The Window to the Playground

As a part of being a doctor, there are many emergency duties and shifts where we lose patients. But there was one incident, one patient that I would never forget. This was when I was doing my nephrology postings during my internship. We had to select a super speciality of our choice and work there for 3 weeks in the hospital.

There was an 8-year-old kid, Prashanth. He was diagnosed with nephrotic syndrome when he was five, and none of the medicines seemed to work for him. The only suggested option was to get a transplant, which they could not afford. His mother, if not in the hospital, worked as a domestic help, and his father, a labourer, was drunk most of the time (even in the hospital).

Prashanth was a quiet kid. He listened to everything we said, took all his medications without any fuss. We had to constantly put him on dialysis at least twice a week, and he never complained about the needles. I always found him standing near a window, looking out. He never talked to anyone except his mother.

It was this one time he started crying when my co-intern was searching for a vein to change the IV. I tried talking to him, but he didn’t respond. I finally told him I had comics in my room and that I would bring them to him the next day. He stopped crying. He looked at me with a shy smile and hope in his eyes. I showed him a few pictures of the online Tinkle version and told him I’d get a copy of that book, and he was grinning the whole time despite someone piercing him with needles.

The next day was a festival. I wanted to spend some time at my friends’ place and asked my co-intern to wrap up the rounds on my behalf, which she did. I had to go to the hospital in the afternoon for something, and then the ward nurse came running to me. “Sir, Prashanth’s been asking for you since morning. He is refusing to eat anything or take any oral medications,” she hurriedly told me.

I went to the ward to see him eagerly waiting for me. He jumped out of bed; he wanted to run to me, but his condition didn’t let him. He looked at my empty hands to see if I was hiding anything behind me. That’s when it hit me, “Oh, the Tinkle, I forgot.” He understood that I didn’t bring him the Tinkle. His face just lost everything it had till then. He didn’t complain, didn’t say a word; he just walked to the window and stood there.

I went running to my room, got all four Tinkles that I had with me, and came to the hospital. He was the most joyful person in the ward that day. His mother told me that she hadn’t seen him this happy since the time they started running between hospitals.

Prashanth started opening up to me after that incident. He greeted me every day on our rounds. My professor was surprised to see this because he had been treating Prashanth for the last six months, and this never happened. He couldn’t properly read but was excited looking at the book with lots of funny pictures. He took me to the window that he stood by every day. The window opened towards our college ground, where somebody was constantly playing at every time of the day. He was just watching people run and play every day.

He said, “I want to go out and play like them.” I was dumbfounded. I couldn’t say anything. I had never got attached to any patient like this before. I knew if there wasn’t a transplant, it was only up to an extent that these dialysis sessions could help. “Will I ever be able to go to school? Can you make my pain go away?” he asked. I had no answer to any of his questions. I told him, “Yeah, soon you will.” He went back to looking at people playing in the ground.

His dream was so small I could fit in my pocket. Yet it was the one thing I couldn’t give him.

His face and body swelled up every 3 days, which made us rush to free up the dialysis slots to squeeze him in. We crossed the limit that a patient can get access to free dialysis in the government schemes. My professor somehow managed to squeeze him in, looking for every way to get him treatment.

Time passed, and his condition worsened. His RFTs stopped improving. His face and body constantly swelled from the loss of protein. My posting in nephrology was done. I said bye to him. He didn’t talk to me and hid his face because I told him I wouldn’t be coming every day anymore. “Come and check on him once in a while, sir,” his mother told me, teary-eyed.

A month later, my colleague, who was then working in nephro, called me “Macha, I’m sorry to say this, Prashanth is no more. I know you were a little close to him, so I wanted to let you know.”

That was probably the first time I asked God, “Why?” He was just 8 years old. I understood why doctors keep saying, never get attached to your patient.

This changed the way I behave with any of the patients after that. I know we can make their day better by being nicer despite all the fuss going on in our minds. Since then, I am at my best attitude every time I talk to a patient, and I have understood what boundaries I should have.

-Dr. Satwik Kuppili 

Post-intern

Konaseema Institute of Medical Sciences, Andhra Pradesh.

*Names, ages, and certain details have been altered to preserve patient confidentiality. This story is shared with deep respect for the child and his family.