Burnout Room is a work of fiction drawn from the shared experiences of residents in Pakistan. Ravi General Hospital, its staff, patients and events are invented, and any resemblance to real persons, hospitals or incidents is coincidental. Real organisations appear only as public background. Some characters make choices that breach professional standards; the series portrays these to examine them, not to endorse them.
Our roster was made monthly and pinned at the top of the unit WhatsApp group. Everyone treated it as a suggestion. The changes came early in the morning, before anyone was awake enough to argue.
Dr. Bilal (SR): Change in roster. Hamza on leave. Tonight’s call: Sana, Usman. Aaj hamara emergency day hai.
I read it in the staff parking of Ravi General Hospital, which was never really staff parking. Every morning I found a rickshaw, two motorbikes and somebody’s Corolla in the spot I had been told was mine. I was two months into my first year of FCPS Medicine and I still believed some things were fair, so I typed a reply and pressed send.
Me: Sir I was on call on Friday.
Dr. Bilal (SR): Adjust kar lo. Next week dekh lain ge.
Seven people saw it. Nobody replied. A minute later Usman messaged me privately: “Welcome to Medical Unit II, jahan next week kabhi nahi aata.”
Usman Tariq was the other first-year in our unit. He was from DG Khan, lived in the hostel, and had an opinion on everything, usually a funny one. On my first day he had told me the three rules of the unit. Never be late for the professor’s round. Never ask Dr. Bilal for leave on a Monday. And never, ever stand between Dr. Ali and the professor.
Our ward had sixty beds and, on most days, around ninety patients. Two patients to a bed was normal, one with his head at the top and the other with his feet near the first one’s pillow. The attendants slept on the floor in between, on flattened cardboard boxes. You learned to step over them without looking down.
Professor Shahid Mirza’s round started at half past eight, and he walked faster than anyone his age should. Twenty people followed him: residents, house officers, students, and Dr. Ali at his elbow, holding his phone and his charger. Ali was a second-year resident. He was also the professor’s nephew. Everyone knew it and nobody said it.
“In our time,” the professor said at bed 6, to no one in particular, “we lived in the hospital. Ghar sirf kapray badalne jaate thay.” The house officers nodded as if they had been there.
Sister Rubina stood at the nursing counter with the drug register open, watching all of us the way a mother watches children near a road. She had worked in that ward for twenty years. She knew every doctor’s handwriting, every patient’s attendant, and which tap in the washroom still worked.
At noon a message came on the PG trainees’ group from the accounts office. Stipends for August and September would be released “after budget approval”. Below it someone had posted a crying emoji, and someone else a GIF of a man laughing. My brother’s academy fee was due on the tenth. I put the phone in my pocket and went back to my discharges.
It was our unit’s emergency day, which meant every medical patient who came through the emergency department was ours until the next morning. By eight in the evening we had admitted twenty-six patients, and by midnight there were more than forty, two of us, and Dr. Mahnoor, the third-year who was supposed to supervise us but was also covering the high-dependency beds at the far end of the ward. Mahnoor was the quietest doctor I had ever met. She moved fast, wrote neatly, and never seemed to eat. Around eleven she found me standing in front of a patient with a blood pressure of 70 over 40 and handed me half a packet of biscuits without a word.
“Pehla saal sab se mushkil hota hai,” she said. “Phir aadat ho jati hai.” She looked at the window for a moment. “Ya nahi hoti.” Then she walked back to her end of the ward.
The night was the usual October night. A dengue counter by the emergency door, with a queue of people holding platelet reports and asking everyone in a white coat whether 90,000 was dangerous. A young boy in DKA whose father kept asking if it was “sugar wali bimari ya kuch aur”. Two strokes waiting for a CT scan that ran on tokens, with nineteen people ahead of them. An old man vomiting blood whose son had to run to the pharmacy outside the gate because the injection we needed was “short” in the hospital store. Every few minutes someone said “ye bahar se le aayein” to someone else, and somebody’s son went running.
At half past eleven Dr. Bilal called. “A patient is coming from the MPA’s office. Bed do usay.”
“Sir, there is no bed.”
“Bana do.”
So I made one. I woke an old man from Kasur who had been in bed 31 for four days and asked him to share with the man in bed 30. He did not complain. His son folded his cardboard box and moved it two feet to the left. The patient from the MPA’s office had gastritis. He went home the next morning.
Ammi messaged a little before midnight.
Ammi: So gayi?
Me: On call hun
Ammi: Achha. Agle Sunday ko Khala Nusrat wali family aa rahi hai. Chutti le lena.
I left it on seen.
Just after one, an attendant began following me from bed to bed. “Doctor sahib, teen ghantay ho gaye hain, koi dekh hi nahi raha.” I had seen his father forty minutes earlier. I told him the reports were coming. “Aap log bas chai peetay ho,” he said, and took out his phone and started filming. I kept writing. My hand was shaking a little, and I hoped the camera could not see it.
Around three, Usman came back from the canteen with two cups of tea in a plastic bag and put one in front of me. He was smiling at something on his phone and closed it quickly when I looked. “Kuch nahi. Novel parh raha tha.” Usman did not read novels. I was too tired to ask.
