Reformed by a Rasgulla
Rossogolla . Rasgulla . Roshogolla . Im not entirely sure if this syrupy dessert made of semolina dumplings and sugar is considered the king of Indian desserts , but I love it . It may not be good for diabetics , but they still enjoy it . In today’s calorie-conscious world , it may be branded “ very unhealthy “ but if you were to offer me one , I would surely gobble it up . If you think this is a Rasgulla recipe , please stop reading , for I can assure you , you will be disappointed ! If you decide to continue reading , I sincerely hope you’d find this encouraging and enlightening , just as I did .
It was the latter half of 2004 . I had just got back from leave after spending a few days back home with my parents . One look at the 8 year old boy during my morning rounds told me he was too sick to make it . I was the only resident doctor working in this mission hospital in a remote tribal part of interior Orissa . No mobile services , no internet , frequent power cuts and practically not much contact with the outside world . The nearest town was 1.5 hrs away by road , and the closest tertiary care hospital was a good 5 hours away . The staff were aware that they should not admit anybody who seemed ill whilst I was away . I was told that they had asked the patients father to take him elsewhere but he refused , citing financial reasons . This boy , RB , was extremely breathless , could not even speak a word . He was running a high temperature and looking at his chest wall movements , I knew he had a severe Lower respiratory tract infection . And when I touched his chest , all I could see was his face grimace in extreme pain . He was too exhausted to even shout his pain out . That’s when I realized he could be having an Empyema ( collection of pus in the pleural cavity wall that lines the outer part of the lungs ) This is serious , I was worried for him .
He needed further investigations , at the earliest possible .” Quick ,we need to first confirm the diagnosis , know what bug is in that pus , we need to get that pus out , he needs a chest tube to drain out all that pus , needs a specific antibiotic for that bug , and .. “ and the look on the nurse accompanying me on rounds said it all . It was as if she was telling me ‘‘ What are you talking about . Its almost 6 months since you’ve been here , and I know you’ve just got back from leave , but have you forgotten , we don’t even have an Xray machine here “. Oh great , now what do I do . A few weeks ago , before going on leave, using the Microbiology lab record I had used as a medical student , I had managed to order some reagents to be able to do a ‘ Gram stain ‘ , which would help in identifying bacteria , if any , from a sample . They had been delivered , more than a month since when I first placed the order , during the time I was on leave and the unopened packet was still lying in the small ‘lab’ where only a few basic blood tests were available .
I could speak five languages relatively fluently , was trying to learn the tribal language to make it the sixth , and I decided that I would myself speak to RB’s father to convince him to take his son elsewhere . I called him away from his son’s bed , and started talking to him in Oriya first , then Hindi but then realized he did not understand . The nurse pitched in to translate , something which I tried to avoid as much as possible because some times what I asked for/wanted to know and what the interpreter conveyed to the patient would be very different . Here I didn’t have a choice though , I was upset with myself that I hadn’t yet picked up the tribal language , but there was nothing I could do about it now – there was no way I could have had a direct conversation with RB’s dad .
I first told the nurse to make sure she told him exactly what I told her , and she nodded . One by one , I explained to him all the possible complications his son could end up with . But he still didn’t seem convinced to go elsewhere . Then I played my trump card , in a rather harsh tone ‘ Listen , your son will DIE if he stays here .’ I just wanted him to take RB and go , somewhere , if not to a bigger hospital , atleast home . I had already given RB his death sentence . I was hoping the father would take his son away before he started gasping for life . There was a brief pause , and I knew he’ d now agree to go , but to my surprise he told the nurse , eyes full of tears ‘ If he dies , he dies , but I cannot take him anywhere else . I can’t afford even the transport to the town . Please tell Doctor saheb to do whatever he can to save my son ‘ I was also thinking about the legal implications if he were to expire in the hospital but it was as if this illiterate man read my mind ‘ And please tell saheb neither me nor my family will ever blame the hospital ‘
I was shaken . What if RB died tomorrow , or later today , or now ? How could someone leave his child’s life in the hands of a young doctor who’s just graduated a few months ago , I pondered . Not stupidity , but helplessness arising out of poverty , I realised . Anyways I requested the nurse to quickly arrange for an aspiration of the pus , under local anaesthesia . I realized the anaesthetic wasn’t needed , RB was too sick to even realise that I had poked him . He was struggling to keep his eyes open . When I put the needle into his chest wall , there was frank pus , as I had anticipated . I took out as much as I could , till my fingers started aching terribly , withdrawing the pus out little by little . But there was no improvement in RB . He was still breathless , still struggling . I told the father his son’s chest was a “ well of pus “ and would need to go through this painful process of a needle poking his chest wall, repeatedly . I had never treated someone this way before , because in the tertiary care hospital where I did my internship , all such patients would be on a chest tube which allows all the pus to drain out . I had no clue how long it would take for him to get better . I called the pharmacy in the city to ask if they could send me a chest tube , but the earliest would be 5-6 days, as they would have to get a child’s size tube from elsewhere and then send it over to the hospital . That would be of no use . But I thought atleast if any other patient needed it , I could use it so told them to send it anyways . The manager there said he’d call me back in an hour to confirm the same .
