Uncivil Hospital

John, Anjali and I take a relaxed late night walk back to Jayesh-bhai's after treating ourselves to orange ice candy (Indian English for popsicle) near Subhash bridge. Halfway home we stop to sit street side on an impressively-sized gas pipe section on either side of which slum folk are prepping for bed on plastic sheets and blankets spread out on the dirt. Anjali strikes up a lively conversation with an older woman while a collection of scooter and motorcycle drivers buzz in from the road to cluster around the odd assemblage. Thirty yards distant, from the shadowed depths of the street side encampment, a man motions feverishly for me to approach. I have become accustomed to ignoring such invitations as nuisance quiz sessions as to country of origin, good name, father's name and so on. I pretend not to have seen the man and look blankly to the opposite side of Ring Road where sundry wallahs are still peddling tea, tobacco packs and sugarcane juice from their carts. As I swing my head back to where Anjali's dialog remains the center of attention I catch sight of the man crab-walking his way toward me heavily favoring one leg. He cradles a wood crutch in the depression formed between thighs and torso. Now there can be no disguising that I have seen him. He takes a breather to motion me hither once more and I notice for the first time that he has a bloody shirt wrapped about the right thigh of the leg not in use. Holding my attention he starts to peel back the shirt to reveal a large ruddy area where the skin is missing. I frantically motion for him to keep the makeshift bandage in place and turn to John and Anjali.

"Hey you guys, I think this guy's hurt real badly. We're probably going to have to take him to a hospital." Anjali and John look to where the man is still eagerly displaying the top portion of what appears to be a massive wound. A quick discussion ensues. I offer to take the man to the hospital myself, but Anjali points out there will almost certainly be language barriers and offers to come along. We all are carrying multiple bags. The three of us, our baggage and the man are unlikely to fit into a single rickshaw--certainly not without risking further damage to his leg. Securing two rickshaws seems out of the question at this hour, so we determine we should hurry to Jayesh-bhai's, drop our belongings off before the house is locked for the evening, and then return to hunt for a rickshaw. Our plan is shared with the man who has made it streetside and Anjali asks that he stay put until we come back.

Parvati, Jayesh-bhai's adoptive eighteen year old, is watching one the many overly dramatic Indian serials when we arrive. Countless reaction shots heavy with see-saw zooming effects are utilized to heighten the impact of stiffly-delivered soap dialog. We brief Parvati on the mission, but she politely declines our invitation to come along and instead assists in filling water bottles and stashing luggage before we head back out.

Murti's Law: Exhaust spewing rickshaws will hound your every step when you want to walk and are no where to be found when you need a ride. Back on the main road we try to hail a rickshaw on the emptying streets, but are spurned by the few that speed to unknown destinations fat with fares. We head up the road to where a lonely rickshaw sits decommissioned for the night. The driver is prodded from his nearby cot and we make our pitch for conveyance. He is receptive until he sees the bandaged leg of our companion and then explains that the rickshaw cannot be used for injured persons and only an ambulance will do. You know you're in for a long night when you are jilted by a rickshaw-wala with an empty vehicle. When we finally succeed in hailing a rickshaw on the road we decide on a new tact and obscure our companion from the driver's view. Anjali asks for the nearest hospital and the driver assures her that he knows the way. John sits up front with the driver and I, then our injured friend and finally Anjali carefully stuff in the back taking care not to make contact with the injured leg. No sooner than we start out and Kishan makes an odd sound, scrunches his body and I feel something wet hit my exposed leg. When I look over to him he is adjusting the bandage and grinning broadly. Anjali looks over to me smiling. "What was that?" I shake my head side to side, resigned to having been exposed to unknown fluid number 101. Chalk it up to just one of the occupational hazards of being a "do-gooder."

After several left turns that complete the sides of a square it becomes apparent our driver is lost despite his good-natured assertions to the contrary. He slows the rickshaw to a crawl and asks for directions from pedestrians who give conflicting instructions. Eventually I spot the sign of the hospital in the distance and point it out to the riskshaw-wala who is relieved to be drop the pretense of navigational expertise. A squadron of police loiter about their jeeps at the hospital's entrance and one steps forward to ask Anjali what our business is at the institution. From the way the police are settled it appears they have been there for hours--a couple sleep in the back of one jeep with their legs crossed and resting on the front seat. We show Ashok's injury and they begin peppering him with questions which reveal the injury is over a year old. The policemen tell us they can't be involved with his case because of the time lapse. "This is a private hospital," a round-faced officer with thick moustache says, "Who is going to pay for the work on his leg?" When I indicate my willingness he says the hospital will only try to take advantage of us and charge far beyond whatever the work costs. He recommends, in a way that suggest we have no choice, that we head to the public hospital across the river.