A few minutes later Sister Rubina put a chart in front of me. “Doctor, ye dobara dekh lein.”
It was the insulin order for the boy in DKA. I had written 50 units an hour instead of 5. My handwriting, my signature, my stamp. I had written it perhaps half an hour earlier and I could not remember doing it. I corrected it. “Thank you, Sister.”
She looked at me for a long second. “Munh dho lein, doctor.” She did not write anything in her register. I did not tell anyone. I still haven’t.
At half past four Usman told me to sleep for an hour. “Ja, main dekh leta hun. Kuch hua toh utha dun ga.” The duty room had one bed with a broken leg, and Usman’s bag was on it, so I sat on the plastic chair and fell asleep with the phone in my hand.
Twenty-five minutes later it rang. “Doctor, bed 22 ki saturation gir rahi hai.”
Bed 22 was Haji Sahib, a seventy-year-old COPD patient we had admitted at nine with a chest infection. When I reached him he was sitting bolt upright, pulling at his oxygen mask, his chest heaving. Saturation 81 percent. His son was holding the cylinder gauge as if that would help. I took an ABG, took him off the reservoir mask and put him on a 28 percent Venturi mask, aiming for 88 to 92, which his son did not like at all, started a nebuliser and went to find Mahnoor.
She was at the other end of the ward writing a transfer note. She came, looked at the gas, and said quietly, “BiPAP chahiye. HDU mein machine free hai?”
It was not. The only free BiPAP in the hospital was in the medical ICU, and the ICU registrar would not look at the patient until our senior registrar called him. I called Dr. Bilal. He did not pick up. I called again. On the third call he answered, his voice thick with sleep.
“Sir, bed 22, type 2 respiratory failure, BiPAP chahiye, ICU wants your call.”
A long silence. “Theek hai. Main karta hun.”
By the time the ICU accepted him and we had found a ward boy, a trolley and an oxygen cylinder that was not empty, the sky outside was turning grey. I walked beside the trolley down the corridor and into the lift, watching the saturation on the portable oximeter and turning the cylinder up a little whenever it dipped, while his son walked behind us reciting something under his breath.
When I got back, the morning had started without me. The night’s samples had to reach the lab before eight or they would not be run until the afternoon. Three new patients had no file numbers because the computer at the counter had been “down” since midnight. Usman was writing the list for the round on the back of a lab request form, and he tore it in half and handed me my part without looking up. “Bed 9 se 18 tumhare. Professor sahib aaj jaldi aa rahe hain.”
I went from bed to bed with my half-list, copying last night’s reports from crumpled slips that attendants pulled out of their pockets. Bed 14 was a woman in her fifties with vomiting and weakness whom I had admitted around midnight. Her son had handed me her potassium report while I was on the phone about bed 22. I remember putting it in my coat pocket. That was the last time I thought of it.
There was no water in the washroom tap, so I washed my face with half a bottle of mineral water and walked into the round in the same shirt as yesterday. The professor stopped at bed 14.
“Potassium?”
Nothing came. Somewhere in my head I knew I had seen that report, but I could not find it. Ali, standing at the professor’s elbow, said “3.1, sir,” without looking at any file. He had checked the lab computer that morning while I was in the lift with Haji Sahib.
“If you don’t know your patients, who will?” the professor said to me. “Is tarah logbook sign nahi hogi.” Behind him, two house officers looked at the floor.
The round ended a little before eleven. After that came the discharges, then the new orders from the round, then the handover to the evening team, then a reminder from Dr. Bilal that I was presenting a case on Thursday. Somewhere in between, I put my hand in my coat pocket and found the potassium slip, folded in half. 3.1. I had carried it all night. I folded it again and put it back in the pocket.
I left at two in the afternoon. Thirty hours. Perhaps forty minutes of sleep, in pieces.
At a signal on Multan Road I rested my head back for one second. Then there was a horn, the light was green, and a rickshaw driver was shouting at me from beside my window. I did not know how long I had been asleep. I drove the rest of the way with the window down, pinching my arm at every turn.
At home Ammi came out of the kitchen. “Itni der? Khana garam kar dun?”
“Mujhe akela chhor dein,” I said, louder than I meant to. She went quiet. I went to my room and lay down with my shoes on. I did not cry. I did not apologise either. Every few minutes I picked up the phone, sure the ward had called. The unit group had 46 unread messages. Somewhere in there, I would find out later, was a video.
The next morning came another change in the roster.
Dr. Bilal (SR): Tonight’s call: Ali, Sana.
Dr. Ali: Sir kal mera presentation hai professor sahib ke saath.
Dr. Bilal (SR): Ok. Sana, Usman.
Usman sent a single laughing emoji, then deleted it.
I typed: Sir I was on call on Monday, I haven’t slept properly since. I looked at it for a long time. Then I deleted it.
Me: Ok sir 👍
Seen by 7.
Next in Burnout Room, Part 2: The Video. Thirty-eight seconds of video, one lakh views, and an apology Sana is told to sign.
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