Seated in the shadow of a hulking machine – a true story (an old blog from facebook NOTES app 2011)

‘Tis another stark, sunny day, as I step into utter chaos. No other word could have better described the pandemonium that awaited me as I entered the ‘Free section’ of Aravind Eye Hospital, Theni. I stare down at my badge, that read in bold letters “Aravind Eye Hospital, DR. VINOD NATHANIEL, COMPREHENSIVE OPHTHAL FELLOW”.

There was nothing great about it – just a reassurance that if I couldn’t handle what was coming, the rest of the doctors would come running to my aid. My mind, still on the cases I had operated less than an hour ago, I barely hear the cries of numerous old ladies and gents (affectionately hailed as ‘paatis’ and ‘thathas’ respectively) most of which had to do with why they had to wait for two hours to see a doctor. I pass by, fortunately unnoticed because of the convenient advantage of a huge milling crowd.

As soon as I make my way to the doctor’s enclosure, I see two sturdy machines making a bold stance, clothed in black and white, seemingly waiting for someone to take over their reins. The mighty Haag Streit stood tall and proud, sporting its bulky but old frame on the left. A slightly smaller model quietly stated its presence on the right. I pause for a second to choose which one I’m going to use- almost immediately my glance shifts to the lighter slit – lamp: though demeaning to my strength to use a lighter machine, I find it bearable to do so, due to the added convenience of being directly under the fan, that emits a long – awaited – cool – breeze.

I call out to the staff at the registration desk, “Sister, how many cases today?”. The reply is an unwavering “85 sir”. My mind then dives into what its worst at doing – math. I know I have six hours left, of which one hour would be required for a much deserved lunch break. Five hours – 100 cases (I would definitely be bombarded by at least 15 extra cases before the out patient department closed for the day). That meant an approximately hilarious time of three minutes for each case.

The army of ‘paatis’ and ‘thathas’ then commence their attack- one by one, though occasionally two of them end up fighting for the stool at the other end of the slit – lamp, while I continue to stare with a look of consternation. Headaches meant either sinusitis, refractive errors or muscle imbalance. Any other causes would fortunately be ruled out by a referral to a nearby physician. But the battery of cataracts, uveits, corneal ulcers, diabetic retinopathy, vascular occlusions and glaucomatous discs requiring detailed investigation needed a steady, determined, but cool mind, which I was now losing fast. I’m reminded of a movie where the hero manages to get himself and his friends into a fix in a town with raging zombies. It seems that I’m right in the middle of such a scenario – a lone man with a shotgun, against an entire population of attackers.

It’s been two hours now – I was doing good, holding a record time of 2.8 minutes for each case, when I notice a figure calling for attention in my peripheral vision (wasn’t that a paati who I had sent home earlier with glasses? What on earth was she doing back here?) I close my eyes, turn to her and ask her with forced subtlety, “What seems to be the problem?””The problem is, you’ve prescribed me glasses, but I don’t want your glasses! I want eye drops- give me some, and I’ll go home!”

I raise my eyebrows, thinking of the possibility of making this old lady understand that using eyedrops for her refractive error was like outdoing an anaconda with a hair-pin. I weigh my options in two seconds, then decide it would be a tedious waste of time and energy. I ask, “Don’t you have money?” “No I don’t”, comes the frank and tart reply. I request the sister to give her a free sample of eyedrops that would provide a coating for her eye. She then flashes a toothless smile, blesses me with a few good words then fortunately decides its time to leave.

I shake my head once in tiredness and despair trying to focus a blurry mind, then another time for good measure. I continue with my pleasant ordeal of handling the machine. I ask a rather uncooperative thatha to place his chin on the chin – rest, and look straight inside the machine. I now see a rather interesting finding – those look like the punctate form of congenital lens opacities, but is that an associated posterior subcapsular component I see alongside? Now wait, the image seems to be becoming blurry – I franctically adjust the joystick to get a good focus but in vain. Finally, the image has gone. I peep outside wondering what on earth is going on at the other end, and I see the thatha offering a charming smile, his head miles away from the chin – rest. He apparently had an in-built push-back mechanism that rocketed his head backward, as soon as I placed it in. With the aid of a now- tired sister, I now manage to hold his head at the right place, and write down all his findings.

An half hour still remained, and it came with the not – so – delightful – burden of three patients who required suture removal after three months of cataract surgery. Apart from the bleeding and the eyestrain, this calls for an added task of cooperation from the side of the patient. The last patient seems to be having a minor problem there.

“Thatha look down!”

In immediate response, his eyes do a merry jig, exhibiting a rotatory nystagmus to the right, then bounce upward. I grit my teeth and sing pleasantly, “I said, look DOWN thatha..”

“Yes young lad, I AM looking down..” After a few more minutes of futile trying, I request the sister to instill what I feel was a cascade of local anesthetic, then proceed to remove the rest of the sutures, with the ‘dancing thatha’ continuing his jig every time I remove a suture.

I finally finish, then ask the sister at the reception how many cases had assaulted us today. The answer amazes me – One twenty cases! I then slowly eject myself from my seat behind the slit -lamp, and make my way to the world outside, a tired but content man. Tired with the attitude of some of those cute paatis and thathas, but definitely content with my hectic life, seated in the shadow of a hulking machine.

– Vinod Nathaniel © 2011



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