On the 18th of March, 2023, a 22-year-old student of Mathematics at one of India’s few National Research Institutes was taken to the ER of three different hospitals in Orissa after passing out on a train to one of her weekly Psychiatric appointments.
Neuroleptic Malignant Syndrome is a rare condition developed in response to Neuroleptic drugs - the kind your friendly neighborhood psychiatrist will hand out to every Tom, Dick, and Harry who spits out three Beautiful Mind symptoms out of your high school psychology textbook. It’s a strange reaction; NMS. A person will lose lucidity, floating in and out of the edge of consciousness and past the point of coherence as his limbs lose motor function, his WBC count drops, immune system gives in. The body stops fighting back.
There is no real way to diagnose NMS apart from a prior knowledge of the regular consumption of the offending medication, which makes its identification particularly tricky. Nothing tells on it, not your blood, not your CT scan, not your MRI. Your vitals remain normal until they don’t, and you drop dead; sepsis spreads too fast. A seizure they couldn’t see coming.
There is an idea [Patrick Bateman voice] of mental health. Some kind of abstraction. Touchable and watchable, easy on the eyes, and the nose, and the ears, and the flesh. Easy on the mind. And there is a reason for this: it’s that the kind of person who fights for this idea—it’s a hobbyistic defender—is too weak to handle anything more.
Chitra Banerjee (names of all persons changed) was in the ICU for over a week at the super specialty of the very hospital that had been treating her for her appreciable and cinematic mental disease assortment of Schizophrenia, Depression, Anxiety, and General Psychosis before she was diagnosed with NMS. Here are three days’ accounts of what it actually means to bear witness to a bona fide psychiatric crisis, in a country whose discourse on mental health is entirely hegemonised by people who know absolutely nothing about it.
The Players
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The First Responders: Chitra’s college batch mates and friends who brought her to KIMS on the day of. Maitreyi, Gautam, Sumedh, and Anand.
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The Psychiatrists: Dr. Deepthi and Dr. Sudipto, the two Psychiatrists overseeing Chitra’s treatment at KIMS for the past seven months.
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The Family: Dr. Banerjee, a consultant physician based in Delhi and Chitra’s mother, and her other daughter, Priyanjita.
The Incident
I—March 18th
Morning—Maitreyi
Chitra’s been sort of unconscious for some time now. Not fully unconscious, just very sleepy. We were headed to Kalinga Institute of Medical Sciences (KIMS) for her appointment, and she was fine in her room, but then she got really sleepy on the train, and she hasn’t woken up since. We’ve spoken to the doctors at KIMS, and this is supposedly normal; it’s nothing to worry about. We’re going to take her back to college so that the ambulance can take her to KIMS. There’s nothing to worry about.
Everything is fine.
Afternoon—Gautam
We reach KIMS by around twelve-thirty. She is on a stretcher, and then we take her in. This nurse comes around, and she’s staring at us. Maitreyi and Anand go in to take care of the billing, and I stay outside with her. And the nurse asks – says, “Kya hua?” (“What happened?”), But she doesn’t, she doesn't say it to me. She actually– she, what I can only describe as – slaps Chitra. Hits her across the face. She asks her again, “Kya hua?” Which is very ridiculous, because she very clearly looks like she’s not conscious. Not like she’s sleeping, but like she’s unconscious.
I don’t even really register it, that this is happening. She ignores me—I’m sitting right beside her, she could’ve asked me, but she chose not to—and then leaves. I doubt she was ever actually interested. I’ve never really been in hospitals in this way before. I didn’t know this is how it is. I didn’t expect this kind of apathy. I didn’t expect them to be this ruthless.
We go through the billing, and we move her to bed number four. They were asking us a few questions inside; there was one doctor. The billing was also a very– a very slow, very unnecessarily long procedure. And from then on it was just waiting.
You’d expect that in a hospital—in an emergency ward, no less—if there were an emergency, that they’d do something about it. Something would happen. But nothing does. People come around, ask what’s going on. Oh, she’s unconscious? Very well. And then they leave. It’s certainly a very horrifying reminder of just how apathic the hospital system is. It’s the kind of place where I can very easily envision someone dying, which is a funny thing to say about a hospital floor. Actually, if someone dies here, I’d say it–
I’d say it makes a frightening amount of sense.
