What Next Bombay?

I’m not going to recount the episodes that have occurred in the past. I’m not even going to dwell on the 3 blasts that brought about this post.

I am just going to vent, so if you do not want to hear complaints and anger, get away from this now!

The psyche of people living in BOMBAY (this is how I am going to refer to my city, and anyone who wants to pick a bone with me regarding this, I dare you!) has changed so drastically that now that something even remotely close to tragedy happens, we’re tuned to brush it off unless it has affected us directly. We were called by many people living outside the country, family and friends who are as close as family, all afraid because the BLASTS had taken place in our city. All concerned and rightly so. The atmosphere at home and the clinic was slightly different though. According to them, we were nowhere close.

My wife, bhabi, nephew and son were all at Metro that evening. I was at babulnath. Yet we thought it was fine because we were ‘nowhere close’ to the blasts…It was close enough for people not in the city to call us, but as long as we were a kilometer away, we were far off and not affected. Most people in areas of terror attacks fear for themselves even if they are miles away. It just doesn’t matter to us anymore.

26/11 was frighteningly close to my home. I was at Mondy’s as it happened. Our friends stayed over that night! We were afraid then. Nothing this time. Repeated attacks have either made us really strong or extremely stupid.

The other thing I want to rant about is people blaming the politicians and the intelligence agencies. What do you think they were supposed to do. We live in our city, spit on our roads, litter like there is no tomorrow (or dustbins), get irritated when cops stop us or have a nakabandi because it screws traffic and still proceed to blame them the next time something happens.

I remember the drunk driving crusade that the cops started. I loved it. Used to feel proud when I stopped seeing cops working in the dead of night to prevent people like us who drink and drive from dying. Most of us though, disliked it. Hated them for catching us, if they did. Cried foul when licenses were taken and court appearances demanded. Would you drink and drive internationally….I don’t think so!

You want to live in a safe city, reclaim it from inept politicians. Take your own responsibilities seriously. Stop at the goddamn red light for a change. Even better, get your license legally without a bribe or an agent. There are enough and more rules and laws. All we need is to implement them, and we shouldn’t need the police to tell us or force us to do so. Of late, I have been intentionally driving into people coming down the wrong way in a one way street outside my home. One uncle on a scooter almost fell, yelling at me for doing it purposely and was shocked when I said yes I did. Hopefully, he won’t be riding down the wrong way again. I also picked up some chewing gum a 40 something Aunty spit on the road because the shopkeeper wouldn’t let her use the bin. Small things but it’s a start.

Do something, don’t just rant on facebook and twitter.Also, don’t dismiss candle marches so easily. It may not have got the desired result last time, but it did shake up the government. Libya also started with something as small.

If you think you have the guts to make a change happen, stop the next cop you see riding on his bike without a helmet and ask him where the hell it is. My mom has done it and I have never been more proud of her. Stop the cop riding on JJ flyover when he won’t let other bikers ride there. Yell your lungs out at someone asking for a bribe and watch him wet his pants. They only do what they want because the majority let them.

Lastly, this thing is not about religion. It never was. It’s about making a stand and voicing opinions. They want our attention and they have it. I liked Advani’s point about learning from the US. He, however, did not specify what to learn. Should we learn to give body cavity searches to people in wheelchairs, or learn how to bomb the countries we like least?? Or is it the fact that there has not been another attack there…. You can’t copycat nations. You don’t have an identity if you do that. We wouldn’t be independent and a democracy if we did. We got through the British, we can get through terror. All it takes is a few very angry people from one very angry city to start something. Be it traffic rules, or terror. Do something!!!

NIGHTMARE OF 26/11

This is a small write up of what an anesthetist went through on 26/11. I thought it was an amazing read and asked if it could be reproduced here. It is unmodified and exactly as she wrote it out. 

"It all started around 10 p.m. There was a lot of confusion in the casualty. We heard some terrorists were gunning down innocent people.

