Editor’s note: This piece was originally published in 2011, when doctors all over Punjab went on strike to protest the inhumane working conditions that they have to deal with. However, the account is still relevant today.
My Dearest Amma and Abba,
Please forgive me that I chose to be a doctor.
I did not mean it to end this way, really. This reality is so deviant from the fantasy I had in mind that I just stand here, shocked and dumbfounded.
Do you remember, Amma, when you would tell me stories in the night and as I’d gently transcend into sleep, you’d kiss my forehead and pray to God for me to become a doctor? You would laugh when I’d play “doctor-doctor” with my little sister and pretend to magically solve all her fake ailments.
Your eyes would gleam, tenderly.
Do you remember, Abba, when I’d come back from school with my result card and you’d proudly show it to anyone who’d come visit us? You had dreams for me.
And I did everything I could to fulfill them.
Remember when I passed my intermediate with an above 80 aggregate and then I got into a good medical college? How you both almost danced with joy! I remember how you distributed laddos around the neighborhood and how Abba told all his friends that even though he was a factory worker, his son will become the best doctor in the town and that he will retire peacefully once I start living this dream for him. For a middle class white collar family, it promised so much. Abba gave all of what he had been saving from his meager income for my tuition fee so merrily, it made me cry.
I resolved to live up to his hopes.
I was your trophy. Your dreams became mine. And egged on by the hopes of being noteworthy, famous, selfless and I admit, financially stable someday, I worked harder and harder.
But little did I knew, that the destination was long and the road arduous.
I gave up friends and get-togethers just so I could study for my degree. I stopped playing outdoors just so I could manage to cover the colossal burden of my syllabus. I did not even realize when I turned from 18 to 24. I hardly did anything kids my age did.
All I thought was that one day I’ll make you both proud.
And finally the day came when I graduated. Do you remember that time? You had called up all our relatives and, swollen with pride, you had told them how I am now a doctor. Teary eyed. Gleeful.
As for me, I couldn’t wait to start experiencing what it really was to be a doctor; to begin my clinical experience – as a government hospital house officer.
There were so many like me that day, house officers and post-graduate trainees, eager to finally start the new life ahead… the practical side.
And then, the real story began.
We, the junior doctors, worked day and night, at a stretch for 24 to 36 hours, even though we got no recognition. We worked without electricity, without fans and without furniture. We worked in conditions so inhumane, it is impossible to describe; with filth lying around and cats roaming the wards. With not even a proper sewage system, let alone sterile equipments.
We risked our lives every day when we ascultated chests after chests of patients with open TB coughing in our faces, cleaned fungus-filled abscesses with stench so strong, it was nauseating even for their blood relatives. We carried patients upstairs on our shoulders and backs to get radiology done. To ask for expert opinion. We chipped in to buy medications for our patients. We were the first to come and the last ones to leave. We settled family disputes. We cleaned their bed sores, gave them medications, changed their cannulas and drips, recorded their vitals and charted their urine outputs – although these duties are primarily what a nurse is supposed to do in developed countries.
We ran codes and defibrillated alone because many a time our seniors were so busy and over-worked they couldn’t supervise us.
We declared deaths. We saved lives.
We had to break bad news to the family members all by ourselves because this is Pakistan and we can’t afford to have social services and grief counselors.
We volunteered when the flood came.
We rushed to hospitals at nights whenever emergency was declared owing to a bomb-blast. Amidst smell of freshly burnt flesh and relatives screaming, we tried to focus on getting the job done.
You know Amma, these people who criticize us, sitting in their air-conditioned rooms having decent office hours and proper lunch and tea timings, should at least come and see us once. The media should come see us once before they start putting up the most unauthentic news stories, Abba.
But this is not what they see.
The news is just not spicy enough, you see. Telling people about us young doctors country-wide who fight the battle on the frontline everyday doesn’t bring you enough TRP.
What brings TRP is masala news.
Remember when you saw the news of a patient expiring with his relatives and a local news channel claiming that it was due to our negligence? At first the news strip read “mubayyana ghaflat” and then within seconds “mubayyana” was excluded with the reporter shouting at the top of his lungs calling us killers and death devils. He was so sure that he did not bother bringing in a neutral qualified physician to document that this indeed was negligence. It did not, even for a second, go through his head that maybe… just maybe the patient was so debilitated, so terminal on arrival that all attempts went futile.
