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New Delhi, July 12, 2019 :
Last weekend was just another weekend for me… Not the toughest or the most challenging two days of my life, but not the easiest either… I would say just about an average weekend for any second year Surgical Resident or for that matter any young doctor doing her post-graduation in any Medical College.
Friday evening my childhood friend called to suggest that we should ‘hang-out’ and ‘chill-out’ over the weekend so as to catch up on one another’s life! I had to once again excuse myself as I had done many times in the past 18 months, as I was “On-Duty” this weekend. Considering we were inseparable best-friends for 10 years in school, it may seem rather strange that we have not met for 6 months even though we live and work in the same city! However, when you know that I am a doctor doing her residency while she is a busy and very successful executive in an MNC, the situation becomes quite clear. She has a five day week with a very good six figure monthly salary and annual bonuses, whereas I have a six and sometimes seven day week with a meager stipend of Rs. 42,000 per month and I am studying as well as working almost 365 days a year, to get an M.S. and become a surgeon, with no guarantees of a good job after so many years of hard work and toil!
I joined Medical College 7 years ago with a big dream to become an accomplished Surgeon and serve the people of my country and improve their health and happiness. After 4.5 years of UG studies and 1 year of Internship and 1.5 years of PG life I was starting to feel very exhausted and in my mind I would often question myself if it was all worth it and if my dream would ever come true! Just so you understand what an average weekend is like in my life I will share what I did last weekend. Definitely Saturday & Sunday is not a R&R = rest and relaxation time for us resident doctors!
Sat 6:30 am after a quick bath and cup of tea I go for In-Patient Ward Rounds. Between the Male and Female Surgical Wards there are 26 patients under the care of my Surgical Unit. We have only Three Surgical Units in this Medical College Hospital, each with 1 Associate Professor, 2 Lecturers, 1 Chief Resident (CR), 1 Senior Resident (SR) that is me and one Junior Resident (JR) forming a Unit. If we are lucky we may have an Intern assigned to our Unit. Normal work days are a 12 hour day for most of us which includes In-Patient and Out-Patient care as well as Lectures and Tutorials. Additionally we have Emergency Night Duty every third day of the week and by rotation a Sunday Duty each month. I am “ON DUTY” at the hospital on every Wed and Sat hence these become 36 hour shifts for us residents. Last weekend I was “ON DUTY and ON CALL” from 7 am on Sat morning till 6 pm on Mon evening! Most residents have very similar working hours!
Sat 7 – 9 am are ward rounds and patient reviews, dressings, blood draws and chart updating. Most days I skip breakfast to catch up on pending work.
9:30 – 10:30 are Grand Rounds and Bed-Side teaching happens with the Professors. There is no clean toilet for doctors near the wards…. I have to run all the way to the residents quarters two buildings away to answer nature’s call… this is a much bigger problem during my periods!
10:30 – 13:30 is OPD time when I attended to about 40 – 50 new patients. I arrive at a clinical diagnosis and give the treatment if ailments are minor, or send for investigations and admissions if requiring surgery or In-patient treatments. There is hardly any time to talk to each patient!
14:00 – 18:00 is OT time that is what we look forward to most, as the maximum skill training and knowledge enhancement happens while we assist the senior surgeons on the cases. On the way to OT, I just grabbed a stale sandwich and a cup of bad coffee at the canteen. The Operation List was long and we had an on-table complication, so we finished only at 7:30 pm. I am very thrilled to have done my very first independent and successful Laparoscopic Appendectomy today!
18:00 – 6:00 am the next morning was Emergency Duty. My CR is on medical leave after contracting Hepatitis-B probably from a patient, so my work load is much higher. I too got a needle stick injury last month when we were operating on a HIV positive case. I have followed the full protocol and treatment after this mishap and pray I will not get AIDS myself! I attended to 3 major accident victims, sutured about 14 minor injuries in the Casualty (Sat nights we see maximum drunken driving accidents) I assisted the Lecturer who operated on a burst appendix and I had to put in two chest tubes in ICU patients. I hardly got 2 hours to rest my tired feet and gritty eyes during that night. The On-Duty Resident’s Room near Casualty is very small and shabby with a fan that makes an annoying squeaking sound. There is not much privacy, no attached toilet and the one that is shared by all doctors is often too filthy. No provision has been made for safe drinking water for the Casualty Department staff, so we must remember to carry our own bottle of water or go thirsty!