RB’s whole family was in the hospital that day . His uneducated dad, mother , and his 3 elder siblings . I think they knew he wouldn’t make it , and so wanted to be by his side . But everyday when I went to see him in the ward , atleast 2 of them would be missing . I knew they took turns in cooking in the hospital’s common kitchen . But the dad would try his best to be there and meet me , atleast once a day , even though we never understood each other’s language .
The first few days I had to aspirate his pus twice each day , morning and evening . He couldn’t take more than that . His father would carry him daily from the ward to the procedure room , as he was too weak to walk . Using the recently-acquired gram stain reagents , I and the lab technician could identify a bacteria , and started him on the appropriate antibiotic ,wondering if he’d ever get better .
It was 6 days , and the chest tube hadn’t yet been delivered . I angrily called up the city pharmacy again . The manager said he had called back as he promised , the other day , in an hour’s time to confirm , but the hospital’s landline had gone dead after I spoke to him that day . He tried many times , couldn’t get through , as telephone lines would frequently go dead . After waiting for a couple of days , he finally sent back that whole set of chest tubes , to the main supplier who he got it from . I again requested him to send them over , as early as possible . If any patient like RB were to come to the hospital anytime in future , it would come in handy .
Ten days down the line , RB was still alive , and didn’t seem to be needing the chest tube anymore . He was doing much better than I had expected . With each day , the amount of pus I could get in the syringe was coming down . My fingers would still ache , so I would do this only after seeing all the other patients for the day , and only once daily in the evening . Also , I had to keep aspirating at a lower level in the chest as compared to on the first day . The illiterate but smart father , had mentioned this to the nurses too , that he noticed the “ well of pus “ was becoming drier by the day , and that’s why doctor saheb has to put the needle lower and lower . Not bad , I thought , for someone who never went to school and who spoke nothing but his own tribal language . That day on rounds I asked RB ‘s dad to ask him what he would like to eat when he recovers fully , he knelt down next to the bed , the father-son duo spoke for a while and the only word I could understand was RB saying “ Rasgulla “
RB was becoming wary of the pokes , he started to have pain but would quietly sit through without making a fuss . I was very impressed , never expected an 8 year old to be so co-operative with a painful procedure , that too everyday . He started to eat well , was able to even walk by himself from the ward to the procedure room . My fingers were not hurting like before , and this continued for 23 days . The 22nd and 23rd days , I could not get even a drop of pus . RB’s chest was full of needle marks , those on the top much better healed and almost unseen as compared to the marks on the lower part of the chest . But he was happy , playful , very alert and active . It was a miracle , a young boy for whom I had harshly given a death sentence 3 weeks ago was ready to go home .
I wanted to get him something nice to eat , maybe a chocolate or a box of sweets but being a small village , nothing was available . I’d have to get something from the town , which was not easy . Also if I got something for him , I’d have to get for all the other patients , atleast for all the other kids admitted in the wards , so I soon dropped the idea .
