I spent my first couple days in the hospital just watching surgeries because I didn't know what department I wanted to see first, plus that seemed most exciting! My first surgery was a lobectomy sleeve resection, performed in a 63 year old man who had a tumor obstructing his intermediate bronchi. So to get rid of the tumour completely, they removed the upper lobe of his left lung, hence the lobectomy. It was about the size of a lamb chop and very black, from all the pollution in India the man had been breathing his whole life. For the most part, watching the surgeon stick his hands in the gaping hole in the man's chest was alright with my stomach, but a couple of times my head felt prickly and my vision started going dark like I was about to faint, so I had to sit out for a few minutes.

After that first surgery though, and for the most part, I had hardly any problems at all. Next I saw a lumbar resection, where they were decompressing a woman's lower spine, a kidney transplant (AWESOME! A kidney looks a lot like a chicken breast in size and color when floating in a bowl of blood and ice), and finally, a haemorrhoidectomy. Anyway, that was enough surgery for me, so I’ve spent the last three days following around Dr. Pinak and Dr. Prashant, the two head doctors of the ICU and very friendly people. Each day I arrive around 9am and follow them as they do their morning rounds, which take until about 10:30am. I like the rounds because they’re mostly quite organized, especially when compared to the rest of the day. For each patient in the three rooms comprising Fortis’ ICU, (the average amount of people in the ICU at any given time is 20-30, although it fluctuates quite rapidly), Prashant, Pinak, a few minor doctors, and the particular patient’s nurses discuss how the patient fared during the night, what their condition this morning looks like, and what should be done for them for the rest of the day. For easy access to current information about the patient, these discussions take place at podiums placed at the foot of each patient’s bed, which store the sick person’s paperwork, image scans, and medications, as well as generally useful equipment like sterile gloves and syringes. The doctors all chatter to each other in Hindi for around 5 minutes before writing down a treatment plan for the rest of the day on the back of the observation sheet filled in by the nurses each morning.

For the most part I still can’t understand the discussion, or why which medications are chosen, but there are some standard procedures followed during the rounds process. The heart rate, respiration rate, blood pressure, central veinous pressure, (an intravenous monitor is kept in your wrist at all times just in case), and blood oxygen concentration are all checked and analyzed. Almost everyone in the ICU has a pretty high heart rate, so you’ll see “tachycardia” written on everyone’s observation chart. What’s a little more alarming though is RR or respiration rates being high, then people start to get disturbed. However, usually this is due to the presence of fluid in the lungs, so people can usually just get a tube and suck it out. That’s the most common procedure in the ICU: suction. Because so many people in the unit are so weak and there are so many lung injuries, a lot of their bodies simply cease operating the “escalator mechanism”, as Dr. Pinak calls it. Basically at all times, tiny cilia are moving out the mucus secretions from our lung up our throats and then back down into the stomach. Because this mechanism isn’t occurring, the patients experience a build-up in their lungs that causes them to gurgle and choke until we can clear it out of their system. Some of them require a little more than your average vacuum and undergo a bronchioscopy, which is when a tube with a light bulb, lens and suction mouth component is inserted deep down into the lungs of the suffocating patient. The doctor looks down the tube from an eyepiece attached to the top of it, and uses the light to find and suck out all the blood clots and mucus causing such a problem. The general process of suction sounds far too much like someone slurping the last dregs out of a milkshake, so I have vowed to never slurp milkshake again

I’m still working on calming myself when I watch people slide the sucking tubes up patients’ noses and down their throats because I know it’s so uncomfortable, and the conscious patients make clear it’s extremely uncomfortable as well through their moans and struggles. I feel really bad for them, but Mum says it looks worse than it is so I try to remember that. Many of the older ones, (and most people here are 60-80), who are confused about what’s going on, try to physically resist, and then have to be restrained while this incredible violation of their personal space happens. That’s another thing I found odd here, how many people are under some sort of restraint. Although some restrainees are just people who are very active while unconscious, many are awake elderly ones who try to pull out their tubes. Some patients stop when spoken to, but those who don’t usually have one hand bound to the bedrail, or what’s called “boxing gloves” are put on, so that their hands are wrapped in gauze until their fingers can’t move any more. I don’t think this calms them down any, but it makes them give up, which is for the best because one man was actually in the ICU for an injury he accrued by pulling out a urethral catheter.

Anyway, once a plan of action has been decided for the ICU, the main doctors will usually just patrol around the ICU and supervise their instructions being carried out by the nurses, and do some of the more complicated procedures themselves. For the most part, the nurses feed patients and manage the enormous number of tubes going into each of them. Although it varies slightly from case to case depending on what’s wrong with the patient, most ICU residents have a feeding tube up their nose, some sort of oxygen tube up their nose or down their throat, a CVP monitoring needle and tube in their wrist, a urethral tube so they don’t have to move to use the bathroom, an IV tube to administer fluids and nutrients, and a collection of tubes inserted into their neck to allow for easy injection of medication. A man who was in a car crash and fractured his skull also has a tube stuck in his brain for activity monitoring, so he looks a little silly with this probe sticking out of the top of his head. As a result of all this tubing, transferring people in and out of the ICU is a complicated process of plugging in and unplugging, so each patient looks rather like a robot or a television set except for the flecks of blood and iodine staining their sheets.

Usually, the mornings are slow times where people are simply being fed, having their tubes and tube-holes cleaned, or new medication administered. The morning around 11 is also the time when loved ones come and visit the patients, and get the latest information about the mounting medical bill. The medical expenses here are as astronomical as the United States, with the difference between the two that having good insurance in the US means healthcare is manageable. In India there is a cap on how much your insurance is allowed to pay - the equivalent of $1000 - but according to Dr. Pinak the average 3-5 day stay in the ICU costs the equivalent of $4000-5000. I’ve watched a few consultations between Dr. Pinak or Dr. Prashant with the patients and most of them look almost as grim about the billing as they do the illness. One elderly man in here with pancreatitis, who speaks English quite well and is a history professor, has been in the ICU since the 7th of April due to complications that keep arising. Although originally C.P. Uphadyay was admitted to have his right knee replaced, an infection and then pancreatitis developed, and now since they’re considering whether he should have another surgery done, so he still has at least 4-5 weeks until he can rejoin the rest of the world again. Although I don’t mind him being there because we hang out together and talk about flowers, languages, family, etc. I can only imagine what this lengthy stay is costing his family.

Early afternoons is when activity really picks up in the ICU, because that’s when many surgeries are finishing up and “post-ops” are being delivered into intensive care. Then it’s rather chaotic while people are moved around, and usually there’s some dilemma about there not being enough beds for the number of patients coming in. The new patients from surgery then undergo a sort of afternoon rounds, when they’re very briefly assessed and plugged in to the monitors, but mostly unbothered for the next few hours. It’s a little after this time that usually I go to lunch with the other ICU doctors, where I sit quietly eating my dahl and drinking my pineapple juice while they talk in Hindi. Every now again I’ll steer them into a conversation in English, (we were talking about the Bourne series the other day!), but when they’re just hanging out it’s usually 100% Hindi. In the ICU itself it’s a little better, because they talk about 50% English and 50% Hindi, so I hear just enough to be interested but not understand. However, it’s a lot easier to just pipe in and ask questions about patients or charts rather than ask to have a joke explained. I figure I’ll just keep bothering them in English and make them switch over until they’re so used to having me there they speak it a little more. I do have another week after all.

This weekend I'm going to shop and sightsee and do other tourist-y things, so I'll let you know how that turns out. :)