Do me a favour, kill me

Despite this being a Sunday morning and there being no urgency to get up early, Prashant found it hard to sleep. The lingering thought in his mind refused to go away. His mind kept on reminding him what he had been observing for the last few days. In privacy he had googled his condition and the answers that he got made him worried. Prashant glanced at his side; his wife Sunita was fast asleep; on another cot his ten-year-old son Pradeep was also deep in sleep. Prashant tried hard to push away all his worries and go to sleep but his mind kept on playing the fears that had persisted with him since the last few days.

It had begun on the last Wednesday morning when Prashant had observed that his urine was not the usual yellow clear liquid but there was a perceptible frothy residue after he had peed. Prashant continued to visually monitor his urine on the next few days and observed that every time he passed urine there was a froth in the liquid. He again googled his observation and the answer he got pointed to kidney disease. After some more self-research, Prashant noticed that he had slight swelling in his legs especially the ankles.

In the next few days Prashant confided his condition to his wife and then decided to consult a doctor. Ten-year-old Pradeep, still in class five, had no inkling to what was going on in his family. A battery of pathology tests confirmed that Prashant was suffering from advanced kidney disease. Prashant came to know from the doctor that the frothy urine was the result of protein leaching out from his kidney into the urine.  Symptoms developed fast, within a month Prashant started experiencing fatigue, swelling of feet and ankles, muscle cramps, itchy skin, and shortness of breath. With blood creatinine levels reaching abnormally high levels, the doctors advised dialysis.

Pradeep felt something strange happening to his father. He observed that his father and mother looked worrisome. On occasions he observed that his mother was weeping with no apparent reason.

Prashant knew he was terminally ill. The frequency of his dialysis increased. He started hallucinating. It was again a Sunday early morning, approximately six months later from the day when he had discovered froth in his urine, that Prashant lay awake in his bed. Today his creatinine levels had shot to extreme levels. He was feeling very weak. It was at seven in the morning that Prashant felt a sudden cold shiver. Sunita stood by his side. Prashant tried to focus his gaze to where his son was sleeping but his eyes did not obey his wish. His eyes became still. Sunita knew her husband had lost the battle. She shrieked.

Things were not the same for the family after Prashant’s death. Sunita had to fight a continuous battle to survive. She worked hard doing menial jobs to sustain a living and to afford Pradeep’s education. On occasions when the circumstances would turn unmanageable and hostile, she would find strength from her husband’s words remembering that Prashant dearly wanted his son to become a doctor. Sunita worked beyond physical limits to fulfil Prashant’s dream. The only solace for Sunita was that Pradeep excelled in studies. He would invariably come first in the class and never forgot that his late father wanted him to become a doctor.

When life becomes hard, time usually passes slowly but the reverse happens when there is a specific goal that needs to be pursued. Seven years passed so fast in Sunita’s life that she forgot the pain of Prashant’s passing away. Pradeep became her straw to whom she remained clutched. On his part Pradeep didn’t disappoint his mother. Pradeep qualified the NEET examination in the first attempt, and thus started the family’s journey towards fulfilling the dream of Prashant.

The five years of the MBBS course went smoothly. Pradeep excelled in all his yearly examinations. After completing his MBBS course Pradeep was confronted by two options, either to take a government job or go in for a higher degree. Seeing Sunita work for extended hours Pradeep wanted to join a salaried job but Sunita coaxed him to go in for higher studies. After much persuasion from his mother, Pradeep took the examination for getting admission in the Post Graduate course of medicine. The results came and Pradeep, on the basis of his high merit, got admitted to the Master of Surgery course.

The two years of the Post Graduate course went without any hiccups. With some stipendiary support, Pradeep now tried to put less pressure on Sunita for sustenance. Years of hard work and emotional stress had made Sunita age faster than her biological age. Almost daily she would relive the memory of Prashant. At times she tried to find a reason why God took away her husband so early. For minutes together she would gaze, empty eyed, towards the photograph of Prashant. Her only solace was that Pradeep had fulfilled his father’s dream. This was the best thought Sunita would relish amidst all the sorrow in her life.

