The story begins when the management of a charitable hospital suddenly decides to remove some of its most senior medical specialists for not bringing in sufficient revenue to the institution.
In their place, the trustees appoint a number of new consultants each of whom is required to pay lakhs of rupees as "donation." One applicant who refuses to pay is rejected though he is qualified in every way. Another who is appointed after "paying his dues" turns out to be mentally unstable and tries to murder his wife.
As medical director of Gopalji Damji Hospital, Dr Jagdish Choksi was perhaps the juniormost to attend the meeting. Despite his exalted title, he was painfully aware that his job depended entirely on the goodwill of the seven-member board of trustees. So he took care to arrive at the conference room several minutes before 3 pm, and heaved a sigh of relief as he entered because none of them had shown up yet.
In the sprawling lobby of the hospital, two admission clerks hunched over computer keyboards, hurrying to complete the medical records of several dozen patients who had entered the hospital during the morning. The workload was always higher on Monday afternoons because many senior surgeons avoided routine surgery during the weekend.
Just beyond the admission counter, the cashiers were busy preparing the bills of three or four patients waiting to leave. One of them was talking animatedly to the stocky gentleman at the head of the queue, possibly trying to convince him that they were not going to take the whole day. Soon, he would have to take a really close look at the administration department, though he knew that the crafty administration manager would not let go without fighting every inch of the way.
As he settled into the chair at one end of the conference table, Dr Choksi opened the bulky file in front of him and removed a thin sheaf of printouts that his secretary had prepared for him the previous evening. She had analyzed the records of all patients, which 14 of the hospital’s senior most medical specialists had looked after in the past three years. It also indicated the revenues that each of them had earned for the hospital.
One of the lowest was Dr Rajendra Kapadia, who always had less than five patients in the hospital at any given time, and most of them were in the general wards. These patients had to pay only Rs 50 per day as bed charges, including meals and the barest minimum for the medicines that they might need. The doctor also did not receive any fees from this category.
But a patient admitted in one of the deluxe rooms on the twelfth floor would pay at least Rs 3,000 per day, and the doctor could charge whatever fees he thought fit. Besides, the surgeons who charged astronomical amounts from gullible patients coming from the Middle East were generally favourites of the administration, since the hospital received a 30-per cent share from the doctors’ fees.
Dr Kapadia had been with the hospital for as long as he could remember, and Jagdish had come to regard him as an older brother, and confidante. Hence he had deflected every move in the past few months to ease the elderly physician out. But he probably would not be able to shield him any longer. Others too would face the axe sooner or later, for the management was quite determined that they should make way for the younger, businesslike set of consultants who had flooded the major hospitals in the city.
Jerking out of his reverie as Madhavji Shah entered the conference room, Dr Jagdish Choksi stood up to greet the chairman of the board. Dressed as always in spotless white dhoti and kurta, Shah looked a perfect illustration of the archetypal Gujarati seth. He had made his considerable fortune in agricultural commodities, buying turmeric, ginger, garlic and dhania directly at low prices from farmers all over Maharashtra and Gujarat, and selling them through thousands of tiny retail provision stores in Mumbai, Delhi and Kolkata. Of late, as a receding hairline kept reminding him of his advancing years, Madhavji had taken to wearing a dark gray topi, which he now removed and placed on the table. These days he maintained an office on the ground floor itself, just three doors away from Choksi’s own.
Shantibhai Mehta, widely known as Cement King, arrived a few minutes later, followed by Rasikbhai, the founder of Thakkar Developers, and then Prashant Kadakia, who at 38 was really the baby of the team. All had identical folders before them containing the analysis of revenues brought in by the different doctors.
“As mentioned in the documents provided to you, there are 14 honorary doctors who have earned less than Rs 50,000 annually in the past three years,” the medical director began. While he read out the names and the amounts mentioned against them, none of the trustees said a single word. Each of them was preparing furiously for the vicious wrangling that was about to begin.