It was a weekday when he was going home , and RB’s dad came to my OPD room , accompanied by the nurse , to discuss something . I knew it would have to do with the bill . Being very poor , I even wondered how they managed to buy his medicines and antibiotics throughout those 23 days . The nurse said his dad wanted to leave a packet on the table , and he was requesting me to open it only on Sunday . And from their conversation I heard him say ‘ aaght ’ ( eight ) so I told her “yeah that’s fine , let them pay that and go . The rest they can pay later , whenever they can “. I wasnt sure if the eight meant eight hundred or eight thousand rupees , but I was sure they could’t clear the bill and I told her to tell the clerical staff to let them go after they paid whatever they could . The nurse seemed a little upset , but I couldn’t understand why . After all , we were letting them go without making any fuss about the bill . I waited for her to come back to me to get my signature “ Can leave the ward without settling the bill “ but she didn’t . I knew one of the office staff would come back later .
RB and his family left to their village in the hills . I would never get to meet him again till I left the place to pursue my postgraduation studies . I had so gotten used to seeing a bubbly boy in that bed over the past 3 weeks , that I didn’t like it when his bed was empty . I suddenly remembered the nurse looking upset in my OPD room when RB’s dad had come to discuss his bill , and asked her about it . She asked me if we could go to my OPD room and open the brown packet sealed with a thin redtape on the table . It was a vacuum-packed tin of Haldiram’s Rasgullas . I was surprised , how could such a poor family give the hospital an expensive tin full of sweets . I wanted to know how much it cost and was searching for the price label when she said “ Sir , the other day when he said ‘ aaght ’ he was talking about this tin , which has only eight rasgullas . And that’s why he wanted you to open it on a Sunday . He noticed that that’s the day we work with the minimum number of staff . He said he could not afford to get more sweets , and on a regular working day there wouldn’t be enough rasgullas for everyone ‘ I almost sank in my chair . But what about the bill , I thought they didn’t have enough to clear the bill . I was wrong again . ‘ All his siblings took turns to go and work in the fields as manual labourers , and that’s why they were missing every other day when you went for rounds . They cleared the entire bill before they left the hospital ‘. I was amazed , they worked hard and earned enough not just to pay for his treatment , but also to travel to the town and buy a tin of eight rasgullas when I completely stopped entertaining any ideas of getting something for him . “ And sir remember when he was getting better you asked his dad to ask him what he would like to eat when he gets better – RB’s dad actually asked him something else , he asked him what they as a family should give us the day he leaves the hospital , and RB said ‘ Rasgulla ‘ . She was not in tears , and the only reason I didn’t speak to her for the next few seconds was so that she would not hear my voice cracking with guilt . ” Sir the tribals are always genuine . They always do what they’re supposed to do , whole-heartedly ” The family was no longer with us , but I genuinely wanted to ask her if we could return the unopened tin and give back the money to the family , but I did not , purely because I didn’t want her to hear me cry .
How wrong I was . How humiliated I felt . I was ashamed . I was a doctor , I was drawing a salary every month , but I was a pauper compared to them . They weren’t poor , I was – with my thinking , my mindset , my pre-conceived notions . What a valuable lesson the boy and his family taught me that day . I still love Rasgullas , but to this day , that has been the only instance when I flatly refused to eat one . I remember the staff coming and asking me , “ Sir there’s just one last sweet left , are you sure you don’t want .” Yes I was sure . I could never eat that priceless rasgulla . And also , I never bothered searching for the price label of that tin , coz I was trying to put an MRP ( Maximum Retail Price ) stamp on something – their motives , their gratitude and their thinking – which was absolutely priceless .
A decade and a half later , I got an email whilst away in the UK on a short term job , from one of the staff in the hospital . By now the village had got internet and mobile services too . They had sent me a picture of the family , clicked in front of the same procedure room where he had his chest poked for 23 consecutive days. The family was doing much better than earlier , and had managed to build a small house too in the hills . RB had grown up , he and his elder brother had both got a Government job and would soon need to move to the town . Before moving out of the village , with heartfelt gratitude , they brought a few tins of sweets for all the staff in the hospital . And yes , no prizes for guessing what was in those tins – Rasgullas . Just that this time , it was a weekday and there was more than enough for each of the staff .
The pharmacy from the city did send a full set of chest tubes , but long after RB had left . During the rest of my time there , I never had to use the tubes , RB was the only one who presented with an Empyema , the only patient who ever needed the tubes , but he got better and discharged even before they arrived . And by the way RB is not his real name . Everytime I see or eat or even think of a rasgulla , I cannot help but remember a priceless tin of eight rasgullas , a wonderful family and their 8-year old RB – the ‘ Rasgulla Boy . ‘