“Aren’t those decorations looking nice?” asks a soft voice beside me.
Startled, I turn to find a young woman wearing a red-and-white sari. Her head and face are swathed in the folds of the sari, leaving only the large red bindi on her forehead clearly visible.
We’re sitting on a grassy tuft amid a large campus green. All about us stand buildings with signs in both Hindi and English. Atop the central building waves an Indian flag, around which workers are hanging colorful garlands, tassels and lights.
“It looks very nice. What is it for?” I reply in Hindi, feeling that my accent must betray my American upbringing.
I am a fourth-year medical student. Two days ago I arrived here in New Delhi, after a sixteen-hour flight from New York City. Today I will begin a six-month fellowship working in pediatric oncology centers. It’s a chance to gain clinical experience working in places where resources are scarce–and it’s also a way to learn more about my ancestry and, in the process, about myself. My parents emigrated from India thirty-seven years ago, and my last visit was at age eight, nearly twenty-five years ago. For me, India is truly foreign; my only link to this land, besides some relatives I barely know, is my grasp of Hindi.
Anxiety stirs within me: Is my Hindi good enough?
“Bhayia, it is for Republic Day, when the Indian Constitution was born,” says the woman. “I have never seen all this before. It is my first time here in Delhi–and also my first time being free in months.”
Surprised at her familiarity (bhayia means brother), I respond, “Oh, I see! Why do you say you are finally free? Were you in prison?”
“Bhayia, no! I was in the hospital–it seemed like forever! I came here only for treatment. They gave me so many medicines. I was so sick! After surgery, they told me to come back for radiation, but the wait was too long–two months, last time. Now my husband has come with me to find out how long the wait is now. ”
A passing breeze lifts the sari off her head, revealing a hairless scalp with a long, vertical, well-healed scar–most likely from surgery for a tumor. Quickly, she covers her head again.
But seeing the scar has reminded me of this morning’s events–my first day at the pediatric oncology clinic…
When I arrived, carrying only a shoulder bag with a stethoscope stowed inside, I was just one among the hordes of people thronging the walk outside the entrance. You couldn’t have told us apart.
No one knew or cared who I was. No one noticed how expensive my clothing was, or how jet-lagged and anxious I felt. As I began to edge closer to the clinic’s double doors, which were flanked by security guards, I felt the crowd’s angry glares.
In the midst of the throng, clouds of dust mingled with overpowering fumes of ayurvedic hair oil, homemade cigarettes, body odor and other nameless smells, making me wish that breathing were optional; but I pressed on.
As I neared the doors, people began pushing, and I almost fell. All around, voices pleaded with the guards: “We have traveled for two days to get here and have been sleeping on the street in front of the hospital, sir!”…”We have been here since 4:30 this morning! Please put our chart on top…”
Reaching the guards, I flashed my new badge, and they let me in.
At first I thought I’d entered the clinic’s hallway. Then I realized that this was the clinic itself–a single room with a large table, around which sat six doctors and residents. I spotted Dr. Bhatt, the head of the pediatric oncology division–the man who, until this moment, had been just a name I’d spent months exchanging e-mails with. He motioned me over to sit next to him.
Smiling, he said what I’d been thinking: “Isn’t it crazy out there? Remember, you’re very far away from the U.S. now! We do things differently here! Welcome to India!”
His words sparked more anxious questions: Am I ready to see the things I’m going to see? To experience the things I’m going to experience? Do I even have any idea what those will be? I realized that nothing could have prepared me.
The next few hours were a blur.
By the door sat a huge stack of files–one per patient. One by one, the guards would pick up a chart, open the doors and scream out the patient’s name over the crowd’s roar.
Scurrying in, the lucky child and his or her anxious parents were assigned at random to one of the physicians seated at the table.
The time and attention devoted to the child depended on whether this was a first visit, a follow-up or a case in which complications had arisen.
New patients referred from other institutes received the most time and attention: a complete history and physical. If the child was young enough, this was performed at the table itself; if the child was older, in a partitioned corner of the room.