Sunday there are no OPDs or Planned Operation Lists, however we have to do the Ward Rounds of ALL three Unit cases, which was 102 patients in total today. After a quick breakfast it take almost 4 hours to complete rounds and update the patient charts. I am also expected to attend all the emergency surgical cases along with my JR all through the day and again that night. I am lucky to have a quiet afternoon so I am able to catch up on my reading and preparations for the Case Presentation I have to make on Monday at Grand Rounds.
Sunday evening and night was very busy due to some communal riots that broke out and resulted in a flood of patients with cuts and wounds and stab injuries. We had three deaths and 7 critical patients! Also the paperwork is much more as these are all MLC (Medico-Legal Cases) Seeing young people die has a huge impact on me. I feel help-less and ill-equipped to handle the families of these victims and there is no time to even think of my own feelings and grief at this wanton loss of life I have witnessed.
Physically exhausted and mentally drained I am struggling to stay on my feet by 4 am. At this point I have been ON DUTY for almost 48 hours non-stop! And I still have to get through Monday before I can break off and get some much needed rest and sleep on Mon night!
The tension suddenly hits me and gives me a sick feeling in the pit of my stomach…. I am very behind in my MS Thesis Work and my own studies… How will I ever pass my MS exams and the viva is the question in my tiered brain…. Is this even humanly possible? How do others do it? Am I not cut out to be a doctor or a surgeon? Self-doubt and self-pity engulf me… but I just grit my teeth and rub away the tears filling my eyes, as I cannot afford to look weak and vulnerable in front of my peers and patients…. I step out to see the next case! Being a woman I have to prove myself again and again in this male dominated field of Surgery. I have been thinking of doing a super-specialisation in Pediatric Surgery or Plastic Surgery… but the thought of another 3 years of training and the endless hard work and exams is daunting!
My family lives in another state on India, quite far from where I am studying. I scored well in the PG Entrance Exam hence got a seat in a premier Government Medical College in Maharashtra. I have not been able to go home for 18 months as we do not get much vacation. My grandparents are keen to see me married, but I have no time for a relationship… I barely have any time for myself! There is so much to do and so much to learn and so little time to get it all done!
Solutions:
- Entrance Exam Merit (UG & PG) to give importance to State of Origin in placements of students
- Local Language speaking training for all students from other States and English Language training for students who have studied in Non-English Medium Schools before Medical College
- Mandatory Mentorship (1 on 1) by a Lecturer or Professor for each Student & Resident Doctor
- Clean Toilets and Safe Drinking Water to be made available in Hospital Casualty & Wards, Operation Theatres and Resident Quarters. Healthy food options in Canteens 24/7 for Doctors
- Every Institute & Hospital MUST have orientation and training in Emotional Wellbeing for Students and should provide a trained Student Counselor on the Campus 9 am to 6 pm
- A compulsory Day Off (24 hours) by rotation each week following the Emergency Night Duty. No doctor should have to be on duty or be called for emergencies beyond a maximum of 36 hours continuously. It is unhumanly
- A work-place Harassment (not just sexual harassment but also ragging and work place harassment) Prevention and Complaints Redressal Committee that actually functions efficiently, effectively and confidentially.
- Regular Informal Talks with peers and seniors and Stress management Work-shops as well as Recreational and Relaxation facilities (Lounge, Coffee-shop, Sports) on Campus for break time
- Annual Health Check-ups including Mental Health evaluation as well as provision for Sick-leave, Exam-leave etc. A Compensatory Off when a Doctor works on National and Religious Holidays as is required to keep hospitals running 24/7 and 365 days in a year. Also, working hour should be upto 8 hours in rotation.
- Group Medical Insurance and Indemnity Insurance for all Resident Doctors as protection
- Armed Security Guards at the Emergency Rooms and ICU floors just like they provide in ATMs
- Better laws and quick police response as well as legal action against perpetrators of vandalism in hospitals and violence against doctors and nurses and hospital staff
Author : Dr Ms. Kalyani Dongre , Central President, Maharashtra Association of Resident Doctors (MARD) and Resident Doctor at BYL Nair Hospital, Mumbai
