Blame by Kanwal Nayani (guest writer)

Illustration/Photo-credit: Saniya Kamal

It was a late Thursday morning. An unusually quiet day in the Pediatric Emergency Room. Only two out of the 10 beds were occupied by children – and these are children famous for wailing in agony; uncomfortable because of their ailment, scared because of the hospital environment, and the terrifying individuals in white coats and white uniforms who poke needles into them.

Today, however, both the children admitted into the ER for observation (for gastroenteritis and croup, respectively) were calm, feeling much better, and comforted by their mother’s presence next to them. I smiled at the thought – it’s a great feeling to know you’ve helped a child come out of the pain they were in. I checked my watch – I had at least an hour before their next follow-up. So I did what every medical student does – or rather, is expected to do – in his/her free time: I grabbed an empty chair, took out my book and started studying.

I barely got through the first paragraph when I heard the overhead page, ‘Pediatric doctor, please attend Resus!’ As if by reflex, two of the residents sprang up and started sprinting towards the Resus area (short for ‘resuscitation’, where the patients needing most emergent attention come first, so they can be resuscitated and then managed accordingly). I closed my book and quickly followed suit.

As I reached the Resus area, a familiar sight greeted me. Two individuals, anxiety and helplessness etched across their faces, hovering over a tiny human figure, as if that would somehow transfer its pain into their own bodies. It was their baby girl.

I observed as the resident took the limp little girl from her mother’s arms and lay her on the bed, starting resuscitation as per protocol. The attending physician started calling out instructions to everyone in the room, as the second resident tried to gather the basic information required to save her life. It was the usual ER environment. Nothing different. Until I heard the story.

‘Kya hua bachi ko?’ (‘What happened to the little girl?’)

‘Woh, main isse nehla rahi thi. Paani ki balti main gir gayi.’ (‘I was bathing her. She fell into the bucket of water.’)

Wow! This is interesting. A lot of thoughts crossed my mind at that time. The most important, and nagging one being, how did this little girl fall into a bucket of water? Why didn’t the mother pick her up as soon as she fell? How come she stayed in there long enough to drown?

I looked at the little girl lying seemingly lifeless on the bed, with a whole team making their best efforts to save her life. Pediatric Advanced Life Support had been activated for her. While the residents and nurses were busy doing  chest compressions, I was the silent observer, standing at the foot end, watching intently, trying to keep up with their quick pace, all the time silently praying for the innocent little girl who was juggling between life and death.

‘Take the parents outside and gather more information.’ The attending physician said, looking at me. Five years of medical school had trained me sufficiently in this department. I went over to do what medical students do best. Gather information. I took the parents out into the corridor. Put up my best professional face and in my calmest voice, started asking them.

‘Aapki beti ka kya naam hai?’ (What is your daughter’s name?)

‘Sara.’ The mother replied, in a quivering voice.

‘Sara.’ I repeated. ‘How old is she?’

‘Three.’

‘What happened to Sara? Please give me a few details?’ There. Start with open ended questions. Just as I had been taught.

The mother, still anxious and trying to peek into the Resus area for a glimpse of her daughter, replied distractedly, ‘I was bathing her and her older brother. I had to leave them for a second; there was something on the stove. And the maid was in the room. After a while, I heard my son call for me. Sara had fallen into the bucket.’

‘She had not fallen in! Ali pushed her!’ The father angrily exclaimed.

‘He did not! He’s just a kid!’

‘Don’t cover up his mistakes!’

As the couple decided amongst themselves whether Ali did or did not push Sara into the bucket full of water, I couldn’t help but think that this accident could have been prevented if the mother hadn’t left the two children alone. Even though I wasn’t supposed to associate any emotions with their story, I couldn’t help but feel a little annoyed, even angry at the two playing the blame game, when it was clear to me that it was them who were at fault.

‘How old is Ali?’ I asked the parents.

‘Five. He didn’t push her. I am sure of that. She fell by accident. He tried retrieving her but he couldn’t and that is when he called for help.’

Ah! The story was clearer now. After gathering all the relevant pieces of information, I rushed to report to the attending. By this time, Sara had been intubated (a tube was placed in her throat) and connected to the ventilator, which was helping her breathe.

‘A bed has been arranged in the Pediatric ICU.’ A resident called out.

‘Good. Make arrangements for her transfer.’ The attending responded.

Being a doctor, you are told that you have to be the patient’s advocate. When you hear a story like Sara’s, the first thing you have to rule out is child abuse. Did someone try to drown her intentionally? Was it her parents? Her brother? The maid? Or could it be that she had actually drowned while retrieving her precious toy? Was that preventable? Of course! Who leaves two toddlers alone in the bathroom? Neglect, although often overlooked, is also a form of child abuse.

As I looked at Sara’s mother approaching her, the look on her face made me soften up. She held her child’s hand and looked at her pleadingly, as if Sara would pull out all the tubes and call out for her mother. No doubt she was forcing herself not to take up her baby into her arms and shield her from everything that could possibly harm her.

Maybe I was too quick to judge? Maybe this wasn’t abuse or even neglect? Maybe she had really just made a mistake? We are all human, after all. 

[from Narrative Medicine]

CREDITS:

About the Author: Dr. Kanwal Nayani, AKU MBBS Class of 2015, is currently working at AKU as a Research Associate. She is interested in pursuing a career in Pediatrics.

About the Reviewer / Editor: Huma Baqir, AKU MBBS Class of 2017, is a science-enthusiast and a self-proclaimed advocate of world peace. Her interests encroach theatre, music, food, poetry, travel, public speaking, self-reflection - and that beautiful, delicious little bridge between medicine and art.

Illustration / Photo-credit: Saniya Kamal, AKU MBBS Class of 2018, is curious about life, the universe, and everything in between. She hopes to become a neurologist, pursue art, popularize meta-fiction, conquer the world and stay happy.

Editorial Note: This is first in a series collected as part of the Narrative Medicine Workshop at AKU on January 20^th, 2016. The editorial work was performed by The Writers’ Guild, an interest group at AKU, with the purpose to promote love of reflective reading and writing, within and outside of AKU.

DISCLAIMER: Copyright belongs to the author. This blog cannot be held responsible for events bearing overt resemblance to any actual occurrences.