Evening—Maitreyi
They still have no idea what’s going on with her. She can’t stay in the Emergency anymore. They’re saying she has to be shifted to either the ICU or the OPD of the psychiatric department. We asked them to shift her to the ICU, but they want to speak to a family member. They don’t tell us much anyway.
We tell them that her mother will be here by tomorrow, but they insist on speaking with her now. It turns out this is because the ICU is apparently full, and they can’t keep her there, and the Psychiatric OPD doesn’t have critical care. You might wonder why they’re even bothering to tell us this, then, if there’s nothing to be done. What’s the point? Well, the point is that, luckily for us, while there are no beds in their hospital’s regular ICU, there are beds in their Super Specialty ICU, a costlier subsection of their hospital that just so happens to not be covered by Chitra’s student insurance.
They need a Rs. 25,000 upfront transfer for the first night. I call Chitra’s mother in Delhi before her flight here tomorrow to ask her what’s to be done. She’s a doctor, and she asks to speak to the doctors here. But there are none, except Sudipto and Deepthi, neither of whom is here now. It’s been 8 hours.
Evening—Gautam
Nothing’s happened this whole time. And by nothing’s happened, I mean nothing’s happened.
There’ve been no doctors, no nurses. What few doctors have asked what’s happening have been bystanders. Oh! What’s happened here? Oh, so terrible! Like passers-by whispering. Like she’s gossiping.
She was not put on medication; she wasn’t even put on saline. She’s just on a bed, and there’s a person beside her. Mostly me. Sometimes Maitreyi or Anand. One person at a time.
Her doctor dropped by quite often, the man. Sudipto. Every 1.5 hours. The Neurology guy hasn’t yet come, but the Psychiatry guys have, the ones treating her. He asked us if she’d taken any drugs, and we told him nothing apart from her meds. Them and cigarettes. He asked us specifically if she’d taken cannabis, and we said not that we know of. Did he say anything helpful?
“The only thing I can say right now is that she needs to be kept under observation. The psychiatric department can’t do anything here,” Dr. Sudipto had said.
So no, not really.
Night—Anand
He came around 8, 3–4 times after the ER manager had pestered us to fuck off. He wasn’t as tall as him, nor as well-dressed. His smile was what I can only describe as slimy.
That guy, I suppose, had two motives. He had to get us out of there, either into the Super-specialty ICU or out of KIMS entirely. Chitra’s mother had more or less left the decision up to us by then; she’d transferred the money and told us to do whatever we thought best.
Whether AMRI, AIIMS, the OPD, or the SS. But it was raining outside, and neither AIIMS nor AMRI was responding. And these people would not let Chitra stay in the ER any longer. “She needs to be under observation,” they’d say. "She isn’t critical." The same response. Every time we asked them why they wanted to shift her to the ICU. But observation can happen in an OPD. And if indeed she isn’t critical, one has to wonder why they’d even keep her in the ER for that long in the first place. There was something they weren’t telling us.
There was nothing they were telling us.”
Gautam: “At around 9, a nurse came over to attach an IV. Very quick to action (she hadn’t eaten in 12 hours). Chitra started resisting. She talked a bit then, she’d said, “it hurts.” The nurse held her down, she yelled at her, ”Kya kar rahi ho? Maarungi tumhe.” And she did actually slap - slap Chitra a few times. I was losing my mind. The way it was advertised to us, it was as if this was the only way. That she had to be held down, that this had to be done then. Chitra wasn’t happy about it, she was flapping around. Maitreyi was holding her torso, Anand held one of her sides and a second nurse the other. And I was asked to move down to her feet. To lock them. I thought about slitting the nurse’s throat.
It was a [cannula], I don’t know what it’s called. We didn’t know anything about what was going on. They didn’t bother telling us. We aren’t family.
I didn’t say anything, because it clearly seems to be a very torturous sort of affair for Chitra. And I would’ve liked it to be over as quickly as possible. She was clearly in pain, she was saying it, in words. The only time she was coherent. She was calling for her mother.