Pradeep cleared his MS and during the course itself he had developed an interest in nephrology, the branch dealing with kidney disease. His interest in nephrology was probably dictated by the memory of his father. In fact, his memory of his father was loaded with the events which happened while his father was battling kidney failure. Thus, even Dr Pradeep did not understand whether it was a coincidence or a divine blessing that he immediately got admission in an advanced course in Nephrology at the All-India Institute of Medical Sciences.

Dr Pradeep took advanced training in kidney transplant, a highly specialized field. While completing the course at AIIMS, Dr Pradeep became so busy that his visits to his hometown became infrequent. It was during a brief visit to his hometown that Sunita brought up the subject of Pradeep’s marriage. Seeing the happy glint in his mother’s eyes, a rare sight, Pradeep had no option but to say ‘yes’. A decision dictated not by his choice but as an acknowledgement and culmination of the tireless efforts that his mother had put in to make Pradeep what he was today. In a couple of months, the marriage was fixed and solemnized.

The teenage boy who had left Allahabad after completing class XII finally returned to the city after eleven years with a degree in general surgery and a further advanced training in nephrology and kidney transplant. Dr Pradeep approached a few banks for a loan to make a super-specialty hospital and to his amazement several banks agreed to fund his ambitious project.

The Adarsh Super-specialty hospital was inaugurated by Sunita in a modest ceremony attended by close relatives and some friends. The hospital became functional and soon became a hit amongst the middle class offering highly specialized medical services at affordable cost. Within months Dr Pradeep Awasthi became a well-known name in medical circles.

Dr Pradeep added more specialized instruments to his hospital and soon carried out the first kidney transplant on a sixty-year-old woman who had got a kidney donation from her daughter. The news of first ever successful kidney transplant in a tier II city became a national news.

In the months that followed, the fame of the Adarsh Hospital grew at a fast pace. The medical fraternity started to acknowledge the expertise of Dr Pradeep. On his part Dr Pradeep enjoyed the lime light that he was getting. The constant flow of funds from the hospital was more than enough for Dr Pradeep to step into the higher echelons of the society. Within a couple of years, the fame of Dr Pradeep had travelled to several adjoining cities. In his own right, Dr Pradeep had become a celebrity doctor.

Within a span of just a few years, Adarsh hospital carved a name for itself as the best hospital for kidney transplant. Since kidney transplant was a costly medical procedure which only the rich could afford, Dr Pradeep’s clientele boosted of the most influential people.

Money, fame and acquaintances do not come alone. These things come with certain side effects. To move in the high society where only the rich and influential survive, one needs to imbibe certain traits. The highly successful Dr Pradeep, the best nephrologist in North India, suddenly became a far shadow of the boy who had lost his father at the age of ten and whose childhood and schooling had deep wounds of his mother’s hard labour.

Money begets money. To walk in the fast lane, Dr Pradeep’s mind searched for avenues to enhance the infrastructure of the Adarsh hospital. He wanted to make his hospital the best hospital for kidney transplant. The procedure for kidney transplant was a very profitable operation. Once the hospital had all the facilities in place, the running cost of conducting a transplant was very small.

It was a Monday late evening when Dr Pradeep received a few visitors in his hospital. The visitors had come with a heavy recommendation of a Cabinet minister and therefore Dr Pradeep gave them full consideration. The visitors were swift in coming to the point. They handed Dr Pradeep a manila envelope which had several sheets of papers. Dr Pradeep glanced through the papers and nodded his head. Within minutes he understood what the papers described. The papers presented the clinical and pathological profile of a teenage boy who probably was in late stages of kidney disease.

The visitors told Dr Pradeep that the boy whose clinical profile was in the papers was the son of Jamshed Bhai. The person speaking to Dr Pradeep took the name of Jamshed Bhai in such a way that, in his opinion, there was no requirement of any more introduction.  Dr Pradeep knew who Jamshed Bhai was. Dr Pradeep felt a chill down his spine. Although he had never met Jamshed Bhai but had heard a lot about his position as a well-known criminal in social circles. Dr Pradeep became circumspect; on his part he didn’t want to antagonize Jamshed Bhai but he had to tell him that for a kidney transplant there has to be a kidney donor also. Dr Pradeep told the visitors that he needed to talk to Jamshed Bhai.

