This piece was written by my cousin, Dr. Chand Sahai who had sent it to me several months ago. It first appeared in Housecalls, an In-house magazine for Dr. Reddy’s Laboratories.
Or can you?
I don’t know what possessed me: something evil and Machiavellian no doubt. I registered for the three day Advanced Cardiovascular Life Support (ACLS) course. So what? Someone might comment, in the States doctors do this course every two years, it is a must. Okay, but here in India ? And at the tail end of one’s professional life, you know when you have grey hair, wrinkles, pain in the joints and don’t like divulging your real age (except when one is the army chief and wants to carry on being one, so you say you are younger)?
Anyway, one fine Sunday in December last year I get this routine e-mail in my inbox over which I cast a cursory glance and am about to hit the delete button, when it dawns on me that the course in question is to be held in my backyard, that is in the hospital where I have worked for the past quarter of a century. The sheer convenience of it was so tempting and yet… The only reason I was a mite hesitant was that I would be in the company of babes: post graduate students, residents and others in the green category. Be brave doc, I told myself, at least or at last something has sparked interest in your dull mundane routine and your grey cells haven’t given up on you altogether. Who knows I might even be able to give Alzheimers the miss.
So before better sense could prevail allowing me to change my mind I went down to the Intensive Care office, handed them a cheque (the best things in life are not free, no matter what the song says) and was about to leave when the secretary said “Wait, please take your course materials and instructions with you”. I was handed a red book, about 8½ by 11½ inches (and yes I actually measured), had the stamp of the American Heart Association and it was all of 183 pages (including the bibliography and glossary) and I had about a month to read those pages, which also had several algorithms which were to be mugged up to the spinal level that is remembering the steps without thinking. As for the instructions, please be on time, appear for the pre-course test online and bring the results with you and wear loose fitting comfortable clothes (avoid tight jeans, saris and the like), the last flummoxed me for a second then I had it, we needed to be comfortable if proper chest compressions could be carried out.
I have to admit that the fear of showing up as a half-wit in front of those kids, who would be with me during the course, had me studying much harder than I did for all those professional examinations. Imagine how mortifying it would be were I to fail to make the grade while the kal ka chhokras (yesterday’s kids) passed with flying colours. So I literally burnt the midnight oil staying up and trying to learn new and not so new facts, awake way beyond my normal bedtime of 10pm, and then I made the ghastly discovery that my memory wasn’t what I thought it was: there were big holes in it, so large that an armoured tank could probably roll right through the gaps in the neurons in the prefrontal lobe and the hippocampus. So what could I do to shrink the sieve size of the wire mesh surrounding my ability to cram and increase the retaining power of what was left of my brain, so that every time I read a paragraph in the red book it didn’t feel as if I was seeing all those words for the first time. After putting in a lot of thought, two things occurred to me. One that I needed to remember facts and figures for just three days (the time of the ACLS course plus the examination) and second that whatever I retained happened to be the pages I had read the previous day or night.
I managed to get through one reading of the red book, including trying to decipher all those ECGs that were to be deciphered within 10 seconds (so that one could decide like Hamlet in his soliloquy, with the necessary substitutions, to shock or not to shock). Of course if one were to just do the BLS or basic life support then the AED or automated external defibrillator, intelligent machine that it is will take over from undependable, unreliable humans with short attention spans and shorter retentive powers, and let you know if the rhythm is shockable or not.
So the night before the start of the ACLS course I sat for the online test, where the instruction before you began was to save and print your results (something one certainly wanted to forget as soon as possible). The next 10 or 15 minutes I felt I was on a rollercoaster ride definitely of the against gravity type, the questions came on fast and the verdict too (correct or not) till at the end one was out of breath. The result was not too good actually wasn’t that bad either, but certainly ACLS was going require more attention and energy than what I normally expend during any normal workday.
I dressed in ‘loose fitting comfortable’ clothes, and as I got out of the car hoped that no one was looking in my direction for I was feeling as uncomfortable as someone with his or her head on the guillotine. All ignored me; thankfully, everyone was busy swotting at the last moment. The hall had life-sized dummies, all white and inert, laid down on the floor, that was a shock; I somehow had expected them to be on trolleys. The world is meant for the young who are energetic and agile and the older lot should only be the thinkers, pulling strings and planning strategy to be translated into others doing the hard physical work. We would be working in teams (as team leader or team member, one would learn to be proficient in both). The first day we had to clear the BLS, which meant watching a video where an athletic looking gentlemen is shown jogging with a friend and they stop for a breather when suddenly one of them clutches his chest and falls to ground to the horror of his friend and several bystanders, but since it was the USA someone called 911. In the meantime we learned that the old rules of airway, breathing and circulation or ABC had changed to CAB, in other words chest compressions are the ‘in’ thing now after one has ‘cleared the scene’ (is it safe for the rescuer to start rescuing or is there going to be another casualty, for instance in the middle of a busy highway, you might get hit too) next one shakes the shoulder and says “Are you alright?” and look for any breathing/pulse in the neck and then get on your knees (not to pray) but to ‘push hard and fast 100 times/minute. The last one was the most difficult, the only things that I had pushed for the last several years were the buttons on the remote of the TV or the car, and I could not recall when I had knelt on the floor and done chest compression which I counted loudly so that the team member at the head end of the dummy would know when I had done 30 of them so that two breaths could be delivered. I can tell you that I felt quite light-headed and dizzy with the effort and couldn’t help but think that I could have easily replaced that dummy on the floor and given the participants some real-time practice. Then it was repetitions, repetition, lunch, tea, breakfast and an evening ridiculously easy written test. I must confess that the food part was really good but made the post lunch sessions murder, trying to keep awake.
The ACLS was more complicated but basically involved more chest compression and a dummy attached to a machine which measured if your compressions were done correctly (apparently mine were, to my delight), real defibrillators and scenarios like trying to revive an old man against the wishes of his son (one team mate got flustered and shouted ‘security’ when the family member intervened) it turned out that we hadn’t bothered to find out the time frame and in an actual scenario would have been trying to revive a long dead corpse.
There were a lot of laughs, we all learnt a lot, met many doctors from the hospital at close range, sat for a really easy looking but actually a sneaky multiple choice test paper, scraped through and received a certificate. But the question is would I do it again? Not on your life, at least not for another two years, that should give me enough time to join a gym and dye my hair.