The atmosphere is eerie. The large well-lit room reeks of medicines and disinfectant floor cleaners. The ‘bleep bleep’ of monitors add to the somberness. Uniformed nurses, tired and weary-eyed rush through their handing-over to their colleagues who’ve come in for the next shift. The uniformed and tired housekeeping staff with disheveled hair, with cleaning mops and bottles of disinfectant in their gloved hands look sleep deprived. Drops of blood on the floor still remain to be mopped. Young doctors, looking smart in their white coat, with the eternal stethoscope slug around their shoulders look browbeaten as they take over from their tired, and seemingly somnambulistic colleagues, who’re almost off the blocks to hit bed after a heavy night duty. On the first bed is a 24-year old well-built burly man, whose face and head are swathed in heavy bandage. His unshaven face looks swollen and grotesque where the bandage has fallen off, as he violently rocks his head from side to side on the pillow. He forces himself in vain to get out off the bed over the railings. He is restrained to the cot to prevent him falling off it. He has just had an operation on his head to remove a big blood clot. He has also had an operation of his abdomen to remove a shattered spleen. The orthopedic surgeons are planning to operate him to fix his badly fractured Femur (thigh bone) once he is stable enough. He, on his way home after painting the town red on Saturday evening, zigzagged his way through the busy weekend traffic on the Shanmugham Road off the Marine Drive in Kochi. He tried to force himself on his superbike through nonexistent space between two private buses competing with each other to pick up homeward bound passengers. One of the buses oblivious of the speeding motorist swerved to the left, knocking him over. On the second bed lies an 18-year old teenager, all bruised, on blood stained sheets. She was driving pillion with her violent neighbor. She is quiet unlike her neighbor who has to be restrained. The lovers, in the ‘heat’ of their romance had thrown caution to the wind, not bothering to wear helmets. She is hooked to a ventilator. Stacks of infusion pumps gently push drugs into her still body. She does not move to Attempts by doctors to elicit response by pressing hard on her sternum. She does not move when the nurse pushes in a long catheter into the tube placed in her trachea to aspirate secretions. The nurse shining a torch into her eyes to examine her pupils find them dilated and unresponsive to the bright light. The nurse shrugs. She knows what’s up next. The neurologist would make his rounds to look for her brain stem (part of the brain that control breathing, cardiac and other vital activities) functions. The neurologist after doing a battery of tests gives that dreaded verdict ‘She’s brain dead’. The intensivist will soon arrive by the bedside to perform the apnea test, which if positive, confirms brain death. She soon arrives and elicits a positive apnea test. The test would be repeated six hours later to confirm beyond doubt the diagnosis of brain death. The second test is also positive. The neurosurgeon is in charge of the patient as the CT scan shows a badly mangled brain. He has already spoken to the distraught family that she‘s brain dead and that there is no hope of recovery. He tells them that in such a situation, the family could consent to donate her organs to other needy patients. The ICU counselor is already speaking to the family about the nitty gritty of donation. Her’s is a delicate job, a tightrope walk, which she executes with empathy, circumspection and firmness. A teary-eyed couple supported on the shoulders of two youth comes into the room and whispers to the neurosurgeon, ‘We are donating’. That decision sends the nurses and other paramedical staff into a frenzy of activity. The 18 year old teenager, who is brain dead will donate her organs. The operating room is alerted. Surgeons walk in and out to examine the patient and check on her battery of investigations.
