The Duties of the beleaguered surgeon
Kartavya: Duty, Obligation
In my rare outings outside of the valley, I find myself meditating as the train slowly crawls through the valleys of Bulgaria as it makes its journey towards the capital. I have made this journey so many times that I have come to count on the landmarks as the measure of time having passed more than the watch I wear. It is a strange way to measure time, I am quite sure, but it is one of the things that I have discovered about myself. Sometimes, I make the journey north in ambulances, transporting the critically injured to the major hospitals in the capital. In those journeys too, I find myself peeking through the ambulance's windows as the measure of time. The view of the vast Pirin mountain range is a reassuring measure that the journey will become shorter, and as soon as I spot the small villages where the churches become sparse and the mechanical decay hangs over the valleys as surely as mist does, I know that we are approaching the capital. However, it is only when the Stara Planina mountain comes into view, resembling the shape of the Dronagiri mountain carried by Lord Hanuman, do I reassure the patient before me that we are almost there. If they are conscious, they will always look at me with a mixture of relief and fear: relief at knowing that the uncertain ambulance ride is almost over, and fear at the unknown that awaits them at the capital. I reassure my patients that I will be with them till they are assigned a room and therapy is started, and advise them to hold on to hope. The Stara Planina mountains beckon us pilgrims towards something that the patient before me will have to endure on their own. These patients, whom I have to transport, are my patients, because I was the one who saw them at triage, assessed them, and stabilized them. They are my patients because the responsibility of their care falls to me.
In the town where I live, alone as an Indian person, I am easily recognizable. Most of the recognition comes from patients or their families, and each time it is humbling to stand before the people I have the privilege to serve. In many ways, I lack the fundamental understanding of Hinduism, and I am not devout in the way I think the faith demands. However, I keep returning to an ancient word, one that I have not heard spoken in the decade since I left India: Kartavya, the fabric that holds my ethical decisions for as long as I can remember, and one that has felt natural to me. When I tire of the long shifts, and my hands ache from the retractors I hold, in my mind I remind myself of my kartavya, and it is the only still point in a moving world. For the non-practicing Hindu like myself, the practice of my faith is imperfect. I do not observe religious fasts, I do not say my prayers, and my knowledge of my cultural heritage is disjointed. Half-remembered tales of courage, duty, and piety come to me in bits and pieces, disjointed like the dreams of a long-forgotten youth. I cannot recall the words to most of the prayers I was taught as a child by my family, and sometimes, when I glance at the words of various prayers, I have to shamefully rely on transliterations in English to be able to say them. The words themselves stumble out unfamiliar and alien, and I stutter when attempting to say them. The syllables lack the gliding fluency I remember, and gifted though I may be in the acquisition of languages as a polyglot, the words of prayer in Sanskrit always elude me. I turn to the word I understand most, Kartavya, which means duty, and I reconcile myself with the imperfections of the man I am.
The word "Kartavya" is not merely the performance of duty, but almost a sacred obligation to perform one's duty. I understand my own Kartavya clearly, as a surgeon in training, foreign or not. I do not think of my duties and obligations lightly; I think of them when I am at the end of my physical endurance, or when I have reached my intellectual limits. There are days when I wake, early and longing for something that is not as challenging as what I face as I serve a catchment area of over 2300 square kilometers. Sometimes, when the night shift is dark and the patients keep coming, I stand before the hospital's entrance, remembering that it is my kartavya to push past my own limitations, and it is the closest I will get to any divine redemption. For the man I am today, forged through years of study and work, this is the only faith I can practice, because the rest of my own faith is fundamentally inaccessible. For a man incapable of reciting the prayers in the language of his forebears, the performance of duty bears the closest resemblance to divinity he can reach. In a distant time, I was prescribed prayers and rituals, including the worship and salutations to the Sun, through invoking Surya, the God of the rising sun. I dismissed the idea, as I woke before the earliest rays of the morning sun, and at the time of sunrise, I was at the hospital for morning visitation. I recalled the early morning walks through the dark forest to reach the hospital, and I remembered that I never saw the sun directly, only the slanted glow of the vermillion of its rays, glancing off the mountains. In the forest towards work, I have recalled the desire to stop, seducing me through the thousand different reasons I could use to turn around or stay meandering in the fresh undergrowth of spring. I admit that the temptation has come to me after long and difficult operations, or when every ounce of my being has been futile against an aggressive and destructive disease.
When all my faith is lost in my own abilities, I remember that it is my kartavya to show up to the surgical ward. It is my kartavya, as a surgeon in training, to enter the operating theatre and do whatever I can. It is also my kartavya to know when my duty is not to heal or restore, but to provide comfort and support and let men with greater skill take charge. The vast pantheon of our Gods, wherever they may be, will probably see fit to forgive the lack of ritualistic devotion of their only adherent, an imperfect mendicant. If they do not, then my conscience will.