The car which took Dr Pradeep to Jamshed Bhai’s mansion was a black Mercedes and was sent by Jamshed Bhai. The car drove directly inside the residence. Dr Pradeep found Jamshed Bhai well mannered and polite. In the conversation that followed,  Dr Pradeep told Jamshed Bhai that the process of kidney transplant was dependent upon someone donating a kidney, also that the clinical parameters of the donor must match with the person receiving the kidney.  From his personal experience, Dr Pradeep knew that for a normal person the criteria of finding a kidney donor was the most difficult precondition, however, he didn’t see any such worry in the countenance of Jamshed Bhai. Without any fretting, Jamshed Bhai asked Dr Pradeep what was the procedure to select a compatible kidney donor. Dr Pradeep told Jamshed Bhai that the first step was a general blood test and after that a few other tests were required. It was just before midnight when Dr Pradeep returned to Adarsh hospital. His mind preoccupied in deciphering how Jamshed Bhai had been so cool with respect to finding a compatible kidney donor.

Jamshed Bhai didn’t sleep after the doctor had left. He strategized. Within a couple of hours after the doctor had detailed the general conditions of a possible kidney donor, two black Thar jeeps and a Fortuner left the residence and started the prowl. Within a couple of hours, the vehicles returned. The five gagged persons who were made to walk silently inside the mansion included two labourers, one rikshaw driver and two beggars. None of the persons had any idea why they had been abducted. 

The technician from the Adarsh hospital was picked up from the hospital as soon as he arrived and escorted to the mansion, he was ordered to take the blood samples of the five men. A phone call to Dr Pradeep ensured that the blood tests be completed as soon as possible. Dr Pradeep saw the blood test results and matched them with the clinical profile of Jamshed Bhai’s son. Two samples out of the five blood samples matched the clinical profile. Information was sent to Jamshed Bhai and by afternoon one rikshaw puller and a beggar were sitting in Adarsh hospital, both had no idea why they were in hospital.

The transplant procedure was scheduled after the next couple of days. The operation took four hours and was successful. Jamshed Bhai personally came to Adarsh hospital to thank Dr Pradeep. On the tenth day a happy fifteen year old boy was discharged from the Adarsh hospital. On the same day a frail nondescript rikshaw driver was also wheeled outside the hospital. Two men guided him to a waiting Thar Jeep.

Two days passed, the Adarsh hospital was crowded as usual in the forenoon. A few patients sitting in the waiting hall were reading a Hindi newspaper. A minor four-line news item on the third page was too small to catch anybody’s eyes. The news item related to the death of a rikshaw driver in a road accident in the preceding night.

Time passed fast and Dr Pradeep climbed the social and financial hierarchy of the city. His bungalow was an address by itself. His list of properties spanned the country. He owned shopping malls and business establishments. Rumours had it that he charged crores of rupees for kidney transplant and on an average there were three or four such transplants each week.

Not just kidney transplant, Adarsh hospital was also known for its other surgeries. The hospital was always full with patients. As part of the protocol, Dr Pradeep had made it mandatory that the hospital must keep a record of the clinical data of all patients irrespective of the surgical procedures required. He had got developed a software that categorized all patients according to their MHC (Major Histocompatibility Complex) compatibility, known as HLA  (Human Leukocyte Antigen). This is the major parameter that plays an important role in organ transplant.

Given the huge prestige of Adarsh hospital as an acclaimed Kidney transplant centre, Dr Pradeep frequently received requests from politicians, bureaucrats and bollywood stars. All these requests were accompanied by an unsaid offer of no holds barred money. After all, kidney transplant was always a death saving intervention. More often than not, the kidney recipients were also willing to pay any amount of money to a donor which the hospital could arrange.