When it becomes clear the police will not avail their vehicle for the new destination we pack ourselves into the rickshaw once more and have directions explicitly communicated to the driver before heading out. The streets are almost completely empty now and are rickshaw is embarrasingly loud in the unusually serene context--a lonely survivor of a post-apacalyptic Ahmedabad sputtering through uncharacteristically fresh air. I sing a filmy song along with the radio and put my arm around Kishan who harmonizes and momentarily becomes downright giddy. Anjali leans over and tells me she thinks our hospital-bound friend is quite toasted. We buzz past walls replete with Victoria underwear advertisements that look like they haven't been updated since independence. The color scheme and implementation give the appearance of a mammoth, laterally-oriented Warhol installation. These stand in stark contrast to saucily bold billboards hawking Extreme briefs with a nearly naked couple engaged in foreplay. The "x" in "extreme" serves double duty heading the vertically oriented "x-rated." Once we cross the Sabarmati a couple of bhangi (sweepers) are the only signs of life before we arrive at the campus of Civil Hospital Ahmedabad.

A couple of plumpish guards armed with rifles man the door to the emergency ward and peruse our party of four with obvious bemusement. In retrospect, it would have behooved us had the guards denied us entry to the hospital at this point. Inside my eyes are immediately drawn to what appears to be an unattached thumb complete with bloody entrails just in front of the operating room doors. Closer inspection reveals that it is a blood stained wrap of a digit that is no more in residence but has left a gauze littered pool in its wake. Three yards beyond a dog lies dead tired or just plain dead. To the right we are beckoned to a caged reception area by three inmates manning a single dirt-stained PC. While one questions Kishan from a reclined plastic yard chair, another sits atop the counter and enters the necessary bureaucratic bunk with handless stubs. We are asked to pay a fifty rupee entrance fee and it is impossible to tell if it is a legit fee or simply the cost of having the trio direct us to the next destination. We are waved up the hallway around a corner to where a girl is screaming uncontrollably on top a hard metal gurney that could pass as a realistic prop in a 19th century period piece. Her family wheels her up the hallway with no staff in attendance as far as I can tell. I desperately want to offer her some comfort, but am afraid the appearance of a white person may only increase her anxiety. We wait in front of a desk as two frowning staffers decide where to send Kishan. Finally it is determined we should go to the other side of the hospital and a wheelchair with three working wheels is produced for our use. For it to function at all it has to be held in a perpetual wheelie--no problem as this is my natural inclination when pushing a wheelchair anyway. The wheelchair, like the gurney, is made entirely of metal with no cushioning for butt, back or arms. It appears to have been painted read at one time and soldering repairs are visible at the joints. We squeak past sleeping patients to either side that are stretched out on sheets or simply the floor itself. Carefully we negotiate the chair over bumps and down an unlit corridor which leads to a littered outdoor passage and finally to our ward.

Three soiled and blood-stained cots are lined up outside the x-ray room. A turbaned man contorts his body in pain on the middle bed while a disinterested staffer stares blankly at his clipboard. With our appearance a crowd of security personnel, doctors and miscellaneous staff quickly forms around us and we fill them in on Kishan's status. The doctors only half listen to our briefing before leveling a barrage of questions Kishan's way. The questioning turns into lecturing, taunting and then spiteful attacks during which time no effort is made to look at the wound or offer any succor. I step in to ask the main doc if we should take Kishan somewhere else. The question is successful in interrupting the inquisition and the doctor informs us that x-rays will need to be taken before anything else can be done.

"Don't you want to see the wound first?" I say, "I don't think there are any broken bones. He just has a large amount of missing skin." The doctor says that it is standard operating procedure for everyone coming on the ward to have x-rays taken before being examined. I try again, "Can't you take just a quick look at his leg before x-raying?" I am assured that this is not possible. "The x-ray will show everything," the doctor assures me, "Then we can decide what needs to be done."

The doctor is a thin man in his late forties and wears a dress shirt, tie and pants, but no white overcoat as if he is off duty. Like so many Amhedabadis in positions of authority he maintains a well-groomed moustache. Something about his manner strongly suggests he is an actor playing the role of a doctor rather than an actual physician. The hospital itself has the appearance of a low-budget set designed for afternoon soaps that hasn't been cleaned during the off season. Over the course of the night I find myself waiting for the doctor to turn to me and deliver the hackneyed, "I am not a doctor, I just play one on television." Even the staff mills about waiting for an unseen director to call them into action before tending with intensity to any of the moaning wounded.

I pull Anjali aside while we wait for the x-ray room to become available. "Why were they giving Kishan the ninth degree? It's like they don't even care about his injury."

"I know. One of the guys that was grilling him evidently is an ex-policeman who recognized Kishan because he busted him for drinking about a year ago," Anjali explains, "He could tell that Kishan is drunk and evidently no one who is intoxicated is allowed in the hospital. He was threatening to bust him."

The x-ray room is the cover of a retro sci-fi pulp in three dimensions--all that's missing is the catchy teaser, "X-Rayed Into Submission." Kishan is made to leave his crude wooden crutch outside the room and crab walk over to the table for his x-ray. The machine's operator is concerned the crutch may contain some hidden metal. Too many Ian Fleming novels or errant radiative doses have evidently taken their toll. While we wait for the film to be processed John decides he should have his long troublesome shoulder x-rayed and heads back to the main counter to register as a patient. Kishan's alcohol-induced positivity is beginning to wear off and he shows signs of wanting to bolt. Anjali explains the importance of sticking around to have his leg examined and reminds him that it was he who approached us for help; if he takes off now it would all be for naught. An hour passes before a technician appears bearing the x-ray film. He sticks the plates onto a wall mounted light box and studies them briefly before announcing, "There are no broken bones here." His tone suggests that he is suspicious that someone has played a trick on him.

