD every now and then, at work. But never really understood the case medically. I am not sure if there was a chance.
    Unfortunate as it was for him and his family, I was trying to convey the state of the public hospitals in India. The people are keen and willing, but resources are strapped…a state of the corrupt and populous society that we live in!

  3. Anonymous says:

    Sanjay,

    Read the article on Sion Hospital and the comments.
    What you say about the apathy, lack of process planning, corruption, filthy conditions etc. are all rife. But the saving grace of Sion Hospital are its interns and registrars. I have heard from several upcoming doctors that if they ever have to be admitted with serious problems in an emergency they would select Sion Hospital. Those guys work their guts off to help the patient. This is despite abysmal pay and living conditions.

    Janak

  4. mrigank says:

    hey!
    i’m a second year medical student at Sion Hospital.
    the reason why those resident docs wasted time on cutting paper is because they are at the bottom of the hospital hierarchy…they work the most, are paid the list and have to manage everyone from their Heads of Department down to the wardboy.
    there is one word that you’ve wrongly used – you called it a ‘big’ hospital. LTMGH is the smallest municipal hospitak in Mumbai. it started off as a military hospital pre-independence and has remained the same size since…there is simply NO PLACE to expand. that explains the illogical arrangement of wards and OPD’s; they’re built wherever space could be created. that’s why the gastroenterology OPD is in the OPD building, ward is in the ward building but the endoscopy unit is in the college building.
    i agree with the rest of your criticism.
    in the 1.5 years that i have been here at sion, i have come to admire the doctors, senior or otherwise, who practice. they cater to most of the population north of sion, while KEM, Nair and JJ are safely ensconced in the south. i don’t think you fill find better clinicians anywhere else.
    keep writing.

  5. I’m a health reporter and have spent hours in the casualty department of sion hospital. Good read. You’re extremely observant to have noticed so much 🙂

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