On the next bed is a patient who is also hooked to the ventilator. This guy is 25 and looks hulky. He has just been operated by the neurosurgeon to remove a blood clot from his head. He is breathing and his pupils are reacting to the torch light. He is lucky not to be brain dead. He too had decided to ‘enjoy the weekend’, and had sped on his shining new Harley Davidson. His abdomen looks badly bruised with crisscrossing abrasions. The monitor above him looks scary. His blood pressure is down and his pulse is racing. CT scan of the abdomen shows a badly lacerated liver. His left leg looks scary with flesh torn away to expose his femur which has broken at many points. He has numerous fractured ribs on his right side. A tube sticking out from his right chest drains maroon blood. A tired, sleep deprived duty anesthetist is placing a thin catheter into his spine through which analgesics would be administered to relieve him of his pain. He is to be operated by the orthopedic surgeons soon. The gastrointestinal surgeons are trying to treat his liver injury conservatively (with non-operative means) on the next bed lies an elderly man, whose face resembles a battered battleship. The maxillo-facial surgeon has a lot of job on his hands, later in the day. He is also connected to a ventilator. He was walking beside the median at night on the national highway bypass right in front of the hospital when a youth on a bike rammed into him. The rider probably would not have seen him in the dark of the night. The ‘streetlights’ standing on the median dissecting the bypass resemble decapitated ostriches. They do everything but light up the bypass. The youth after knocking him down rode away uncaring of this victim, who was carried into the hospital Casualty by good Samaritans in the dead of night. Luckily he has no other injury.
This is a typical scene in the ICU where I work, as I walk in on Monday mornings for rounds after a typical weekend, which people choose to ‘enjoy’. Their means of transportation is invariably that agent of death called the two-wheeler. Some call it the bike. Bikes these days come in a new avatar of ‘superbikes’, which get the riders to the pearly gates or wherever it might be, at superspeed! These bikes possessing tremendous power through great speed, enhancing the ‘super macho’, image of the rider and even the pillion rider are simply unfit to be driven on Indian roads, in their existing condition, with potholes and unmarked bumps, unscientifically constructed dividers and medians catching the riders by surprise, should they get enough time to be surprised. Highways lack enough signage and are poorly lit except on full moon nights! Pedestrians engage in guesswork to cross these roads. Through these highways to heaven ride these superbikes with gay abandon. They are law unto themselves. The riders may or may not wear helmets. If they do, they place them over parts of their anatomy they need protected by priority, come what may, in case of an accident. Some place it high up between their thighs, over their crotch! A lot of them place them on the rearview mirror. They zigzag their way through nonexistent space between vehicles in a country, the roads of which have very high traffic density. A lot of them ride over the white dotted line right on the middle of highways (as if those lines were drawn for them to ride on), exposing them to danger of being hit by other vehicles. Usually abusive and haughty, sporting an ‘I don’t care’ attitude on their visage, these gentlemen on the handle and ladies riding pillion throw a glare at drivers of other vehicles if their hurry on the highway to heaven is not honored! Should they be knocked over, for their fault or not, other motorists and passersby gang up against the driver of the vehicle which knocked the super rider. In India, the responsibility for the wellbeing of smaller vehicles, which these two wheelers invariably are, compared to other vehicles on the road, rests on the larger ones. The hapless driver of the ‘larger vehicle’ is pulled up by the public in the middle of the road before ‘law’ arrives, which also is tipped in favor of the ‘smaller two wheelers’, even if they are responsible for the accident. This ‘small vehicle syndrome’ is utilized to the hilt by these two wheelers who break every rule on paper. These two wheelers, especially the superbikes are increasingly being responsible for death and grievous injury on Indian roads. It is usually the youth who lose their life and are maimed in their prime of life. The momentum required to fracture a human long bone is tremendous, and these modern two wheelers are well equipped to do just that. Otherwise, how could a two-wheeler which jumped over the median the other day to ram into an auto rickshaw, instantly reduce the rickshaw driver into a lesser human being, who had to spend long days in the ICU and huge money to regain semblance of some normalcy? It has to be seen to believe the kind of damage pedestrians who are hit by these agents of death on two wheels sustain. These hapless victims of irresponsible death race resemble those hit by huge trucks. These guys who ride on the roads like a writhing snake which has just been struck, has to be tamed to preserve their own lives as well as others’. A glance through the list of organ donors these days reveal that a large number of them were in the prime of life who chose to ride the two-wheelers exactly as they shouldn’t. The helmet, which definitely have been shown to save lives are placed in places which does not contribute to saving the life of the user. It is not that there is dearth of traffic rules. Rules there are aplenty, to be broken conveniently with the authorities meant to implement them, choosing to look the other way.
The Justice T K Chandrasekhara Das appointed by the government to look into the frequent and rising road accidents in Kerala submitted a 270-page report in October last year with an exhaustive set of 51 recommendations including restructuring roads, amendments regarding age of drivers, fitness of vehicles, and more liberal and scientific placement of signage and warning boards.