It was barely 7 am. But the dining room on the sixth floor was already buzzing with activity. The stainless steel thalis were stacked high, one upon each other, ready for the young men and women in white coats, who would barge in for a hurried breakfast and rush out to begin their ward rounds. Today was Wednesday, the day of idli-sambar for the veggies and egg burji for the carnivores.
Being a junior resident, Vineeta Mahajan was in a constant tizzy, particularly if Dr Sanjeev Saxena, the chief resident with whom she had been assigned, came in for breakfast ahead of her. This happened not less than twice a week, but today she was in luck — Dr Sanjeev was nowhere to be seen. As she heaped the idlis on her plate, Vineeta prayed that her superior had not finished his breakfast and left.
As she bit into her second idli, she felt a hand on her shoulder, and turned around. It was Dr Anil Motwani from General Surgery.
“Has Dr Parikh seen that old lady in 904? Can we schedule her for tomorrow?” he asked her.
“No he hasn’t. But we’ll try to see her today itself,” Vineeta said, struggling to speak with her mouth full.
Fishing out a tiny index card from his apron pocket, Anil made a note to check if he had entered the reference in the case paper. Sometimes he thought the hospital insisted on too much paper work, and not enough time was spent with the patients themselves. But with the threat of the consumer courts hanging over their head, most doctors felt compelled to document every tiny detail in the medical records. In a tough call, it could be their only defence.
“No OT today?” Vineeta asked as the two hurried towards the lift to begin their rounds.
“There is a hernia repair in the afternoon, but nothing in the morning,” he replied.
Tomorrow, however, there would be a full list starting from 8 am and Anil was going to spend most of today preparing the cases, making sure that their x-rays and blood tests were done; and the reports ready for the pre-operative reviews (by the anaesthesiologist) later tonight. With any luck, he might be able to return to the quarters in time for the 9 pm news on Star Plus.
Vineeta’s first patient was on the 13th floor and Anil waved to her as she got out of the lift, but of the elevator door closed before she could wave back.
“There is a reference for Dr Parikh,” the dusky staff nurse told her as she entered the ward. She glanced at her watch and decided there was time to see the new case as well. It would save her the trouble of rushing back here before the honoraries began trooping in.
The new patient’s room was just two doors away from her own, and with a gentle knock, she stepped inside. “Good morning. I’m Dr Mahajan, Dr Dilip Parikh’s assistant,” she said cheerfully, as she looked at the case sheet in her hand. Veljibhai Narayandas had a slight temperature for the past few days and the urine report suggested a mild infection.
“Do you come to Bombay quite often?” she asked him, casually. It probably had no relevance to the case but she always made a special effort to put the patient at ease during their first meeting.
“Oh, yes. Earlier I used to come at least once a month,” the crusty old man replied. His growing textile business was now managed by his son, ever since Veljibhai began to have those fainting episodes a few months ago. And his visits to the metropolis had become less frequent.
His blood pressure was 180/110, Vineeta noted, but said nothing. It would have to be brought down before the stone in his right kidney could be removed. Using a standard proforma that she practically knew by heart, she questioned him in rapid-fire fashion for any other symptoms — like an unnoticed headache or hallucination that might point at something serious.
Next, she removed an ophthalmoscope from her apron pocket, and examined the eyes, where telltale signs of high blood pressure were often concealed. She found nothing that would worry the anaesthesiologist too much when the old man was operated upon next week.
They all wore the same worried expression, sitting or standing in small groups just outside the entrance of the Intensive Care Unit on the 19th floor. To Yogesh Tripathi, it seemed rather appropriate that the ICU was on the top floor of the hospital building, as though the patients on each of its eight beds had already made their reservations for the journey beyond.
The tightly controlled format of news writing, which had been his profession for the past five years, allowed no scope for such fanciful impressions; but he stored them for some future time when he might be liberated from the tyranny of the ‘inverted pyramid’.