Money, fame and prestige often come hand in hand with malpractices. Science says that every human has a sense of ethics which is innately ingrained. These ethical values constantly dictate what is right and what is wrong. The first instance of an unethical practice is difficult to undertake however after a few such instances, the human brain becomes blunted. The mind becomes insensitive to ethical values. Over the course of years, during which Dr. Pradeep had achieved fame, he had imbibed the trait of medical malpractice without any remorse.

There had been several instances in the last few years where kidney was secretly taken out from unsuspecting patients who were under treatment for other abdominal surgeries in Adarsh hospital. Since such instances always involved recipients who were rich and famous, the money that Dr Pradeep received for such transplants was astronomical.

Mondays were always hectic in  Adarsh hospital.  The forenoon OPD clinic was consistently oversubscribed. Dr Pradeep was neck deep in work when his secretary silently whispered something into his ear. Dr Pradeep abruptly ended the ongoing session with the patient who was on the other side of his table and took the phone from his secretary. With a wave of his hand he gestured for his secretary to leave the room. Once alone, Dr Pradeep stood from his chair and then said ‘hello’ to the caller on the phone. 

The conversation lasted seven minutes, the only answer to all questions from the other side were replied by a polite ‘yes’ by Dr Pradeep. Once the call was over, Dr Pradeep called his secretary and informed that a VIP appointment needs to be scheduled at four in the evening. The OPD session, which had been halted, resumed in Dr Pradeep’s chamber.

At exactly quarter to four a high tech ambulance entered the Adarsh hospital from the side gate which was usually reserved for VIP entry and for Dr Pradeep’s personal use. The patient was immediately wheeled inside the hospital under the supervision of Dr Pradeep himself. While the patient was being shifted to the reserved ICU, Dr Pradeep leafed through the file of the patient. The clinical history of the patient was bad. As per the pathology reports both the kidneys of this forty six year old woman had failed. To be alive the patient was undergoing dialysis every alternate day. Dr Pradeep knew that the only option that could save this patient was urgent kidney transplant.

The blood test reports including MHC profile came in the evening. Dr Pradeep was too overawed by the family relationship of the patient and realized that to ask any questions would be difficult. Just as he was contemplating options, Dr Pradeep’s secretary handed him his mobile and in a hushed voice, covering the mic, whispered something. Dr Pradeep greeted the caller softly and listened with respect. Several times he said ‘yes sir’ and asked no questions. The call ended in four minutes.

Dr Pradeep opened his laptop and scanned the list of patients currently undergoing treatment in his hospital. He gave a command in the software and the screen displayed eight patients who were currently undergoing treatment for gastrointestinal problems. From his software he looked at their clinical profile and matched the same with the profile of the woman patient who had been admitted to ICU and who needed a kidney transplant. Of the eight patients he scanned on his laptop, he could identity only one patient who, in his opinion, could be a prospective kidney donor.

Jagdishpur was a hamlet approximately twenty kilometers from the city. Sukhbeer was a small farmer who had inherited a small piece of land from his parents. The land was just enough to sustain his family. By the time males in cities go into college, Sukhbeer already had a wife. Shanti was only fifteen years when she got married to Sukhbeer. Within a couple of years of marriage Shanti had experienced two miscarriages. However, the next pregnancy went to full term and young Janwi was born after three years of marriage. The family of Sukhbeer lived a contended life in their one room cottage. Despite living at the edge of poverty, Sukhbeer was by and large happy.  He loved his wife and spent evenings playing with his daughter.

It was a usual day in the village when in the evening Shanti complained about severe pain near the navel that shifted to the lower right abdomen. Sukhbeer became worried. He went to the village market place and consulted the doctor. The doctor gave some medicines which brought relief to Shanti that evening. A few days later Shanti experienced a fresh episode of abdominal pain accompanied by vomiting. The doctor repeated the medicine but advised that Sukhbeer must take Shanti to a better hospital. As a passing comment, the doctor mentioned that the best hospital for such a medical problem would be Adarsh hospital.