“Her knee hit my stomach while she was trying to free herself. And she didn’t say sorry, she couldn’t utter the words. But I remember her looking me in the eyes. They were half closed the entire time, but she looked me in the eyes then. She couldn’t say sorry, but she said sorry. She was co-operative. She just didn’t like the nurses.”
Priyanjita: “Maitreyi calls me at around 8 again to confirm my mother’s decision regarding the ICU. I take the opportunity for what it is to get the doctor - eager to come to the phone now to discuss the payment situation - to speak to my and Chitra’s mother. It is an interesting conversation to overhear.
“Yes ma’am, about the Super Specialty -”
“Yes, hi, I’m Dr. Banerjee speaking , I’m a Physician.”
“Oh, alright, ma’am.”
“What’s happened to her exactly?”
“Uh, we don’t really know. She’s conscious, barely, but confused. We think she may’ve had a seizure, but for now we can just observe her.”
“A seizure? Why do you think it was a seizure?”
“Well, she’s - she’s confused.”
“You think it was a seizure because she’s confused?”
“…”
“Alright.”
“Ma’am, the ER can’t keep her any longer -”
“Listen to me carefully. Chitra does not have a seizure disorder. She will not just have a seizure -”
“She’s been con -”
“Right, she’s been confused, and this is why you think she’s had a seizure, right? Something needs to have triggered the seizure. What are you doing to remove the drugs from her system right now?”
“We asked her friends if she’s taken any drugs -”
“You asked them if she smoked weed. Anyway, she hasn’t been lucid for over 12 hours now. I suggest you carry out a gastric lavage -
“We don’t know that she’s overdosed. She’s only been taking the prescribed medicines.”
“Whose dosages were recently altered. What does the toxicology report say?”
“Uh, we - haven’t done one yet?”
“What have you done?”
“We’ve been observing her.”
“…”
“Ma’am, we need to move her from the ER.”
“Consider a gastric lavage.”
She disconnects the phone. We’ve already spoken to Chitra’s friends at the hospital about the ICU situation. The problem is not where to go, the problem is them not telling us why. We’re not helpless because we’re not poor. Only beggars can’t be choosers.”
Anand: “The air of the Multi-Specialty is very different from that of the main hospital. The people there aren’t annoyed for you to be breathing in it. We ended up deciding to move her there that night.
We didn’t really have a choice.
At the reception, the admissions guy sees me and the man from the ER whose brought me here (the one with the slimy smile) and his mouth splits into a grin. “Ohh naya patient patient! Wo bhi ICU!” I ignore them as I fill out the admission forms. The way that the payment process for the admission works is, you have a quote amount, and you need to pay it only then will you be transferred. We’d asked him about the fee difference before he’d said it would be a minimal change. That minimal change has now gone from 25 thousand to 40.
I will have to call Chitra’s mother again.”
March 19
Sumedh: “Chitra’s mother, Dr. Banerjee, came this morning. They won’t let us see her; the ICU has very strict visiting hours, one hour in the morning and one in the evening. One man allowed at a time. We’ve still been taking shifts, even though we’re no longer needed. Perhaps we can be helpful. Perhaps we never were.
“Her mother needs a place to stay, that much I can help with. She’s not a very talkative person, but her phone had died for a while in the evening, so we ended up talking. Chitra still hasn’t woken up. They’d told us she wasn’t critical yesterday, but apparently she still is. Was mumbling nonsense when I saw her, like they’re words, like she believes them to be words, but they’re most certainly not. Her lips are frozen shut. She doesn’t open her eyes. “The doctors still have no idea what’s happened to her. They run tests, and all of them come back normal. Then again, Dr. Banerjee said they didn’t run a toxicology for the drugs that she may have been taking, or even the ones she actually was. Just a basic one. That seems productive. Like everything they’re doing.
“They’ve tied her to her bed. Apparently, she was struggling a lot last night when she was moved to the ICU. She’s spent 20 hours there now. Her lips are swollen. Some kind of sepsis. There are bruises along her body; they keep asking us if someone’s been hurting her. Cigarette burns and cuts on her arms. What proof is there that she does them to herself? They ask. “I don’t know. Why haven’t you done a Gastric lavage?” Dr. Banerjee asks back. I don’t know what a Gastric lavage is. I’d like to know the answer.”