Yogesh’s own father had been inside for five days, hanging on to life by a mere thread, as his liver and kidneys were quickly failing beyond repair. He wondered what had brought some of the others here, though he could gauge nothing from their faces. But he knew that the gentleman, who was now gazing out of the window across the corridor, prayed each morning to every deity that he could think of, so that his teenaged son would recover.
The young chap had been in a terrible accident on New Year’s Eve four months ago, and was by now quite unable to breathe without the help of a machine. His old man, however, was unwilling to surrender, turning up on the 19th floor everyday. Even if the boy did come out of the ICU alive, he would never be able to recognise anyone, much less speak or eat or stand up on his feet. Was such a life worth it? Wasn’t this a suitable case for euthanasia?
Dr Vineeta Mahajan walked briskly along the corridor, pushed the door of the ICU open and just before she disappeared inside, she saw Tripathi’s son standing near the entrance. She made a mental note to have a word with him about the old man as soon as she was free from the latest crisis. The pager message said the patient in Bed No 6, who was operated just yesterday, had slipped into a coma, and she was already chalking out a course of action to tackle it. She would most probably not have to put it into action, since the ICU doctors would never give the outsiders a chance. But she liked to be on hand whenever one of her patients faced an emergency.
Yogesh saw her too, but she hurried inside so fast that he did not get a chance to speak to her. He promised himself that he would catch her on the way out and decided to put off his lunch by a half hour, lest he should miss the opportunity again. But when there was no sign of Dr Vineeta after a full hour, Yogesh found himself debating whether to make a dash to the PCO on the ground floor and telephone his office or wait a little longer.
It was nearly 6 pm when Yogesh reached the Morning Post building, which had become his second home ever since he joined the newspaper five years ago. With his level of seniority, there was no need for him to do the graveyard shift; he could concentrate on special stories instead. But this fortnight it suited him because the whole day was free and more importantly, he would be able to hang around the office — ready to rush to the hospital at a moment’s notice in case there was some really bad news.
The Press Trust of India ticker tape, which nowadays came directly on the reporters’ computer screen, put out the usual stuff — an accident in Solapur which claimed four lives; a walkout in Parliament over alleged corruption by some minister; a rasta roko somewhere in Orissa. Then his eyes caught something about the Customs Department having seized a huge amount of smuggled gold from Sahar Airport.
Snatching up the bunch of press releases on his desk, Yogesh scanned through them rapidly until he found the one from the Air Intelligence Unit. Then he returned to the video display terminal to prepare the news item worth a maximum of four paragraphs on an inside page.
The canteen boy brought the first round of coffee a little while later and Yogesh decided to take a stroll along the corridor to the copy desk, where the next morning’s newspaper would have begun taking shape. It would go through many changes during the evening, but like most days, the important news stories to merit the front page had already arrived on the chief subeditor’s desk.
“What's happening in the city?” asked P K Murthy, the chief subeditor on duty, as he saw the night reporter amble along towards the desk.
“Nothing. It’s absolutely quiet on the Western Front,” Yogesh said.
“And the city page is empty,” piped up one of the junior subeditors.
“You can put my photograph,” Yogesh suggested.
“But that’s only if you retire or die. Company policy, you know.”
“If it is the latter, our deadline is 11.30. So be quick,” Murthy said, and they all laughed.
“Yogesh, there is a call for you,” said one of the subeditors, handing him the telephone. It was Pravin Sharma from the Times of India, checking if any accident, murder or robbery had taken place since the afternoon.
This was the night circuit, an informal arrangement of reporters sharing information about routine events with their fiercest rivals in the marketplace. Any chief reporter worth his cabin knew this informal system, for they had all used it in their time. But they always looked the other way, pretending it didn’t exist. Because no reporter could expect to cover the entire city night after night, without missing anything and it evened out at the end of the season.