It was five in the evening when Dr Sudheer decided to see the patient named Shanti who had been admitted a couple of days back in the Adarsh hospital. From the record available on the computer database, Dr Pradeep understood that the patient Shanti was suffering from an inflamed appendix and that she was scheduled for an appendix removal operation the next day.  Dr Pradeep made an entry in the software mentioning that he will himself operate Shanti for the appendix removal and that the operation will take place in the Operation Theatre # 3, this was the operation theatre normally used for kidney transplant operations.

Before calling it a day, Dr Pradeep’s mind again reminded him of the next day’s important kidney transplant and on an impulse decided to meet the woman who was scheduled for appendix operation. Dr Pradeep walked into the general ward and went straight to bed number seven. The doctor on duty and the supporting staff never expected Dr Pradeep to come to general ward. Everyone sprang to life. As Dr Pradeep stood beside the bed, he saw a three-year-old cute little girl sleeping on the patient’s bed clutching the arm of a twenty-five-year-old woman. A man was standing silently in modest wear. Dr Pradeep’s mind filled the gaps. His mind pieced together the family profile. As Dr Pradeep was about to move away, the three-year-old girl opened her eyes and seeing a horde of doctors around the bed hid her face in the bosom of the woman lying on the bed. Seeing this bond of daughter and mother in its most pristine form, a thin smile crossed Dr Pradeep’s face. He left the room.

All preparations were complete for the kidney transplant. The operation theatre # 3 was in complete readiness. The VIP patient who was scheduled to get a kidney transplant was already in the adjoining ICU. Shanti was being brought to the operation theatre # 3. Dr Pradeep crossed the stretcher of Shanti in the corridor, the man who was Shanti’s husband walked alongside the stretcher carrying in his arms the little girl. The girl was constantly watching her mother.

Before starting the operation, Dr Pradeep decided to do a confirmatory ultrasound. The protocol dictated that all patients must undergo a mandatory ultrasound but Dr Pradeep had become a bit complacent these days, he assumed that ultrasound will always be OK. Dr Pradeep was watching the ultrasound of Shanti on the big screen. Suddenly, he stopped in his routine. He asked the technician to repeat the scan. Dr Pradeep looked closely, he identified the condition as Unilateral Renal Agenesis, where one kidney is missing but the remaining one usually compensates. Dr Pradeep broke into cold sweat. The patient had only one working kidney. He stalled the operation. The two patients who were being prepared for the operation were again shifted to their respective ICU and ward.

The dreaded call on his mobile came in the afternoon. The caller was furious. Dr Pradeep tried his best to pacify the caller and explained that he could not arrange for a donor because the patient who was the prospective donor had only one kidney. The tone and the tenor of the caller remained furious, the call ended abruptly. Dr Pradeep’s heart was beating fast. He wiped cold sweat from his forehead. At that very moment his mind flashed the picture of a three-year-old girl clutching her mother’s hand. He shuddered at the thought of taking away that comforting hand away from the child.

The VIP patient admitted to ICU was precarious. Dr Pradeep ordered dialysis immediately. He knew that with this condition the patient was not expected to live beyond a week.

It was at three in the afternoon that Dr Pradeep received a frantic call from his wife. In a trembling voice she yelled that she had just now received a phone call from an unknown number saying that their eight-year-old son had been kidnapped from the school. The caller had closed the call without asking for any ransom or threat.

Dr Pradeep understood the deal. He cancelled all his appointments scheduled for the late afternoon and sat on his computer wondering what to do. From deep inside his mind, memory came tumbling of the first occasion when he had harvested a kidney from an unsuspecting patient. He remembered how his mind had then debated against its ingrained ethical values. Dr Pradeep’s memories now came flooding and a slide show started displaying the faces of the unsuspecting patients who had lost their kidney on the pretext of appendix or any other gastrointestinal surgery. He opened a folder in his laptop and silently scrolled the names. The list stopped at fifty-one. Dr Pradeep wiped his eyes which were wet and reflected how his journey as a surgeon had progressed. He remembered his father and the ethical values he stood for.  From a deep recess of his mind he heard the voice of his father ‘son I  want you to become a doctor’. Dr Pradeep’s mind went a step further, a new question came up, did his father wanted his son to become a doctor without ethics?

