A soundless death

It was just a word,

A ‘mantra’
To be uttered
when we got stuck
We hadn’t seen it
hadn’t read much about it
It was sparingly mentioned
in our textbooks.
But our seniors reiterated that
we could fit it in anywhere
If we ran out of our list of investigations
and the examiner wanted more
we could invoke it.
It was the king of all diagnostic tools.

X-rays to see bones and stones
Collapsed lungs and enlarged hearts
were routine,
Modalities we had grown up with,
But to assess the abdomen
the legendary Pandora’s box
without cutting it open
seemed magical.
To evaluate soft tissues and solid organs
to see what is happening on the inside
from the outside ,
sounded unbelievable
It made diagnostic laparotomy
sound outdated
almost barbaric.

I saw it for the first time as a Junior resident
A small TV with a grainy picture
I was surprised that the radiologist could make anything of it
To my untrained eyes it was like staring at the moon.
You could see what you wanted to see
A smiling face or an old woman at the spinning wheel.
But that was just the beginning.

IMG_3095Slowly I began to notice the different shades of grey.
The interplay of light and shadows
In cysts and tumours
An abscess ready to be drained
Or a benign lesion
requiring patient ‘wait and watch ‘
Body functions in real time
urine filling the bladder,
food propelled in the gut
and the declaration of life
a tiny heart beat.

As technology advanced
images became clearer
Making it possible to see
Blockage to blood flow
A malfunctioning heart valve
A ripped retina causing blindness
The reason of a numb limb
or a swollen joint
It was possible to ascertain the release of
an egg from the ovary
and predict whether the uterine lining
was primed to receive it.
With some expertise, it could be told
when a pregnancy
didn’t make it to the womb
and got embedded elsewhere.
Putting the mother at grave risk

In cases of trauma, in a flash
it could tell whether
there was internal bleeding necessitating surgery
A tendon rupture or a lacerated spleen
Air pressing on the lungs or blood around the heart
Used on the road side
It could save lives by saving time.

With perfect picture quality and the option of 3D images
It can show a baby yawning out of boredom
Or lustily sucking at its thumb
Getting entangled in loops of umbilical cord
Or sleeping soundly.
It is possible to check the baby’s
eye movements
And heart valves
Count fingers and toes
Look for cleft lips and open spine defects
Diagnose conditions requiring expert neonatal care
So that a team is ready when the baby emerges
With colour Doppler we can predict
if the womb is inhospitable, fetal demise is eminent
and deliver the baby before it is too late,
It can diagnose defects incompatible with life
So that pregnancies can be terminated,
Curtailing the misery, lessening the heartache.

But just as it shows everything else
It can also show the genitalia of the unborn child,
which in our society is synonymous with female feticide.
Because in a son crazy nation,
a daughter will be killed ASAP,
The fear of misuse has condemned
the modality to disuse.
Buried in tons of paperwork
and tied in miles of red tape
It will never reach its full potential
An inexpensive, easily available, fairly accurate
diagnostic tool will die prematurely,

As developed nations
exploit this technology
And make it available
not only in hospitals and clinics
but in
ambulances and sports arenas
to hasten diagnosis
expedite treatment
and reduce mortality

We are curbing its reach.
The efforts to curtail its use
and limit the number of users
has had mixed results.
While the sex ratio at birth
has somewhat stabilised.
The child sex ratio continues to fall.

The fault is not in the machine
It is in the mindset
Till that changes
Nothing will change
A daughter can be eliminated
after she is born….
An Ultrasound is not a
prerequisite to kill a girl child!!

( published in The Hindu on 10/12/17)

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2 thoughts on “A soundless death

  1. Anjali Bansal says:

    Totally mind blowing. The evoultion of invesfigations along with our evolution as a doctor is mesmerising. Got hooked till end though felt last passage could have been more sharp and impactfull.
    Keep it up.

    1. Manju Gupta says:

      Thanks Anjali for reading between the lines
      Will try harder next time

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