“Something I did Not Expect”
Hailey Kay Robles-Holmes
Written in July, 2019. Hailey was a first year MD-MPH student at the University of Miami. She completed her Fieldwork Project with WSH in Chennai and Salem, India and has chosen to continue working with WSH for her Capstone project. This is her first reflection piece.
On our second day in India, my co-medical student and I leave the hospital in an “Ola”, India’s version of Lyft™, and set out for the fish market where our patient’s home is located. I have acclimated to India’s driving conditions since yesterday. The street lines are pretty much optional and horns are used as frequently as turning signals. The three of us pack into the second row and travel fifty minutes to our destination. The house is deeply woven into a neighborhood, so we complete our last leg of the journey via auto-rickshaw.
When we arrive, the air is filled with the aroma of sea salt and dead fish. The dock is busy and overcrowded by bright blue and green boats jammed into rows. When we arrive at the house, we are greeted by the patient’s wife, and we remove our shoes. We walk a couple of feet from the front door into the master bedroom that has enough space for the patient’s bed and three chairs where we sit. The patient is an older gentleman with bandages wrapped around the right side of his face. He talks to the nurse with mumbles and hand motions; miraculously, she seems to understand him perfectly. Her soft smile and warm eyes pay close attention to the pain in the room. After a couple questions about his recent bleeding, she gives the wife time to leave the room and begins undoing the dressings on his face.
As she peels the tape and gauze back, she reveals a monstrous tumor that has proliferated from the patient’s tongue. It is difficult to distinguish if the large mass involves the cheek because it stretches the right side of the mouth completely out of view. The tumor is a combination of yellow, green and black. As Asha rinses the area, the bottom of the lesion begins to bleed. She quickly grabs a basin to catch the stream of blood that continues to flow even after applying pressure. Blood begins to pool down the side of the patient’s neck and behind his back. She requests a linen to absorb the blood and the wife hands me a shawl from the door frame, making sure not to witness her husband’s current condition. After some time, the nurse calls our attending doctor and an ambulance is ordered. The wife begins to cry in the kitchen, her husband overcome by drowsiness at this point.
In the midst of all this, I take time to look around his bedroom. Pictures of him and his wife hang from the walls and shelves. He is barely recognizable. In the pictures he has a strong build, wearing an all white suit and gold chains, his hair dark and thick with a finely polished mustache sitting above his lips. Now he lies in his bed, bald and emaciated, with a feeding tube hanging out of his nostril. His wife also looks different. She is distressed and, we find out later, chronically ill herself. I try to imagine what must be going through her mind. She suffers from heart disease, diabetes and currently has typhoid. She wants to be taken care of, but she must be the caregiver. She must wonder about the future… when he dies what will come of her? She will live in the house, littered with memories of their life together, and be filled with grief and her own sickness. I assume she must be terrified, overcome with anxiety over the present state of her husband, and also fearful that the future will be worse.
The ambulance takes 30 minutes to arrive. The nurse has since begun IV fluids, hanging the drip by a self-made sling of gauze wrap. I make note of her resourcefulness. After the ambulance leaves, we wait for our Ola to bring us back to the hospital. We both doze off in the ride home, still battling the jet lag from our 28 hour trip the day before.
Exact details, names and other identifiers have been changed to protect the privacy of the patient.
By Hailey Kay Robles-Holmes