Maitreyi: “I’d had a conversation with Chitra just this Monday. She’d confessed to me something she hadn’t told another soul. When she was first diagnosed with Schizo back in Jan 2021, apparently she’d been put on an antipsychotic called Haloperidol, that isn’t on her prescriptions anymore. Apparently she hasn’t been able to function without it. I found an ampule of it along with some other capsules and medication in her room today. I’ve given them to her mother today, she’s here now. Although they still don’t think it’s a case of OD, her toxicology report was clear. So was her blood test and her CT scan. Then again, they don’t tell us anything very clearly.
“Her medicines make her very sleepy, she hasn’t made it to a single morning lecture in the past 2 weeks. The Haldol helped, I think. Last week they upped her dosage of Arif from 50mg to 200mg. KIMS has never seen a case like this before. Students come around to ask her questions. They add drugs, change drugs, remove them; change dosages. Chitra would tell me, they do this frequently. “They’re experimenting on me,” she used to say. They don’t know what they’re doing.
“They don’t know what they’ve done.”
March 20
Gautam: “I saw her in the morning today. She’s still tied to the bed—mumbling nonsense. I was outside in the waiting room with her mother then, before this board of doctors came along and dragged her into a room next to the ICU. I can’t look at her for long.
“What are you doing?” The voices from room 1117 are quite clear.
“Please sit for a bit.” Her mother genuinely isn’t interested at all.
“Do you know somebody who’s trying to harm your daughter?”
“Explain to me why I would care about this now?”
“There are cuts and bruises on Chitra’s arms and legs. Cigarette burns. Dr. Banerjee asks them why this is any of their concern. They don’t really have an answer beyond, ”Uh, pata hona chahiye.” But they’re very adamant in asking. Who is harming her is apparently a more imminent curiosity to them than doing anything whatsoever to mitigate that harm.
“What are you doing? Do you even know what's happening to her?”
“We have running theories, but - no. We’re thinking of doing an MRI.” They can’t answer. There’s a whole panel of them, 2, maybe 3 doctors, a few juniors, the head nurses, and the best they can come up with is running another worthless test. The start to get defensive.
“What are you doing?” Dr. Banerjee asks again when they pry about the scars.
“Do you have nothing? Do you have any idea what has happened to her?”
No, ma’am, but we have our best doctors on the case. We’re taking care of her.”
“Why has nothing been done? Have you done a gastric lavage? You’ve done nothing, you know nothing.”
“…”
“Have the drugs gone out of her system?”
They don’t have an answer.
Dr. Banerjee leaves the room.”
Maitreyi: Her mother had a meeting with the doctors today, it seems. Chitra’s sister tells me they’re suspecting NMS. Something called Neuroleptic Malignant Syndrome. The words mean nothing to me. I take out my phone and type them into the search box.
I read through the Wikipedia article that pops up. 1 in 20,000 cases of anti-psychotic consumption result in a complication called NMS, it says. Symptoms are physical rigidity, confusion, seizures, fever, and lowered immunity. Under the list of causes is just one item, alone and damning: ‘neuroleptics like Haloperidol.’
Conclusion
On the 23rd of March, 3 days after her interventioned diagnosis with NMS, Chitra Banerjee was shifted out of the ICU to the general cabin. 2 days later she was discharged from Kalinga Institute of Medical Sciences, a private medical institute considered by most to have the best psychiatry and neurology departments in the city, as a surviving case of NMS developed, triggered and only barely diagnosed under its own care.
The problem with “mental health” discourse and supposedly “well-intentioned” ignorant activism for it is that ignorance cannot be well-intentioned, simply because it cannot, by virtue of being ignorance, be intentioned at all. It wouldn’t be ignorance then, it would be pretense. For all that it feels like pulling out one’s guts with a bus brake Nirbhaya style to be unironic about irony - the simple truth about social justice warriors is this: they have never been a detestable and disgusting breed of person worthy of being mocked because they care, but because they pretend to.
Edited by Christianez Ratna Kiruba
Image by Janvi Bokoliya