At follow-up appointments, the parents showed the child’s latest test results and were asked about side effects or any related health issues. If they reported no problems, the doctor usually let them leave without even touching the child. Rarely, when questions arose, an exam would be carried out or further tests ordered. Testing was done in private facilities elsewhere, and so, in order to avoid delays in treatment, the doctors often opted to base their diagnoses and treatment decisions on the physical examination alone.
Surprisingly, the children who received the least attention were those who needed to be hospitalized on account of treatment complications. Because of a severe shortage of beds, the doctors would decide whether or not to assign a child a bed based on his or her past treatment adherence or office-visit attendance; the rationale being that this way, the clinic’s limited resources would go to those most likely to benefit. Even if you were given a bed, this meant you’d be sent to wait on another line, for hours or even days, for actual admission to the wards.
As I shadowed Dr. Bhatt throughout the morning, he explained each patient’s history–always in English, although most patients scarcely comprehended it.
“This five-year-old boy is HIV-positive, as is his father. Father refuses to tell the mom or give the boy any medications, so it complicates his cancer treatment…This is a three-year-old girl with stage-IV rhabdomyosarcoma. She is not responding to treatment, and I have to tell her mom. I hope she does not get too emotional…This is an eighteen-year-old girl with acute lymphoblastic leukemia; she keeps spiking fevers, and we are going to start her on TB meds now…”
As child after child came and went, a sinking feeling gripped my stomach. I felt dazed by the number of patients; terrified by the lack of time and resources; stunned by the doctors’ seeming laxity in working amid such conditions.
I don’t belong here, I thought.
I stood up, grabbed my bag, and walked to the door. The guards opened it, and I darted out.
“I think we have scared off the American!” I heard Dr. Bhatt exclaim.
Pushing through the crowd, carrying my unused stethoscope in my bag, I had no idea where I was going; I just knew I needed to get away.
I started jogging. Maybe if I run fast enough, I can make it back home, I thought confusedly.
It hit me that I didn’t even know where I was. I looked around: I’d run to the center of the institute’s campus. I headed for a grassy tuft in the middle and sat down, out of breath. The winter breeze made me shiver.
I can change my ticket; head back sooner…At this consoling thought, I felt somewhat warmer.
I’d been sitting for what seemed like hours, deep in thought, until joined by my present companion, the woman who’d come to Delhi for treatment…
“Are you feeling okay now?” I ask her.
“Yes, I’m great. My husband treats me well. How many men would stay with a woman who gets cancer? I am lucky–and now I am healthy, too.” She smiles.
“That’s great,” I say. “You don’t look like you were sick! You smile too much!”
“Why be sad? I was treated at this great hospital, and they saved me. Doctors are angels sent from heaven!”
She stops and looks at me. “What are you doing here, bhayia?”
Shifting uneasily, I knock my bag over, spilling the stethoscope onto the grass.
“You are a doctor?” she says in consternation. “Why didn’t you tell me? I’ve wasted so much of your time! You must be so busy!”
“Not at all,” I answer. “You helped make my first day working here a little better.”
“Your first day?! So I was your first patient, then?”
“Yes, I guess you were,” I say. “Thank you!”
I pause, then say, “I guess I should go back now.”
“Doctor sir, may god bless your hands, and may you fix many people, as your colleagues fixed me.” She folds her hands in front of her, in the traditional Indian greeting/farewell, Namaste.
A strange calm overtakes me. I stand and start retracing my steps to the clinic. As I walk, I remove the stethoscope from my bag and drape it over my shoulders.
For the second time today, I approach the clinic doors. This time, seeing my stethoscope, the crowd lets me pass.
I still want to be one of them–to spend the next few months living among them and working and learning alongside them and with them. But wearing my stethoscope, I represent something different to them now–as if the stethoscope has given me an elevated status. I hope that I can change that impression…I hope that I can make them realize that I am a human being just the same as any one of them….
I head back through the double doors and into the clinic.
There stands Dr. Bhatt. He smiles.
“You’re thinking of running back to America? I told you, you’re not in the U.S. anymore!”
I return the smile.
“I’m not ready to go back just yet.”
Ashish C. Massey is a medical student. This piece was originally published in Pulse — voices from the heart of medicine, and is reprinted with permission.
