The Colonels 48 Hours

‘Hello, Mr. J, I am Dr. Shad, and I am the doctor looking after you’. ‘Would you mind calling me Col. J? I feel much like me when I am called a Col”I feel much like me when I am called a Col.” The proud 70-year-old was my new patient, says Dr. Sujay Shad, the best cardiac surgeon in India.

He caught up with me in the corridor as I prepared to leave at the end of a rather hectic day and started chatting, ‘I could afford to go private and that might have been quicker by a week or so. But I have two problems with the private system of medicine; one that the level of trust I have for the NHS (UK National Health Service- the best system of healthcare as it was in the early 90’s) is lacking there and secondly if everybody started using the private medical system the NHS would surely collapse’. He made no bones about the health secretary policies that he disliked as much as I did.

“I miss my mother, he said misty eyed, she was the best cook and she always knew what part of a leaf was edible.’That would not require much knowledge of cookery I thought, but it was nice to see a 75 year old getting misty eyed about his mother. The colonel continued, ‘we were very poor and we were seven of us. Father died when I was very young and mother had to fend for the six of brothers and sisters. I was the youngest and every evening I used to go to the vegetable vendor. He would collect a pile of leaves by his cart for us. If he had a good sale he would place a couple of potatoes or  a tomato inside the pile of leaves. He  kept the special gifts hidden deep in the pile of leaves so I wouldn’t feel small. To discover a special gift was a precious joy and along with my everyday prayers for my family I said a prayer for the vendor’s brilliant sale!! One of the brothers would collect the bones from the butcher who perhaps deliberately left a few scrapes of meat attached; and ditto the baker, his crumbs were excellent.’ ‘Mother would sift through the leaves and separate the edible from the inedible, then she cooked that to a very healthy brew.  Thanks to that we all remained in perfect health despite abject poverty. We were not the only poor in England when the war broke out, poverty was rife and we were probably the better off  for we were healthy and in school.’

‘The war was Godsent, we all got recruited into the army and the sisters joined the trucker’s inland. We were immediately  rich, we had no worries about food, for the first time we had new clothes, new shoes and a free supply of cigarettes. Life was one hell of a party, no more trips to the vendors, no more gruel, and there was always somebody there to look after the soldier. I loved the war, I took part in the landings (Normandy) and fought hard and heavy, I was the only lucky one to come out alive at the end of the war. My three brothers perished.’

‘The free supply of cigarettes did me in, isn’t it doc; I probably smoked a hundred a day, that is the reason I have got this lung cancer isn’t it?’

Almost certainly it’s the cigarettes and almost certainly it is a lung cancer, I said.

 ‘I really miss my mother today; being with her was so comforting. Even when there was no fire in the house to keep us warm in the bitter winters, we all snuggled up together. I got to be with her all the time as I was the youngest’ – he said as he reflected of his rather miserable childhood.

‘I wish the war was a bit shorter, I might have been left with one of my brothers and we might have seen our mother when she was ill. She died when she was only forty and the war ended a few months after that. I returned after the war and there was nobody for me, only the Army remained. For my mother there was no NHS, she might have died of something minor during the war. Despite the post war economic crisis; we got the NHS in 1948. It was the biggest single achievement of post-war Britain.’

So you see doc even if my treatment might be faster with private hospitals, I am all for the NHS, I would never go private. NHS must work, it must remain. I totally agreed with him, shook his hand, bid good evening and left for the day.

He had lung cancer, a rather uneventful operation and a quick discharge from hospital. He was home for Christmas and called to wish the nursing staff and sent them bags of chocolates, biscuits and alcohol. I was not expecting to see him on the ward on the New Year, but there he was suffering a bit of temperature.

Dodgy stuff this temperature after lung surgery. If the chest space gets infected after removal of the whole lung, it is quite an incurable situation. Everybody went through the operation notes, who did the op?  Who was the assistant? Are you sure the stapler fired appropriately? Mr. F is going to be mad if the space is infected. Anyway after everybody on the surgical team satisfied himself that it might not be his fault after all, the routine commenced, all tests were performed and were normal other than a bit of anaemia. Anaemia does not cause temperature, give him a couple of blood transfusions and see how he goes.