"We didn't think there were any broken bones. Our friend could have told you that himself. He has a massive surface wound that needs to be tended to," I offer unapologetically.

The technician returns to studying the plates. "There is some trauma to the surface here," he says pointing to a slightly darker patch along the border of the thigh. "We will have to take a look at his leg." The original plain-clothes doc is called back to offer his assessment. He wastes no time in confirming the technicians diagnosis. "We will need to have a look at the leg. There seems to be some disruption to the skin layer." Thank heaven for x-rays.

The doctor and two nurses assume positions around Kishan's cot and he is asked to remove the shirt that is serving as a bandage. I stand bedside transfixed by the unveiling. I need to see clearly now the affliction that set the night into motion from the forgotten recesses of a street side slum. The wound is massive. Essentially the entire outside portion of his right thigh has no skin whatsoever. The leg is cocked permanently at an obtuse angle due to the scarring of tissue near the knee joint. The two orange ice candies are starting a slow tango in my stomach and I have a brief sensation of the room simultaneously constricting and becoming remote. I am still staring at the vast expanse of exposed inner leg anatomy. I decide to sit behind the growing crowd of gawkers against an anonymous wall. Feeling somewhat better I return to find the doctor instructing the nurse to wrap gauze around Kishan's thigh. The gauze is set on the soiled sheet to be cut. Kishan's thigh hasn't been drained, disinfected, dried or even dabbed. The gauze is simply used to take the place of the shirt. I am too dumbfounded and woozy to protest. The doctor hypothesizes to Anjali that it is only due to the perpetually high concentration of alcohol in Kishan's blood that he wasn't dead long ago. "The alcohol in the blood sterilized the wound," he explains, "Medically there can be no other explanation for his surviving like this." If Anjali's face were on the Vegas strip it would be a forty-foot, flashing neon-colored marquee: "NOT BUYING IT!" The doctor continues theorizing in Gujarati unfazed by her obvious skepticism. Later Anjali tells me she thinks that he started making up medical terms to try to keep her convinced of his expertise. The doctor concludes his diagnosis by declaring that Kishan has been brought to the wrong ward and should be returned to emergency. "Why didn't someone tell us that before the x-rays were taken?" I protest.

"He must go to emergency to have this kind of wound treated. He doesn't have any broken bones."

We return in disbelief with our rickety wheelchair to the front entrance where an emergency room doc has just emerged from the operating room. We hand him the previous doc's notes and after a cursory reading he tells Kishan to sit on the floor not five feet from the bloody thumb wrap. He is made to unwrap the wound once more and again a crowd forms to take in the spectacle. The emergency room doc wastes no time in his assessment, scribbling notes while he talks. "He will be needing plastic surgery and you need to take him back to the ward you brought him from." Before we can ask any questions the doctor retreats back through the swinging operating room doors while a staffer re-wraps Kishan's leg with the same gauze which was lying on the visibly dirt-covered floor where the dog lay earlier.

The first doc strikes a decidedly exculpatory tenor when we return. It is evident he overheard my comments on the lack of cleanliness in the hospital during our first visit to his ward. He puts his arm around my shoulder after Kishan is re-deposited on a cot and tells me I should bring a film crew to the hospital to document the filth. "It is not sanitary here. How can anyone get well in such conditions? Everyone should know about that this is the state of their public hospital. You should come back here and show the people how to clean." The doctor reviews the ER doc's notes and informs us that Kishan must stay in the hospital for at least one week. Kishan wants to leave now. Clearly the thought of weathering the taunts of the hospital staff and going without the comforts of his wife and alcohol is not sitting well with him. John reappears proudly wielding the freshly-developed x-rays of his shoulder. After getting Kishan's promise that he won't take off without us, Anjali and I go with John to have the x-rays read by a specialist deep within the bowels of the tentacled building. "These indicate there is absolutely nothing wrong," the x-ray analyst announces much to John's disappointment, "Everything is in order." I propose a bright spot on one sheet might be a long forgotten bullet to no one's amusement.

Back on the ward Kishan has become insistent that we take him home. Whatever high he had enjoyed from imbibing illegal hootch is now completely gone. His brow is permanently furrowed and he's unresponsive when asked what he will do about his leg if it's not treated now. Eventually we strike a deal: he will see Jayesh-bhai's doctor the following morning if we take him home to spend the night. One last stroll with the wheelchair cocked at an thirty degree angle past families sleeping in the hallway, past a dog that has usurped the former's spot, past the unmolested bloody thumb wrap and finally into the relative cool of the night air. A rickshaw driver is unceremoniously roused from limousine dreams to port us back to our homes.

At Jayesh-bhai's Parvati, incredibly, has waited up for us and listens raptly as we relate our latest adventure. On the television a doctor emerges from the operating room to pronounce the dire status of an injured patient and the camera throbs on the slack-jawed disbelief of each family member in turn.