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Monday 6 April 2020

If n-Coronavirus Passionately Falls In Love With Me, This Is What I’ll Do As A Medical Doctor With Fifty Years Experience

Into the seventieth year of life and having survived a life-threatening heart attack in January 2017, I’m fit as a fiddle – thanks to Mother Nature – and do my bit as an activist along with co-workers in Delhi. Were n-Coronavirus to take abode in my body and I develop mild symptoms like ‘flu’, I’ll quarantine myself strictly at home. Presently 1.25 billion people in India are anyway under a lockdown but are allowed to visit the market place for buying essential items; though of course I’ll have to stop these visits once flu-like symptoms appear. But what about millions who have no home or financial resources? Lockdown ordered in many countries across the globe should make everyone aware – at least now – of what Kashmiris and Palestinians have gone through in the last seven decades.
At home I’ll take a tablet of Crocin (Paracetamol) if fever rises above 100° F. Apart from my usual cardiac medicines I’ll avoid all drugs. Will keep myself well hydrated. Of course middle class existence ensures meals, but what about the working class during clamp-downs?
I do not underestimate the reach of the watchful eyes of the Big Brother; a District Magistrate can – under cover of the Epidemic Diseases Act, 1897 – dispatch a policeman to get me forcibly admitted in a hospital for ‘treatment’. Under protest I would agree. Once having settled there I’d try to ensure a letter-petition challenging the Constitutional validity of the Epidemic Diseases Act, 1897 – a law enacted by the erstwhile colonial rulers. This Act is a Draconian Law which takes away the civil liberties and democratic rights of a citizen. The Indian Higher Judiciary takes up Constitutional validity cases in the presence of real-life case, which I would have become by then.
After the confirmatory tests for COVID-19 get undertaken, were I to develop breathing problem then X-ray chest/scanning of chest would be done to confirm presence of pneumonia. If prescribed antibiotics for pneumonia I’ll discuss with the treating physician since existing antibiotics cannot tackle pneumonia due to n-Coronavirus. I won’t let the treating doctor bluff me. I see no point in consuming medicines which are useless or harmful by way of side-effects. I won’t consent to being administered untested drugs even if  this has the tacit backing of W.H.O. Recently an Italian tourist visiting India – upon developing pneumonia due to n-Coronavirus – was administered such untested drugs. He subsequently died in a hospital in Rajasthan. This qualifies to be an ‘encounter death’ – a term used for cold-blooded murder of innocents by uniformed security personnel in India!
As for relief to my breathing problem I’ll consent to medication like steroids, bronchodilators for opening up my respiratory passages keeping in mind my underlying heart condition.
At a later stage – when breathlessness becomes severe, as it will likely – if need arises for a ventilator, I’ll deny consent for two reasons.
Why I will opt out of a ventilator?
Firstly, ventilators (along with their appendages) are difficult to be sterilised properly; and actually give patients another type of pneumonia (iatrogenic) which may be impossible to treat. Ventilators notoriously often become vehicles of introducing drug-resistant, hospital-borne infection – often fatal – against which existing antibiotics have become ineffective. My second reasoning is this:  I see no logic in this exercise.  I’ll explain –
True, ventilators could be of use in patients with severe pneumonia in which the causative organism is known and antibiotics – tested and duly approved – exist. In such a situation a course of antibiotics could clear the pneumonia (congestion/patch) in 1-2 weeks or more. Once the pneumonia has resolved and patient is able to breathe on one’s own (voluntarily), he/she is gradually weaned off the ventilator! A happy development in ordinary case of pneumonia. However in the case of COVID-19 pneumonia (really nasty one at that) no time-tested and duly approved medicine exists. In some countries (including India) untested drugs are being used in limited cases (like the Italian tourist treated in Rajasthan with fatal results).
About patients or their relatives (if patient is not conscious) who consent (read coerced) to untested drugs and also ventilator, the attending doctors feel they have done their best; the patient’s family, friends and well-wishers go through an emotionally exhausting period. It is the unconscious patient who suffers the ordeal; with the ventilator in place the patient has to be sedated 24×7. As the nurse regularly sucks the fluid out of the respiratory passage a perceptive person can observe the patient’s body twitch. And the pneumonia will not resolve since medicines don’t exist as of now; the doctors will not remove the ventilator on their own; these doctors would quote the Hippocrates oath in their defence. The immediate family members won’t have the courage to ask for the ventilator to be switched off; neither the priest nor a judge will provide a clear-cut answer.
Finally Mother Nature resolves the dilemma created between the doctor and patient by a machine called Ventilator. The weakened flesh of the patient succumbs to multi-organ failure after days of ‘avoidable medical torture.’ At that point of time sleep’s elder brother/sister – to wit death – takes over. The philosophical question remains un-answered. Whose life is it anyway?
After not consenting for a ventilator, I’ll request the medical staff to consider administering me oxygen through nasal tube; and intra-venous fluids in case I’m not able to eat anything orally. That done, I will thank the medical staff and request them to leave me alone. Every human being has a right to peaceful and graceful exit from planet earth.
P.S.
  1. This piece is clearly not an advisory; patients should follow the advice of their attending doctor.
  2. Yes, ventilators have a role in many conditions as a temporary aid & should be considered.
  3. It is understandable if patients consent to un-tested drugs.
  4. Mortality rate for n-Coronavirus infection is under four percent. Over ninety-six percent recover.
Dr. P. S. Sahni is a member of AIDS Bhedbhav Virodhi Andolan (ABVA) and has worked in six epidemics/infectious diseases – Cholera (1971) West Bengal, bordering Bangladesh; National Small Pox Eradication Program (1974) Bihar; Leprosy (1984-89); Cholera (1988) Delhi; Plague (1994) Delhi; HIV/AIDS (1988 onwards).
Email: aidsbhedbhavvirodhiandolan@gmail.com

1 comment:

  1. Many thanks Dr. Sahni for writing and sharing this article with all your experience ... this can only come after selfless dedication and consistent work with the poor and marginalized communities .

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