Off to home after a few days of hospitalization and then he was back there. ‘I am sorry to see you here again Col,’ ‘I am sorrier to see you here doc despite all the lovely nurses on the ward’. On the second admission the boss decided that the safest thing might be to decidedly know whether or not the space in the chest was infected. For that the patient was taken to the operating room and a needle passed into the space, little normal looking fluid was aspirated and sent for testing. No infection.

Mr. F came on rounds looked at the results, very satisfied. So this is no longer a postoperative space infection, send him home and refer him back to his physician who should be competent enough to deal with his temperature and anaemia.

So off went the Col, satisfied that he did not have a dreaded infection, but still not clear as to what he had. He was back with the physician with more anemia and a grumbling temperature. We met socially and shared some more formal handshakes and some private moments in the corridors. This time he wasn’t leaving the hospital soon, which was clear. Physicians always take longer to discharge patients and Col too was intent on knowing what exactly was going on with him.  He lost weight, looked unwell and continued to get a couple of transfusions a week, though all routine tests were normal.

Then one night  I was called by the hospital switchboard: “Mr. Shad, this is the hospital switchboard, I am awfully sorry to bother you at home when you are not on call, but a rather unwell patient on the ward insists on talking to you and the nurses on the ward have let me know that you wouldn’t mind talking to him” ‘Which ward is that, no which patient is that, is that the Colonel?’

“Yes it is the Colonel”.

Soon the Colonel was talking to me and in a most characteristic manner he asked if I would be good enough to see him now.  I walked down to the hospital and saw him in his bed for the first time, otherwise he would be up and about.  ‘Today my belly hurts; it’s hurt for the first time and I thought it might be important, I am sorry to have called you like this, but you are the only one who connects.’

So, the Colonel had something in his belly, might it be a tumour, sometimes one gets two tumors at one time.  It  was a bit early for tumor spread. Thinking along those lines I placed my hand on his belly. Shortly my roving hand stopped and I saw him looking at me.  He knew that I had found something and implored ‘so what’s that you feel?’  ‘It appears to be something that you and I would have wished were not there. But there it is this lump in your belly; we shall get started early in the morning with that lump as a target.’

By the morning, he had already had a bloody motion and we found that he had multiple erosions on the surface of the intestine. With his condition deteriorating we got inputs from various specialists, the chest surgeon, chest physician, surgeon specialist for the bowel and belly, chemotherapist and  a terminal care specialist in rapid succession.

The outcome was that there was going to be no chance of limited surgery, major mutilating surgery was ruled out by the patient himself, there was no chance with chemotherapy, terminal care specialist was equally clear that she wouldn’t be needed for long because the patient had started on his downhill course.

Then everybody left, one by one till  I remained with the colonel and his small family.  I was appointed registrar during one of the colonel’s many admissions to the hospital. He had congratulated me when instead of following the rounds that I did on the 31st of Jan, I was leading it on the 1st of Feb. It must have been many minutes before anyone- the patient, his adoring wife, their caring daughter or Mr. Shad the young registrar on the surgery firm batted their lids.   “How long have I got?” he looked into my eyes.  ‘Not very long Colonel. The way you are bleeding, you are unlikely to last the weekend.’

“We had discussed this earlier, doc do you think I can make it home?”  ‘No reason why not and if that is your wish then I shall see that it can be arranged’.

“My last wish if I may call it so is to be able to spend 2 days at home in my own surroundings in the company of my family. If that were to be possible I would be eternally grateful”, the conversation was proceeding normally on the surface. In a few minutes, I made a rough calculation of the rate of bleeding, how much time he might last and how much additional blood we should transfuse, added some other medications to reduce bleeding and asked for a blue light transport.

I took leave of the Colonel who now sported a grateful smile.  Shortly the blue light came and took the Colonel home as per his last wish. I saw it all from the library windows, and  made my way home; sad for the turn of the events in 24 hours, very sad for my friend, content nonetheless.

Few days later, there was a card from the Colonel’s wife, the colonel was home for over 48 hours and died in peace. Lived a contented life and died a peaceful contented death in his room surrounded by his wife and children.  48 hours were important.

48 hours were important.

One can get help for any heart related disease with Dr. Sujay Shad at top heart hospital in Delhi, Sir Ganga Ram Hospital.