Honorable Mention: Books can only teach a resident so much

February 10, 2012

While in residency, a doctor learns from the death of a child that academic skills mean nothing if you can't save patients. Discover how he learned to be more than a complete academician.

It was the final year of my 3-year pediatrics residency at the King George Medical College in Lucknow, India, one of the most prestigious medical institutes in the country. In the Department of Pediatrics, we had six medical units with names from Monday to Saturday; each admits children on their respective days. The units were steered by one professor with two assistant professors and a team of five residents: one third-year PG, and two second- and first-year PGs each. I had just entered the third month of my final year and was the senior-most PG in charge of the Friday unit.

I was considered one of the most studious fellows of the department and the college at that time and even now. I was sincere toward ward work, polite, and obedient to teachers and students. I was called "brilliant and dazzlingly skilled" in academics and therefore considered a "sensation" in the department during my first and second years of residency. I was "blessed" by all my professors and senior students; none in the department could ever dare to point their finger at me. But one incident changed the way I think of myself and my profession, as well as my attitude toward patient care.

I still remember the most eventful Monday of my medical career. Early in the morning of October 13, 2008, I had an appointment with the statistician at the clinical epidemiology unit to discuss my dissertation.

While I was on my way there, my phone started ringing. A junior resident, Amit, was calling in a panic. In one breath, he said, "Boss, the jaundiced child we admitted yesterday is bleeding like hell. He's gone into arrest, and we are trying hard to revive him."

I was very upset that I had to cancel my meeting. I cursed my fate, took a U-turn, and headed toward the children's unit of the hospital campus. When I reached the hospital, I could see a large crowd at the entrance. The security personnel had a tough time keeping people from blocking the entrance gate. I hurriedly rushed through the crowd, entered the emergency room, and slammed the door behind me.

Sameer was pale and lying motionless, with a full abdomen. He was 5 years old, had had jaundice for the previous 6 months, and was admitted 2 days prior for an evaluation of suspected chronic liver disease. He wasn't bleeding before he was admitted, but now he was bleeding from everywhere one could think of. Three residents were attending him: Harpreet was giving chest compressions, Amit was handling the bag valve mask ventilation, and Jagdeep was already loading the third dose of adrenaline.

Sameer was as cold as ice. I tried to feel his pulse, in vain. There was no heartbeat, respiration, or even a single gasp.

I understood the gravity of the situation and immediately came out of the emergency room. I found the father of the child standing at the door and asked him to accompany me to the emergency room, where I allowed him to see his son through the window. In a low voice, I told him, "I am so sorry to say your son is not responding to our treatment. We tried our best, but things have now gone out of our reach."

The gentleman didn't speak a single word; he was in tears. He swiftly moved out of the room. I tried to stop him, but I couldn't. As soon as the news broke, people standing outside the emergency room became restless. Soon, there was a lot of noise, as Sameer's mother started screaming and crying out as loud as she could, slapping her chest and forehead with both of her palms. She was rolling over on the floor in the reception area. People around her tried to restrain and console her as she literally went mad before she lay unconscious on the floor.

x