ABCD of ‘Military’ nursing: Avoid, bypass, confuse and when everything fails, do !

I was then a 22- years old Captain in the Indian Army, a doctor fresh out of a year- long internship at one of the premier hospitals of Armed Forces and posted to a station in Upper Assam. I felt ‘all at sea’ in the jungles of North Assam that were home to rogue elephants, had the world’s highest concentration of saw-scaled vipers per square kilometre and were endemic for Falciparum Malaria.

Nothing in my MBBS training or Internship at a lovely British Cantonment in Pune had prepared me for all this. I knew I could do with all the help I could find, irrespective of where that help came from. And I vowed to willingly learn from whoever taught me the nuances of ‘Military Medicine’. And that is where I met Havildar Nursing Assistant Makhan Lal or ML as he liked to be called.

This wonderful man, about 50 years of age, was truly an angel and a great teacher rolled into one. He was always polite, an epitome of patience and forbearance every time I was impatient and even petulant. He always had a faint smile on his lips and a twinkle in his eyes that I soon found out the reason for. I learnt, on asking some leading questions, that his 19-year old daughter was a student of my very Medical College, four years my junior and aspiring to join Armed Forces Medical Services.

He must’ve found my behavior rather amusing and not unlike that of his adolescent daughter. He had a head start in dealing with my kind. ML was always impeccably dressed in freshly ironed uniform and a starched white apron. He loved to get all the work done from his subordinates in the Emergency Room, and always had suggestions for them on how to complete the tasks assigned. It is another matter that he did not seem to do much him- self.

He always got back to me with a ‘Mission Accomplished’ kind of expression on his face. One day, I could not resist the temptation. “Havildar ML,” I began, “I always see a file clutched in your left hand, as you walk briskly across the hospital corridors. And I have never seen you fail to salute me even when you are so pre-occupied with some important work and in a hurry. How do you manage all this?”

With a deadpan expression, he replied, “Sir, I was taught early in my service that my uniform should be neat and tidy, my gait should be brisk and military perfect, and I should always carry a file in my left hand, even if blank. I should never fail to salute my senior even if 200 metres away. If I did all this, I could walk briskly all the way to my barracks and go to sleep in my bed with- out ever being questioned!”

But perhaps I am being unkind to the Havildar. There would be occasions when he and I would be the only people in Emergency Room of our hospital, all the others having gone for ‘Musketry Drill’ or ‘Range Classification’. If we received any emergency case, ML would happily join me in doing the triage and efficiently managing the patients, knowing well there were no others to outsource the task to. He had another philosophy to explain that- ABCD. I asked him to expand the term for my education. He replied, “Avoid, Bypass, Confuse and if all these do not work, then just do it.”

Ours was a primary care hospital located about 40 kilometres from a Base Hospital that provided secondary care, and was post- ed with all the specialist doctors. To get a specialist’s consultation and opinion on the management of a patient, the primary care physician had to fill a form called ‘Form 6’, with brief history and examination findings of the patient and a provisional diagnosis. One could then ‘refer’ the patient to the concerned specialist.

One day, ML brought an immaculately filled Form 6 of a patient and requested me to just sign it. I was pleasantly surprised, a little amused and faintly annoyed too. After all, referring a patient for a specialist consultation was my prerogative and not that of my Nursing Assistant. Nonetheless, I complimented him for his ‘referral’ and said it was as good as one written by a doctor. ML blushed slightly and told me how he had years of experience filling Form 6. An Infantry battalion in Peace station may have only a Nursing Assistant posted and no Regimental Medical Officer or RMO.

The Nursing Assistant, usually an experi- enced old hand, had to do everything includ- ing dispensing of medicines and even mak- ing referrals. ML said he had spent an entire two-year tenure in one such Infantry battalion off Amritsar with no doctor on the posted strength of the unit. While there, he often had to refer his patients to MH Amritsar on Form 6. He learnt how to do a fair job of it through sheer practice.

His reward was that officers and men of his unit always gave him the respect due to an RMO because he was their only ‘medical man’ in health and in sickness. ML loved to narrate a tale or two from his long personal experience to illus- trate his point. He narrated how his battal- ion’s second-in-command or 2IC once got obsessed that he was going bald due to excessive hairfall. Major Bedi, the 2IC, would often turn up to discuss the ‘problem’ with Havildar ML.

Any amount of reassurances failed to satis- fy the Major and ML thought that as an NCO, he was too junior to tell the 2IC the brutal truth that male pattern frontal bald- ness was merely a function of age and gen- der, and not a disease. One day, Major Bedi cast his diffidence aside and asked Havildar ML to ‘refer’ him to the Dermatologist at MH Amritsar for a consultation. Havildar ML, ever the obedient soldier, filled the necessary Form 6 and sent him on his way.

The same evening, during the Games Parade, Major Bedi sauntered into the M I Room with a bag in hand. And he placed all the contents of the bag- lotions ointments, shampoos, vitamin pills and some other drugs on the M I Room table. But he looked far from cheerful and his brow was clouded. ML asked him how did the Specialist consultation go.

Major Bedi replied that he was most thoroughly examined and only then given all those pills and potions, tubes and lotions and other stuff to arrest hairfall and allow hair to grow again. and then, look- ing straight into ML’s eyes, the 2IC asked, “Do you think all this will work?” ML cheerfully replied that there was lit- tle reason to doubt as he had been seen by the specialist himself, no less. Unconvinced, the 2IC asked again, “Man to man ML, do you think all this will work?”

The moment of truth had arrived. There was to be no beating about the bush with the Unit 2IC. ML gathered all his courage, assumed a solemn expression and asked, “Sir, did you not meet Lt Col Shekhawat, the renowned Dermatologist of MH Amritsar?” Major Bedi replied with an affirmative nod. ML then said, “Did you notice that Col Shekhawat had luxurious handlebar mous- tache but no hair on his head?” A stricken Major Bedi again nodded his affirmation.

“Sir, if Col Shekhawat could not grow any hair on his own head, do you think he will succeed in growing hair on yours? This is male pattern frontal baldness and it will affect most of us as we grow older and wiser.’’ Major Bedi shook his head one more time, quietly got up and walked out of the M I Room, leaving all the medicines behind. Havildar Makhan Lal added how pro- phetic he was that day, by rubbing his hand on his own scalp wistfully.