Yesterday, I couldn’t get up in time in the morning and had to rush to the hospital without breakfast. I was just afraid of getting noticed by anyone from my department that I was a little late. When I reached the outpatient department (OPD), I just got a text from my consultant that he was not feeling well, and I had to see all the patients in his absence. In our department, the work goes on whether the consultant is there or not. The senior resident is responsible for continuing the OPDs and seeing the inpatients as well. The PA started bringing the patients one by one, and there were really a lot of patients. Some were follow-ups for radiation therapy, some were on hormonal treatment, some needed chemotherapy prescriptions, and some were having their first consultation in the oncology department. The people who work in oncology know very well that we cannot neglect even a single thing while prescribing these costly medications and have to examine the patient every time to assess the response and look for the side effects. Our consultants obviously have a lot of experience, and they know how to filter out the things that are relevant and important. They have a tight schedule and have limited time for counseling and listening to the patient. Some days they are irritable and in such a bad mood that the day is not only difficult for us but for the patients as well. Whenever I am seeing the patients in detail while in the absence of the consultant, the patients feel so happy and relieved that the consultant is not there to scold them. They share all of their problems and get examined head to toe that day. Most of them also express their complaints about the consultant to me and are so happy that they always want to see me again and get examined by me.

It was a difficult day for me because there were a lot of patients, and everyone wanted to be seen in detail. There were new patients as well, and some took even an hour to discuss their treatment plan in detail. Obviously, it’s their right to know everything about their future treatment, side effects, and prognosis.

The PA just has this thought that she has to complete her work and go home on time, and she is never considerate enough that the doctor can be hungry or thirsty as well. He or she can have needs like normal people too. I had to see all of those 25 to 30 patients in six hours because I had to go to the ward, as I was on call that day. Anyway, I saw all the patients, and most of them were really happy and satisfied. Many of them made me happy by hugging me and promised to remember me in their prayers. I think such moments are the real reward for the doctor when the patient leaves the office happily, and that too from the oncology clinic.

When I reached the ward, I saw a very young patient with metastatic carcinoma rectum. She had been suffering from stage 4 disease for the past year. All her treatments (palliative chemotherapy and colostomy) had been done in Germany, and she had just landed three days back in our hospital emergency with acute intestinal obstruction. The surgical team saw her in the ER and advised conservative management. I have no idea about what happened that day because the surgical team didn’t admit her under their service and just referred her to oncology. I noticed that there were at least ten attendants with her. Our security has no control over the number of attendants in the hospital because nobody listens to them. The people think that they can do as they please just because they are paying a hefty amount as compared to the government hospitals where the treatment is almost free.

The attendants had a lot of questions for me, which gave me a hint that the primary physician had told them nothing at all. I tried to answer their queries in the best possible way I could. The patient was really sick, frail, and on continuous IV medications for pain relief. She was on total parenteral nutrition just because of her nil oral intake. Obviously, she was a clear-cut case of palliative care, and in my assessment, she was not a candidate for any kind of treatment in this condition. Her heart rate was 135 bpm, and her blood pressure was really low. She was drowsy as well. In the meantime, the staff came to tell me that the chemotherapy was ready to be administered to her. I wondered how we could administer chemotherapy to a patient in such a condition. I called the primary physician about how we could administer chemotherapy to her in such a condition, as she could have any reaction to chemotherapy as well. The consultant told me that he had already discussed with the family that the patient should be DNAR and had decided to prescribe the patient chemotherapy in palliative settings. He was not even listening to me, and I had already searched the whole file for DNAR documentation but couldn’t find any. Despite his arguments, I didn’t consider it safe to start the patient on chemotherapy in such a state. I sent the chemotherapy medicine back to the pharmacy. On further interaction with the family, I got to know that they were not at all ready for the patient to be DNAR code. They wanted every intervention to be done.

I don’t know if it was a state of denial or the fear of losing their patient, but they were extremely aggressive towards me and the staff. The whole family of the patient was sitting around the bed, and all of their eyes were fixed on the vitals monitor all the time. When I suggested shifting the patient to the Intensive Care Unit, they simply declined and wanted all the interventions to be done in the ward because they knew that the charges of ICU in a private hospital are a lot higher compared to the ward. After half an hour, the husband started shouting, and his loud voice was making everyone in the ward uncomfortable. He had reservations about everything. According to him, the monitors were not working properly, the nurse didn’t know how to do the IV cannulation, the blankets were not good, and the heating was not proper.

I called security and involved the inpatient department (IPD) supervisor as well and requested them to allow only two attendants with the patient as per policy, but they couldn’t do anything. The IPD supervisor tried to counsel them a little but then left with advice for us not to mess with them. Every time anyone tried to have a dialogue with them, their answer was that they were paying a lot. Due to the situation, it became impossible for me to even go for a lunch break because they were not listening to the staff, and everyone was so terrified of them that they were not letting me leave. The situation continued for many hours, and the patient didn’t improve at all. Whenever I suggested we shift her to the ICU, they declined and suggested we observe her for a little while more. The family members were giving a lot of conflicting statements themselves. They did not agree on a single decision among themselves. The husband wanted to retain the wife in the ward, while the mother and sister wanted their patient to be shifted to the ICU. The father had no opinion of his own and seemed dominated by his son-in-law.