Patients were being brought to the casualty and directly being admitted to the ICU where the initial steps of resuscitation i.e. Airway, Breathing & Circulation were being taken care of. Patient’s that were brought unconscious were immediately intubated with Nasogastric Tube insertion, considering all were full stomach.

The anaesthesiologists were called in the casualty & ICU to help initially, but later, we realized this was turning out to be a mass casualty. As the patients were pouring into the hospital in battalions, we knew more was to be done. We got the Major O.T., the orthopedic O.T. and the neurology O.T. opened. All this took place in such a fast pace only due to the great co-operation of the O.T. Matron and sisters & ward boys. There was blood shed everywhere. Victims were being rolled in. We mobilized extra trolleys for anesthesia drugs. All 7 operation theatres were opened.

All the anaesthetist consultants were stuck at home because of the curfew situation so the anesthesia residents were left to manage this critical situation. I, Dr. P.R. was a 3^rd post anaesthesia resident with 5 more juniors with me. Our team was led by Dr. J.C. who was the chief resident. We were ordered to use Ketamine & scoline for crash induction & muscle relaxant Pavlon (Pancuronium) for maintenance. We assumed all patients to be full stomach & accordingly carried out crash induction.

Ketamine: Drug of choice for induction because unlike propofol / pentothal, it causes tachycardia & hypertension thus maintaining vitals in a haemodynamically compromised patient.

Scoline: Induction relaxant of choice as scoline brings up the pressure, also causes

excellent relaxation & is the agent of choice in crash intubation.

Pavlon: (Pancuronium) long acting muscle relaxant. Relaxant of choice as it causes sympathetic stimulation, tachycardia, hypertension. Also due to long duration of action requires less top ups for maintenance. As we were short staffed & had to manage multitude of tasks including fluid electrolyte balance & blood management, pavlon really helped us.

Most patients brought in were critical with multiple bullets, in a state of shock, so patients were maintained on100% oxygen and muscle relaxant top ups. These patients were not reversed at the end of operation & were sent to I.C.U with the tube for staged weaning after confirming their general condition.

Some patients with minor injuries were extubated on table provides they had good vitals to begin with & were conscious.

Aspiration prophylaxis Ondensetron & Rantac were given.

Patients with multiple bullet injuries were brought in, most of them with shock, feeble pulse, unrecordable blood pressure. A direct arterial line was managed in those cases where central lines were not possible. Peripheral lines with wide bore cannulae were used to push blood. ‘O’ Rh –ve blood was used when cross matches were not available. Fluid management with initial crystalloids & colloids was carried out and as blood became available after cross matching, we pushed it along with Fresh Frozen Plasma and Platelets.

Ionotropes namely dopamine, adrenaline and nor adrenaline were started to maintain falling blood pressures.

Resuscitation was done in full swing and monitoring of Pulse, Blood Pressure and SPO2. Keeping the blood pressure in mind, sedatives like midazolam were avoided.

One of the cases was a Japanese National who was very critical with multiple bullet wounds in the liver & intestines. We tried our best to resuscitate him along with CPR and shock but alas, couldn’t save him.

Of particular interest was the case of J. N. This female was brought in with multiple bullet wounds with a multitude of fractures including arms, pelvis, spine and left brachial artery tear. Her pulse was feeble, blood pressure unrecordable and only after crash induction were we able to obtain a Right Femoral arterial line (left femur was bruised and fractured). We started ionotropes alongside fluid resuscitation and blood, FFP and platelet transfusions.After 12 hours of surgery, on the next day she was taken to the ICU where further management of her DIC (disseminated intravascular coagulation) and general care took place. We thought she wouldn’t survive but miraculously she pulled through.

Totally 23 operations took place that night, out of which two expired on the table. The cases kept rolling in, some commando’s included in them. For 4-5 days the hospital was a war zone. In this way, the mass casualty was managed in a hospital in Bombay!"

I could actually feel what she must have gone through. This post is dedicated to her bravery and spirit of working right through the calamity. We will never forget!