TALE OF TRAUMA CENTRES
Spending time with family members of accident victims can be a lesson in human psychology, as also the connection between the brain and the body
There are ways to educate oneself about the multifarious ways in which our mind supports the body. One can be as enlightening as watching “The Creative Brain” on Netflix, where neuroscientist David Eagleman taps into the creative process of various innovators. Another can be spending time at a trauma centre, a harrowing experience for the patient taxed with unconsciousness, dysfunctional motor and verbal response and days of wait-and-watch for the accompanying family members.
A group of young boys and a middleaged man stands outside the emergency ward of Neurosurgery at Delhi’s Guru Teg Bahadur Hospital when a guard tells them to leave the premises and wait elsewhere. In response, Mohammed Yusuf moves with his nephews some five metres from the original spot, away from the guard’s line of sight. They are waiting for a direction from the doctors to take his admitted sister, Sarvari Khatun, for another round of CT scan.
Upon being asked, Yusuf tells, his sister was only having a cup of tea when she fell from her chair, hitting her head on the wall behind. It is her fifth day at the hospital where she has not gained consciousness after infusions of four units of blood. “The doctors were going to operate her as soon as we got her here, but the decision was dropped and she is in constant watch as of now,” says Yusuf who is told that an operation may follow if the medicines are not able to heal her brain. It is the internal bleeding and clotting that has caused her to remain in a vegetative state with involuntary movement in an arm and a leg.
Sarvari, who is lying in an inert position among some 20 others in the hospital’s emergency ward, is on a ventilator with her head shaven. The air-conditioned room lit with sun’s rays has an 80-year-old patient with no awareness and some body movement to a 5-year-old girl who fell from the stairs with a strong headache accommodated on the same bed with an unconscious infant who fell from the balcony of the first floor.
While various mishaps get people in a situation like this, it is mostly head injuries that lead to internal bleeding and clotting of blood that is considered severe and further leads to dysfunctional mind-body coordination. While it may be difficult for a regular person to read a CT scan report, a Glasgow Coma Scale is an easier way to learn about a patient’s condition based on their eye, motor and verbal response that is charted from point 3 to point 15. Reduced acknowledgement of various physical stimuli is often considered a comatose state.
It is time for Sarvari to withdraw from her ventilation system and get a CT scan done. Her son mentioned this happened a few days before she was going to go for Haj with her husband. “Earlier my niece was hit by a cow who gored her stomach. She was brought to GTB emergency and was operated without any approval from the family. These people don’t wait for the family to arrive and give the required treatment to the patient. Now she is perfectly alright,” suggested Yusuf. He is satisfied with the handling of his family member. However, unlike other ailments, a brain injury requires the family to have utmost patience as only time can heal the nerves in the brain that help him/her regain consciousness.
Dr Gurubachan Singh, a neurosurgeon and head of the department here, is a lauded professional, willing to help in every way he can. His consulting room often has family members of patients living in as they come to the hospital from different states and cannot afford to rent a space in the Capital. His phone number is etched in bold letters inside the emergency ward and other rooms in case a person has a grievance to address.
Situated on the third floor of the casualty building, GTB’s neurosurgery department has multiple wards for pre- and postoperative patients and for those who are in constant vigilance in the ICU. Their family members, a couple for each patient, are allowed a corner outside the ICU to lay their bedsheets and sit/sleep. They are called to do jobs like changing diapers, sheets and urine bags at different points in the day.
One of them is the wife of Gurdeep Singh, a resident of Ghaziabad who is admitted at the hospital for the last 17 days. “He got a paralysis attack wherein he ruptured his nerve in the brain. This is his second time in the ICU in these days. According to the doctors, his mind has healed but his blood pressure and sugar level are taking a toll on his kidneys”, says his ailing wife, showing photos of her husband in her phone.
Doctors, guards, staff members, ward boys and the family members of the patients, all come and leave as per their shifts except those who are unwell, often in a disoriented state with no awareness or consciousness of themselves which goes on for days, especially at trauma centres.
Ask the guard on duty at Delhi’s Safdurjung hospital where the trauma centre is and he will direct you to the AIIMS’s Jai Prakash Narayan Apex Trauma Center. It has a full-fledged building of its own, with police cars arriving every 10 minutes with an accident case. According to Jitender Kumar, the guard on duty, 200 to 300 accident cases are brought to the hospital, out of which 150 come in a police vehicle. The trauma centre is a go-to for all trauma victims in the vicinity and is better maintained and bigger in size in comparison to GTB’s, being a standalone centre. Three wards for ICU patients with a capacity of 60 is an improved number. It is the day for many neuro-patients who have arrived to meet their doctors for their routine check-up. There are all kinds of people: some who arrive in an auto or a Mercedes and others who hire a cab for a smooth ride here.
Om Prakash, who was hit by a tempo on his way to Agra from Delhi back in November 2018 is here with his family members for his bi-monthly check-up. The 50-year-old is said to have lost his memory and often abuses anyone he meets, something he never did previously. “He was going back to Agra where he lives and a bus driver rammed Prakash who was on his bike”, tells a lady from his daughter’s in-laws family. “Hame lagta hai ye abhi bhi coma me hi hain” (We feel he is still in a coma), she adds jokingly.
A man whose father is in comatose after an accident is heard saying that it is only when we come to a hospital that we learn about the pain others go through and that no ailment is specific to a single patient. While road accident is a major cause of brain injury, with about 1,500 fatal ones that took place in Delhi in 2018, other major causes are falling off from a height and cracking a brain nerve.
As Om’s entire family waits in a queue to see his doctor, they are hopeful of hearing better reviews regarding his health. Om is lying on the stretcher like many other patients waiting to be examined. Part of his skull bone, transferred to a region near his stomach, needs to be put back in his head. That will take another round of surgery. He is bedridden and is taken care of by his wife, a lean woman in her late 40s. Listening to another patient’s case, one of the ladies accompanying Om says, “Some people eat to live while others live to eat.”.