The phone rang once again, as soon as Yogesh got back to his seat, and Yogesh cursed under his breath before picking up the receiver.
“Have you got any details of the derailment near Matunga?” asked Subramanium from the Free Press Journal.
“No. What happened?”
“Two air-conditioned coaches of some express train got off the rails between Dadar and Matunga. Five people have been seriously injured. Are you going to the spot?” Subramanium asked. Yogesh said he probably wouldn’t, since no one had died and it was already past 8 pm. But he had spoken too soon. Within ten minutes, his chief reporter, Dinesh Khare, called up and instructed Yogesh to leave for Matunga immediately.
“I think we should consider the names one by one,” said the chairman of the board, as Dr Choksi put the hit list in his outstretched hand. No one answered. Only after a full minute of dead silence did Madhavji realise that the others were waiting for him to begin.
“Alright gentlemen, what should we do about Dr Naresh Dayal? With less than Rs 40,000 per year, he is near the top of our list.”
“He is one of our seniormost doctors. It may not be fair to throw him out so late in life,” said Rasikbhai Thakkar.
“Yes, but he has a lot of property and investments. So he has no need to work,” Dr Choksi said.
“In any case, he was not earning much himself. So he won’t lose very much by not coming here,” said Shantibhai. The cement king had once approached Dr Dayal several years ago for a donation of Rs 50,000 for an orphanage in which he had been chief trustee. Dr Dayal had politely declined, and as a result, Shantibhai had found himself in a tight corner. Now was the time to pay the tightfisted character back in his own coin, Mehta thought to himself.
Dr Rajendra Kapadia was next, and then Dr Narendra Vohra. One by one eight names were scratched off the list — eight people who would receive polite letters from the Medical Director during the coming weeks, “inviting them to discuss their positions” as honoraries with the hospital. At the meeting they would be quietly informed that their admission privileges were being withdrawn. The timing, too, was perfect, because honorary doctors held one-year contracts from April to March, which were automatically renewed in the past. But the hospital had given no legal commitment to do so.
By the time the committee reached the ninth on the list, it was 5 pm. The heat of the April afternoon and the intense discussion had sapped their energy despite the cups of tea and coffee that came in at regular intervals.
“We might have a problem with Dr Gajendra Mody, because his billings were above Rs 2 lakh this year,” Dr Choksi said. They had been much lower in the previous two years, almost as if the aging orthopedic surgeon had got wind of the management’s plans before they had even been worked out. Also, the unions loved him, and both the director and the chairman were aware of this.
“But if he is going to stay with us, it might be rather difficult to remove Dr Ramesh Panchal,” said Prashant Kadakia, who had kept his mouth his shut till now. Just last month, Dr Panchal had examined Kadakia’s six-year-old son, Anand, who had fallen off his bicycle and broken his left arm. The little chap’s arm was still in a plaster cast, which would only be removed after another fortnight.
“You cannot compare the two, just on the billings of one year,” Prashant continued, “since Dr Panchal had a better record for the year before last. Besides, Dr Mody’s performance might be a fluke.”
“But Prashantbhai, we have to consider the overall record for three years,” Dr Choksi said, wondering if they would have to retain both of them. In that case, young Dr Ashish, who had just returned after completing his training in spinal surgery in Houston, USA, would have to wait for a while. Dr Ashish Sheth was also related to him by marriage and he would have to think up a good excuse before his wife’s eldest brother rang up the next time. Unwilling to give up just yet, Prashant pointed out that the hospital needed senior surgeons who had already made a name, to hold the fort until the younger batch gained the patients’ confidence.
“So we have Dr Mody. Besides, Dr Mody is a better surgeon than Panchal,” said Madhavji in a tone that said, “that’s enough, young man.” The youngest member of the team caught the look in the chairman’s eyes and decided not to fight any more. But he would make them pay for this, when the right time came, he promised himself.