Despite these rules and recommendations, Indian statistics look scary. Among a total of 1231 two-wheeler accidents recorded during2000-2004, majority(77%) of victims belonged to age group 18-44, with males comprising 83%, and females,17%. 5% of the victims(n=75) succumbed to injuries, of whom 45 died on the spot. Among the various factors contributing to the gory scenario studied, the most important one was over speeding.
In Chennai, two-wheelers, followed by Lorries caused the maximum number of fatal accidents in 2010. The analysis of road accident data in 2015 reveals that motorized vehicles accounted for 95.5% of the total Road Traffic Accidents, with the breakup of vehicles involved as follows: two-wheelers with (28.8%) lead the list, followed by cars and jeep(23.6%), trucks, tempos and tractors(19.7%), buses (8.3%), auto rickshaws(6.1%). Further, the share of two-wheelers in total road accidents has increased continuously from 26.3% in 2013 to 27.3% in 2014 and 28.8% in 2015. Trucks and two-wheelers were at one stage responsible for around 40% of road fatalities. According to the NCRB report (National crime Records Bureau, ministry of Home Affairs, Government of India) published in 2014, 24.9% victims of road accidents in India were occupants of two-wheelers.
Statistics of Road Traffic accidents in Kerala vouch for the ‘villainy’ of the two-wheelers. Kerala stands third in India in terms of road accidents, with 4,000 deaths and 40,000 serious injuries annually, with pedestrians and bike users accounting for 80% of road accident deaths in the state. Of the 760 accidents reported in the city of kochi till August 31 this year, 551 were caused by two-wheelers. A total of 136 accidents resulted in deaths this year up to August 31, in which 87 two-wheeler riders lost their lives, while as many as 605 persons were grievously injured.
Most of the accidents were caused by rash and drunken driving, and overtaking through the left side. Noticeably, most of the badly injured did not wear helmets. As per the data available with the police, a total of 22,500 cases were slapped on two-wheeler riders who did not use helmets till August 31st of 2013.1,332 were booked for drunken driving, of these 966 were two-wheeler riders. Statistically, in drunk driving cases, bike riders makeup 75% of them.
Thus, two-wheelers contribute significantly their ‘share to ‘life on a fast lane’, charactererized by death and mayhem on kerala’s roads, which has 6,567 vehicles/100 square kilometers, (while it is 1,673 vehicles in the rest of India. While the accident rate in India is 7.2/1,000 vehicles, it is 15 in Kerala. Monetarily, the tiny state stands to lose Rs.600 crores every year on account of damage to vehicle and property.
Having travelled thus far, is there really a case to ban two-wheelers in the country? Or is it enough to tame the shrews riding them through measures like:
- Increasing the age to obtain legal driving license
- Taking away the immunity offered by the official and unofficial ‘small vehicle syndrome’
- Cancelling the driving license if pulled up for causing death, grievous injury and drunken driving
- Heavy fining for intimidative and abusive behavior and for noncompliance to use helmets, even by the pillion riders.
- Hiking up fines for flouting rules laid down by the Motor Vehicles Departments.
- Installation of speed governors on the superbikes,
Having said that, the authorities too have a huge role to play, and a big responsibility to provide the citizens what is rightly due to themfor the taxes they pay, by
- Providing well lit roads, and roads with adequate warning boards and signages at the right places
- Removing encroachments and illegal structures jutting on to the roads
- Removing hoardings that interfere with visibility
- Providing well maintained roads, free of potholes, unmarked bumps, unscientifically constructed medians and dividers,
- Providing adequate facilities for pedestrians that they no longer are at the mercy of motorists.
December 31, 2016 at 5:34 pm
The description of the ICU is heart wrenching. The pain and suffering seem so very difficult to digest. Prayers for all those unfortunate people who were walking by on a darkened corner at the wrong time, those who just wanted to taste the ‘thrill’ of a crazy bike ride ending in something close to a tragedy and those who were just victims of yet another bike accident.
Your posts are so very well written, doctor. For a moment, I was in the ICU looking at all the gore, blood, pain,and agony.