Thankfully, all the other patients in the ward were stable, and I did not have to worry about them. All of my focus was on what could happen at the next moment. I was sitting numb with fear and hypoglycemia, maybe. I was worried for the girl, too, because we had tried a lot of medications, but nothing was working, and my mind was not even working properly due to fear and anxiety. I felt as if I had forgotten everything. The only times I left the ward were just to go to the chemo bay to check blood bags for transfusion. Whenever I left for a few seconds, the staff called me back.

In the end, she became more and more sick, and I had no other option but to shift her to the ICU. When the ICU team came, the senior fellow noticed that I was extremely worried. He handled the situation more tactfully than me and again discussed the code status with the family. The sister, who seemed the only sensible family member, finally agreed to move her to the ICU. And according to the husband, I was responsible for her condition in the end. He was shouting so loudly, and I felt as if he would slap me at any moment. After the patient was shifted to the ICU, I took a sigh of relief. When I looked at the clock, it was past midnight. I didn’t realize that I was sitting in such a tense situation for many hours. Then I went to the cafeteria and the washroom. When I came back, I reviewed the records of all the other patients that I had neglected all day, and it took me a further three to four hours.

When I was done with everything, I felt as if the whole day had been very stressful for me. I remember those times when I was a fresh graduate and an intern at a public hospital. Being a junior doctor, I not only did the documentation, examination, diagnostic workup, and discharge work, but I was also responsible for moving the patient to another ward or radiology. I was responsible for getting their CT scans and X-rays done. I accompanied them to MRI rooms and had to make a lot of requests to the radiologists to do their scans because they never took the patient seriously until he or she was accompanied by the doctor. I used to roam around the whole hospital just in the hope of arranging life-saving medications for very sick patients. I did ambu bagging for whole nights on pediatric and adult patients in the hope of saving people. I used to draw the blood from all the patients and take them to the laboratory in person. I arranged blood and was responsible for the safe transfusion of blood products. I did dressings of every patient, changed stoma bags with my own hands, and monitored fluid intake and output on my own. I suctioned the secretions of patients with respiratory problems. I was responsible for maintaining the patients on inotropic support on my own. In my rotation during gynecology, the junior doctors were responsible for calling the patient’s attendants on the microphone to take consent before surgery or in case of an emergency. Men were not allowed in the labor room, OR, and ward, so we dragged the beds of our patients on our own. I feel as if the junior doctors were not only doctors but were considered transporters, clerks, nurses, dressers, and administrators, all in one. We couldn’t complain that we were overworked because we were getting trained at that time. The case is not much different in the private setup now as well because we get humiliated every other day with an excuse by the patient that “We are paying a lot.” The hospital administration wants to get the work done by four to five people by a single person just because they want to earn. The junior doctor has to listen to each and every complaint of the patient. Once, a patient called me to his room just to complain that the cucumbers in his salad were not sliced properly.

I was tired and exhausted after the round the next morning, and when I booked a ride home, the rider was extremely unprofessional. He took the longest possible route to my home and rode the bike on all the bumpy roads of Islamabad. He took all the flyovers and highways that made me uncomfortable. I was so weary that I couldn’t say a single word to him, although I felt as if I would slip from the bike at any moment. My hand became numb while gripping the handle on the back of the bike forcefully, and my shoulder started aching, but I had no energy left in me to complain.

These kinds of days always make me rethink my choice of choosing this profession as a career, and that too on my own will, just with a thought to help my people. I consider myself an empathetic physician and always think, why should I deprive my people of a doctor who is not only safe, kind, and knowledgeable but a great listener as well? But days like these make me think and reflect on my life. I feel as if I have wasted my whole 30 years. I couldn’t learn a skill, I was just studying my whole life. I lost my happiness and liveliness somewhere on the way. My hair turned grey at an early age, and I already feel old compared to my non-doctor friends. I became more responsible for my age. I forgot my interests and the things that gave me joy. I don’t know how to cook, I am zero at maintaining a household, I have no time to spend with my family, I have no life at all except to go to the hospital and come back. There is no concept of sick leave. I have to work even when I am sick, hungry, or sleep-deprived. I have no job security, and I am always fearful about my future. The employment options are very limited in Pakistan. The thought of becoming a failure makes me overthink every day. The bitterness of senior doctors makes me sadder every day. If I exclude the time it took to become a doctor from my life, I don’t know if there are any years that I really lived.

When I reached home, after breakfast, I went for a walk. The sky was still the same. The flowers were still blooming. I thought of all the happy moments in my eight years of practice when the patients hugged me, were thankful for my care, and looked at me with love. I tried to remember all the people who had always showered me with prayers. I tried to recall each and every patient who became cancer-free after the long and difficult treatment, and I felt joyful. I think Pakistani doctors are a lot more talented and hardworking than other doctors because we not only learn to work and manage with limited resources, but we play a lot of other roles besides being doctors as well. But the majority of our people are thankless and never hesitate to physically or verbally abuse the doctors at any moment. No one comes to our rescue when the situation is like this. Maybe that’s why most doctors try their best to leave this pathetic health care system, as their hard work is never acknowledged; they are underpaid and face physical and verbal abuse as well.

The author is an anonymous physician.