He captured all scenes of the relatives crying in the corridors and protesting but he did not bother asking from the poor house officer the other side of the picture. That patient had metastatic terminal colon cancer Amma. It was so advanced that even in the first world countries the survival rate is very low. You know Amma, we could have placed him on a ventilator but I work in the biggest government-run hospital of the city and we only have five ventilators, two of which are out of order. We have written several times to the provincial government for fund allocation and we were finally told that the budget is tight. It is not possible.
Do you know Abba that a single ventilator costs less than 1/10th of the price of a bullet proof car? Sadly, we now have to be very cautious in deciding who is worth being put on a ventilator and whose life is no longer productive enough.
Am I to be blamed?
But the reporter did not care.
All he wanted was audience. Nothing else.
Where was he when a cardiac patient crashed because the entire floor had just one defibrillator and it could not be used simultaneously on two patients? I can understand the government not understanding this because our leaders rush to the elite London hospitals on feeling the mildest of chest discomfort (which has a more political than medical differential diagnosis). But I expected him to at least understand and help us voice our concerns.
I am not saying that we are angels who can never be wrong. In fact, we are so over-worked, under-slept and burnt out that we are bound to err. But not always. And never intentionally. Maybe someday my country will understand this.
Remember the day when I came home all bandaged up? It was because I preferred admitting a sicker patient over someone who was influential but had non-urgent ailment. And his family members and friends beat me and my senior with sticks and canes and threatened to kill me. They verbally abused my female colleagues. You know, Amma, there was no security. Not even a single bodyguard. No one came to our rescue that day. We were all alone.
But who am I to complain, right?
There are incidents of even consultants and professors being beaten, physically and verbally abused and shot dead.
I know it hurts you, Amma, when you hear that all of my old friends who chose to be bankers, accountants, engineers and even taxi drivers are now earning more than me. You may not say to me but I can feel it. Oh, you should be glad Amma that at least I am being paid. Many of my co-workers are working without any stipend at all. You see, Amma and Abba, our government is very poor. So poor that they can only afford to pay a fraction of house officers and postgraduate trainees. The rest work without pay. Yes, we do get an experience certificate at the end but can a certificate really feed someone?
I can’t buy you a jora or Abba his hypertension medications with it, can I?
Although I was one of the lucky ones who did get a stipend but I thanked my stars that Abba is not yet retired or crippled or dead. For if he was, how could have I paid for the house rent, monthly groceries, our electricity and gas bills and still manage to save some for my sister’s marriage with just Rs18,000 and then later Rs30,000?
People tell me that the money will eventually come. But when, Amma? When you both would have died without me being able to send you for hajj? When I’ll be in my mid-forties? And even then, like many others, I’d be doing long hours of private practice on weekdays and weekends to afford a comfortable life. My oh-so-great leaders have enough money to promise to award cricketers with acres of irrigated lands on winning a single match but not enough to announce a decent pay package for us.
So here I am, like my other many young doctors, with no security or help or guidance or financial stability or hygienic meals or paid leaves or a job guarantee.
Should I at least have the right to protest? I am not responsible for the dismal condition of our health system. The government is. So why are these people pointing at me?
All I did was to withdraw my services from indoor and outdoor wards. I promised to myself that enough is enough. That I will not surrender until I am given my due credit and until the health conditions improve. The government did not listen. Mortalities and morbidities were nothing but figures to them.
And then we were pushed so much on the edge that we withdrew from the emergency services. The point is that, Amma, we did not stop the services. They were continued by our seniors. We just withdrew our services. The figures they quote regarding people dying due to our protests are also misleading. They comfortably include all deaths, regardless of the cause, nature and severity of the disease. And no Abba, I am not justifying the decision. In fact, we soon realized that the innocent people are suffering so we reopened our services for blast victims and in cardiac services.
All I am asking for is justice. Are any of my demands unreasonable? Many will critique on my way of demanding but they don’t know that we were silently protesting for a year. Nothing happened.
Please do realize that I am just 25-years-old. I am a son of this land. I decided to stay back and serve. Was that my crime?
I am sorry, Amma and Abba; I couldn’t fulfill a single dream of yours.
I know your hearts ache when you see me, day after day, protesting. Out on roads asking for my due rights like a beggar. But they just won’t listen.
My heart aches too. For my community. For this country.
Please forgive me for not being a better son.
Please forgive me for choosing to be a doctor.
A Young Pakistani Doctor
The article originally appeared here: https://mtrtmk.wordpress.com/2011/04/07/i-am-sorry-i-chose-to-be-a-doctor/