Ratna Devi began searching for familiar faces, as soon as she stepped out of the lift on the 19th floor. In the fading sunset that April evening, she wondered how many more she would have to endure. Her son had already left for work; the poor boy was doing the night shift so that he could take care of his father during the day. And he must be getting quite exhausted.
She often breathed a silent prayer that he too would not get into some sort of trouble; she had heard too many stories about press reporters being killed or beaten up, to feel totally safe ever again. But Yogesh had insisted that he wanted to work at nothing else and his doting father had allowed him to go his way in life.
The high society butterfly, whose husband had undergone an operation, was not to be seen. Neither was the old man whose son had met with an accident. Perhaps they were here during the day, and had gone home to rest, she thought, as she moved towards the wooden bench. Two middle-aged men were already sitting, ready to nod off to sleep at any moment. Both men shifted slightly and Ratna Devi squeezed into the little empty space near the end of the bench. Neither of them gave up even a tiny bit of room, but Ratna Devi was in no mood to pick a quarrel just now. There would be enough time for that later in the night.
Through the heavy mist, she vaguely heard her name being called. At first it sounded like Yogesh, but that was not possible because he would probably be at home by now. She rubbed her sleepy eyes, and saw the young man in a white coat standing in front of her. Was he a doctor? What was he trying to tell her? Was her husband dead?
“He is completely out of danger,” said the deep voice coming out of the ether, “so we are shifting him to a regular ward immediately.” A hundred alarm bells rang in Ratna Devi’s head as she stared blankly at the young doctor, barely managing to read the name-plate.
“But can’t you shift him tomorrow? It is two o’clock in the morning and my son is not here,” Ratna Devi said, her mind racing to throw up some pretext, however flimsy, to stall the young doctor.
“We could have waited till the morning, but we need the bed very urgently. I have already spoken to Dr Parikh and he has told me that the patient can be shifted out without any problems,” said Dr Nilesh Prasad. He handed her a piece of paper with Dr Parikh’s mobile phone number, saying “you can also contact him if you wish.”
“Better try and find Dr Parikh’s assistants in the hospital itself,” suggested someone, as soon as Dr Prasad had disappeared into the ICU. Ratna Devi turned around to see the middle-aged man who was sitting next to her for the past several hours. But before she could even respond, the ICU door burst open and a stretcher trolley appeared, with Tripathi barely conscious enough to recognise her.
Two night nurses carrying plastic packets of intravenous saline practically ran alongside, trying to keep in position so that the plastic tubing and the needles in the patient’s vein would not be displaced. They escorted him to the Room No 1017, on the tenth floor, and with an efficiency born out of long experience, quickly explained the doctors’ orders to the duty nurses on the tenth floor.
Mrs Tripathi raced down the stairs to the pay phone in the lobby, and furiously dialed the number on the chit given to her some time ago. After nearly a dozen rings, she heard a mechanical voice say: “The mobile number you have dialled has been switched off or is not reachable at the moment.” The only choice now was to find the assistants; her adviser upstairs had apparently known that this might happen.
The call from the tenth floor ward went to Dr Vineeta first and she pulled on a t-shirt, which she was still adjusting properly as she strode briskly towards the duty nurses’ desk. Within moments, she was convinced that the patient should not have been shifted out of the ICU, and that, too, at nearly three o’clock in the morning. His blood pressure was still not steady, and his heart was beating a bit irregularly. Besides, the swollen face and abdomen made it clear that Tripathi was still very, very sick.
After a quick examination, Dr Vineeta picked up the internal phone, dialled the number of the residents’ quarters and fired the sleepy sounding peon, who rushed away to find Dr Sanjeev Saxena.
“Vineeta here,” she said, as Sanjeev’s voice came through, still thick with sleep. But by the time she finished summarising their patient’s condition, her superior was wide awake, and already dressing up as fast as he could.
“I'm coming there,” he said.
END OF CHAPTER ONE