Fiction: The lives of five Indian doctors intersect in an American hospital as each tries to belong

Wing B

Northbridge General Hospital

Dr Pooja Awasthi looked at herself in the washroom mirror and scowled. Apparently, her Pilates class was doing nothing for her. Maybe it was her evening binge drinking habit, or maybe it was just middle age, but the reflection staring back at her was not what she wanted to see. Her fading charm added to her growing second thoughts about the idea of beauty, and she couldn’t help but feel distressed.

Adjusting her hair bun, she glanced at her watch. 2.35 pm. Lunchtime.

As she headed towards the cafeteria, the shrillest scream she had ever heard froze her in her tracks. It was like a banshee going into labour. Was it coming from the maternity ward? No, that was on the other side of the wing – this scream was coming from the emergency ward. Dumping her lunch plans, Pooja sprinted towards the sound and located its source soon enough.

The emergency ward was alive with a cacophony of sounds – the low hum of fluorescent lights, the sharp echo of footsteps on sterile tiles and the relentless beeping of monitors. A woman in her mid-20s was being wheeled in on a stretcher, her distressed screams filling the air. She clutched her stomach, crying out in unbearable pain, her face twisted in agony; her skin was pale and clammy with sweat.

“What is it?” Pooja asked the nurse pushing the stretcher.

“Just came in. Extreme abdominal pain,” the nurse replied.

“Why wasn’t she given painkillers in the ambulance?”

“She was, but no painkiller or analgesic is working,” the nurse informed Pooja.

“What did you give?”

“One shot of a painkiller. When that didn’t work, we gave her Tramadol. It didn’t help either.”

“All right, let me see.”

“Dr Pooja, what’s your diagnosis?” her colleague, Dr Andy, asked as he joined them.

“Her stomach seems swollen with gas. I suspect an intestinal obstruction. We need a CT scan immediately,” Pooja said.

“They are cleaning the scan lab right now. A patient vomited in there. Can we wait?”

The woman’s screams grew louder, her body trembling from the pain.

“No, I don’t think we can. Let’s get an abdominal X-ray in the meantime,” Pooja said.

This is bizarre. None of the painkillers is working. What kind of obstruction can this possibly be? she thought as they waited for the X-ray results.

When the results arrived, they only baffled her further. Usually, gases turn dark on an X-ray, but in this case, the areas were plain black. This isn’t gas; this is something else, she thought.

Medicine is often taught from books, but real knowledge comes from experience – countless hours spent on hospital floors, exposure to raw human suffering and insights gleaned from unusual cases. It was moments like these that Pooja drew upon her subconscious library of experience.

And then it struck her.

A memory surfaced of a class she had attended a long time ago. She could still see Professor Sharma holding up a dried-up lump of hair retrieved from a patient’s food pipe, waving it dramatically for the class to see.

“Andy, check her scalp,” Pooja directed. “Anything unusual there?”

“Wait, let me – what? Scalp? What on earth has that got to do with her intestines?” Dr Andy raised an eyebrow.

“Just check, please; I’ll explain later,” she insisted.

Andy shrugged and leaned over the patient. Moments later, he looked up, eyes wide. “Doctor, she’s got big bald patches! What does that mean? Is she under some kind of treatment?” Dr Andy asked, baffled.

“Trichobezoar,” Pooja murmured. Dr Andy looked at her with scepticism. “Wait – you’re saying she’s got a bezoar? From hair?” he asked incredulously. “That seems kind of unbelievable. Let me check what the radiologist has to say.”

He turned to his computer and began typing furiously. “Let’s see…” His expression shifted to wonder as he read the report. “It says here that the indentation in the stomach lining, while clinical correlation is needed, reflects hair-like particles obstructing the pyloric region – the area where the stomach connects to the intestine. Most likely a foreign body… Hair follicles!” He spun around, staring at Pooja with open admiration, a wide smile spreading across his face.

“Unbelievable! You were able to develop so many differentials and rule them out. Genius diagnosis, Dr Pooja,” Dr Andy said.

“Get her to the Endoscopy Lab immediately; I’ll prepare for the procedure to remove it,” Pooja said.

A few hours later, Pooja went to see the patient, who seemed extremely exhausted but visibly relieved. Noticing the faint smile on her face, Pooja briefly explained what had happened. “Trichotillomania is an impulse control disorder where individuals compulsively pluck out their own hair and, in some cases, eat it. The ingested hair often collects in the stomach, forming a large, indigestible mass called a trichobezoar, which sometimes obstructs the intestine.”

“You’re lucky,” Pooja said softly. “We were able to remove the hair mass without surgery. No scars.”

The woman’s eyes welled slightly with emotion as she acknowledged ongoing issues with worry and anxiety. Then she added, “Thank you, Doctor. I thought I was going to die. The pain was unbearable, and I didn’t think I’d be able to handle it.”

“You did great,” Pooja reassured the young woman. “Don’t worry about anything else right now. Your mother is outside; I will call her in.”

The patient’s face wavered between gratitude and vulnerability. “My mother doesn’t know,” she admitted. “And I don’t know how to tell her. I hope you can help me with that. I don’t want her to be upset… But maybe it’s time I get help from a professional. I think I need it.”

Pooja nodded. “We’ll get you the help you need. You have already taken the first step by admitting to it.”

Stepping out of the room, Pooja requested Dr Andy to call someone from the Psychiatry Department.

“Her mother wants to thank you; she is waiting outside,” Dr Andy informed Pooja softly.

Pooja shook her head lightly, already walking away. “Umm, Dr Andy, can you take care of that, please? I am going to have my lunch.”

As she walked towards the cafeteria, she pulled out her phone. A text message from Dr Jindal from the Anaesthesia Department blinked on her screen.

“Diwali party tomorrow at my place. Be there at 19:00, please. —J”

Excerpted with permission from Voices in the Waiting Room, Mayank Gupta, Rupa Publications.