Pursuit of Medicine by Damini Paul.

This is how it goes on TV: A patient’s blood pressure drops, he has stopped breathing and heart monitor shows a flat line. His heart has stopped! Everyone panics until someone grabs a defibrillator. They shout “Clear!”. The patient’s body jerks off the table. And then he gasps as he is shocked back to life.

Resuscitation is the thing that is most often portrayed inaccurately, in both books and TV. The scene above is so ingrained in the average viewer’s mind that it is nearly impossible to get writers and producers to change it. No one even questions it. It’s familiar, so it must be correct, right?

As I board my plane for Ukraine on the night of September 7^th, there was just this one thought bothering me. While everybody else took their seats and immediately dozed off, I couldn’t stop thinking about the several things really wrong with the above stated scenario: FLATLINES.

I’ll explain why. Your heart beats because of an electrical impulse. Each cell generates a tiny impulse. In normal heart, they all work together, making one big impulse, which is the big peaky squiggle you see on a heart monitor- the heartbeat. This makes sure all the muscle cells in your heart contract at the same time, so you can pump around a lot of blood. Now, if something happens and the tiny impulse doesn’t work together anymore, you get a chaotic line, up and down all the time. You can’t recognize the heartbeat from before anymore. This means that the muscle cells don’t work together any more either, so your heart can’t pump. It’s like trying to squeeze something while wiggling your fingers. Effectively, this means your heart has stopped functioning. It can’t pump blood. This is called ventricular fibrillation.

Soon, I fall asleep thinking about the mechanism of ventricular fibrillation. The fact that I left my family behind at the airport, the fact that in a few hours I’ll be at a totally different country, surrounded by people who speak a different language, a language that I’m unfamiliar with; the fact that I left my old life behind to start a new one didn’t seem so overwhelming anymore. Why would it, anyway? After all, this was and is what I wanted. From the time I was a young girl, I grew up listening to stories of how my grandmother, her family having lost everything after the Partition Of Bengal in 1947, sacrificed her dreams of studying medicine and becoming a renowned doctor, because of lack of financial support and the pressure to provide for a family of ten. How she took up a teaching job in a small government institution at the age of twenty, to afford education for her younger siblings in India, to give them the support she never got, to help them become the doctor she could never be. Which, much thanks to god’s grace and favor, she was able to do and is the reason why I can proudly say that I come from a family of doctors.

Waking up the next morning and waiting for my flight to land, I began thinking about the previous scenario again: FLATLINES. 

Ventricular fibrillation is when shock work best. What a shock does is ‘reset’ the heart. It overloads the muscle cells, all at the same time. So after being overloaded, the start beating again, but now they’ve been overloaded at the same time, so they restart at the same time. Now the heart contracts at the same time and it works again.

As my flight was about to land, I start forgetting about the flatlines and become more aware and conscious of my surroundings. This was finally happening. I was finally reaching my destination. I began to realize that the moment I step into the airport, Boryspil airport, my new life begins. I was about to take a step towards my long awaited bright future. Despite coming from a family of doctors, I did not have it easy on me. Dreaming of studying medicine in India is like trying to herd cats; difficult and exasperating. No matter how brilliant a student you are, the education system will force you to question your own potentiality. In a country such as India where the demand for health infrastructure far outstrips the supply, a compromise of commercialization might be unavoidable. There is also a powerful case to be made for the quality of private healthcare being higher – which is great, if you can afford it. There are currently 370 medical colleges in the country that offer 49,840 MBBS seats between them. This makes India the largest creator of doctors in the world. In comparison, the United States only produces 18,000 doctors a year. Roughly half of India’s medical seats are in private colleges whose habit of collecting capitation fees is an open secret. Here’s a statistic for you though: doing a back of the envelope calculation, if 24,260 seats are allotted with Rs 50 lakh capitation each, that totals up to 12,130 crores a year in shady fees.

And the Medical Council of India hasn’t had time to look into this?

I got off the plane with my companions and one of my seniors, cleared customs and met the rest of the crew at the airport. The feeling was mixed. I’m not going to lie, I was scared. I was scared of the all the new people and I was scared of the new place which looked so different from the place where I come from. I was scared to face the new challenges that awaited. I was scared but at the same time, a part of me was happy and overwhelmed with joy because I finally made it and all of this was finally happening. I would get to study medicine, meet  other medical aspirants who shared the same dreams and wished for the same future, I would be taught by such learned teachers and most of all, I would get to live a life where education was human friendly. As I got inside the cab with my luggage, I heard my senior say, “Make yourselves comfortable, it’s a long drive to Vinnitsa.” I struggled to get into a comfortable position and somehow after 5 minutes, I found myself resting my head on the bag that’s on my lap, closing my eyes and contemplating about the former scenario: FLATLINES.

 A flatline is what we call a asystole. It means ‘no heartbeat’. There is no electrical activity in the muscle cells. So, there is nothing we can reset, even if we wanted to. Though, even in the line on an asystole isn’t completely flat, unlike on TV. It’s more like a very gentle wave. If it’s flat, your equipment is probably broken. Asystole is treated with IV epinephrine (or adrenalin, same thing) and chest compression. There’s not much else we can do. The survival rates are, as expected, much lower than those if a ventricular fibrillation, which can be shocked.

It took us exactly 5 hours to reach Vinnitsa from Kiev. We were already starving and exhausted, but as we reached our destination, the place where we are supposed to stay for the next 6 years of our lives, the places that is going to be the initial building blocks f our lives, the place that is going to either make us or break us (and I wish the former for everybody), the place that is going to be our home for the upcoming year and the people, our family; I wasn’t so exhausted anymore.

I grew up watching and reading Dr. Benjamin Carson, hoping every day that someday I might grow up to be a successful neurosurgeon like him. Having lost my grandmother to a neurological disorder which could have been prevented with the right treatment, just fueled the fire within me. And now, I took the initial steps. I looked around myself and at the people who made this happen; a bunch of future doctors, medical aspirants helping other medical aspirants build their lives. At that particular moment, I realized that we are a team. I was filled with gratitude, still am.

 As I entered my allotted room, I heard the voice of my senior and it will forever be etched at the back of my cranium, “Few months ago you all were competing against each other, but from now this changes. From now, you have to compete with yourself, no one else. Tomorrow will be new day. Don’t let your past anchor you down. Here is your chance, take it!”