He kept sitting on his chair contemplating what to do. Dr Pradeep realized that his greed for money and fame were instrumental for his present condition. His son was in someone else’s custody and fulfilling the demand for his release meant that he must commit a murder. Taking out the only working kidney from Shanti to transplant in the VIP patient would result in the death of Shanti. A thought came that he must tell everything to police but that would mean opening the lid to all the unethical practices being done in the Adarsh hospital. Dr Pradeep started crying. He reached a reset point where his mind started loathing him for the fifty-one unethical kidney transplants he had undertaken before this day.  

Dr Pradeep picked up his phone and dialed a number. He waited for the call to materialize. He started with a polite ‘Sir’. In a very polite tone Dr Pradeep told the person on the call that something unexpected had happened and that the operation could not take place yesterday. He told the man listening to his pleading voice that he has now made all the arrangements for the kidney transplant day after tomorrow. In a meek surrender tone, Dr Pradeep begged that his son may be allowed to return home. The man on the other side assured him that his son is safe and will be home as soon as the kidney transplant is undertaken successfully.

It was almost midnight that Dr Pradeep made another important call. He dialed the number of Jamshed bhai and waited. Once connected he asked Jamshed bhai whether he can come and meet him just now.  Jamshed bhai was perplexed by this urgent call from the doctor, however, he asked Dr Pradeep to come.

What Dr Pradeep said to Jamshed bhai was something that Jamshed bhai had never heard. Dr Pradeep folded his hands and in a merciful tone pleaded ‘Jamshed bhai, please do me a favour, kill me’. He then handed a briefcase to Jamshed bhai mentioning that this bag contained rupees one crore. After this initial conversation, Dr Pradeep somehow felt light as if a heavy load has been lifted from his heart. He gave certain instructions to Jamshed bhai and returned to Adarsh hospital after one hour.

The next 24 hours were hectic for Dr Pradeep. He made it a point to spend sometime with his wife and mother, assuring them that his son Rohan was safe and that he would be released shortly.

Jamshed bhai reached the Adarsh hospital at around two in the night. There was silence everywhere. As instructed by Dr Pradeep he went to the back door and opened the lock from outside by the key which the doctor had given him a night before. He took the stairs and reached the office of Dr Pradeep. He pushed the door and peeped. He could see the doctor sitting on his big chair, the table lamp was positioned in such a way that the light fell straight on Dr Pradeep.

Jamshed bhai saw the doctor and stood there with folded hands, he saw from the other side of the table that the doctor waived his hand in acknowledgement.  Jamshed bhai took out his Smith and Wesson 357 magnum revolver and aimed for the chest. He pulled the trigger. The bullet hit the doctor just in line with the heart. Dr Pradeep slumped, face down, on the table. Jamshed bhai was fast in moving out. Within twenty seconds he was on his way back home.

The sound of the bullet reverberated in the confined corridors of Adarsh hospital.  It took almost a minute for the security staff to wake up and run inside the Adarsh hospital. Within fifteen minutes the police reached the hospital. In less than thirty minutes the news of Dr Pradeep’s murder was conveyed to the top politicians of the State.

A huge crowd had assembled in front of the Adarsh hospital. Several rumours were afloat. Breaking news on TV shouted informing the viewers of the gruesome murder of the renowned kidney transplant surgeon. The ruling political party was being blamed by the opposition party on the worsening law and order situation. Most TV channels were playing the byte of the Chief Minister wherein he was stating that the perpetuators of the crime would be arrested soon.

The senior police officials had no clue. There were no intelligence inputs. The police knew that despite the lack of any proof, some action had to be taken. It was just before midnight; the TV anchors again went into overdrive. All the channels were screaming that the police had solved the murder of Dr Pradeep. The police had released the photographs of two people who had committed the murder. As per the statement of the police, they had picked a road side tea seller who had a shop in front of the Adarsh hospital and a rikshaw driver. As per the police statement, the two culprits had confessed to their crime.

The next day’s newspaper carried the following headline ‘KIDNEY SURGEON MURDERED, CULPRITS ARRESTED’.