In the medical world, Triage is just a fancy word for “sorting.” When a flood of patients hits the casualty at once, we categorize them like laundry:
- 1. Red: Life-threatening. Can’t wait. May need ICU immediately.
- 2. Yellow: Serious, but can wait a while, Admit and shift Indoor
- 3. Green: “Stable and can wait the longest. To be disposed in casualty.
Taking the laundry analogy forward, consider that you are sorting laundry for ironing, Triage is putting the a) the silks in one pile for low heat, light iron, and b) the cottons in another for highest temp, steam and heavy iron.
- Over-triage is treating a cotton t-shirt like it’s delicate silk. That is gross waste of resources. but the result may be bad.
- Under-triage is throwing a Dry-Clean-Only suit into a hot wash—it will damage the costly garment and cost you dearly.
The Railway Triage: A Bhubaneswar Special
While every hospital follows its protocols, at the Central Hospital of ECoR in Bhubaneswar, we’ve birthed a local mutation: The Railway Triage.
Here I will only discuss the pediatric care.
After sixteen years of managing pediatric care for the East Coast Railway, I’ve realized our system isn’t driven by pathology, but by the volatile expectations of our beneficiaries. It is a psychological tug-of-war.
If you admit a child, you have to pronounce his medical condition”critical.” Otherwise, the family won’t admit the child. Again ,the word “critical” is the starting pistol for a high-stakes sprint. The next moment they will pressure you—by hook, by crook, or by union leader—to refer them to a plush corporate hospital immediately. The intensity is breathless until the child is physically shifted.
Conversely, if you suggest the same child, needs admission but not critical, the vibe flips. Even if the kid clearly needs IV fluids or injectable antibiotics, the parents will refuse. “Our quarters are just around the corner,” they’ll say with a straight face. “We’ll just pop back into the casualty every hour.” As if the casualty doctor has no other duty but to check your baby’s every hour and you go home immediately after. It’s always a constant battle between unnecessary referrals and a flat-out refusal of minimum necessary care.
If
And then, there are the Weekends.
The Sunday Cycle: Imaginary Complications
The Sunday Cycle: Imaginary Complications
There is a distinct rhythm in Bhubaneswar. Most private pediatricians shutter their clinics on Saturday evening. When a panicked parent calls them on a Sunday, these practitioners often weave a tapestry of “imaginary complications” and recommend urgent hospitalization.
Because our patients are railway beneficiaries, they don’t go to their private facility. They land on us.
Here are two such cases for information.
Because our patients are railway beneficiaries, they don’t go to their private facility. They land on us.
Welcome to The Weekend Triage.
Case 1:
The Sunday Purge (April 12, 5:00 AM)
A 16-month-old arrives with severe diarrhea. Dr. Acharya admits the child, starts the IV, and keeps me posted. By the time I walk in at 10:00 AM, the mother and grandmother have accosted the duty sister 14 times. They demanded to know why the bowel movements hadn’t stopped yet. Three sisters from adjacent wards explained the concept of “recovery time” six different times. They weren’t looking for healing; they were fishing for a referral.
I examined the child. I have to document a very specific note: ” A Gastro Enteritis, Dehydration corrected. Relatives explained that the Purging will not stop before Wednesday, April 15th.” Despite all the explanations, the relatives created such a theatrical scene that our casualty doctor -exhausted—added Loperamide to the mix. We generally avoid this in toddlers (it can lead to some nasty complications), but luckily, it just slowed the plumbing.
The punchline? Monday morning.
The mother, who spent all Sunday screaming at the staff, changed her tone on the Monday morning and meekly asks: “Can we go home now?”
Apparently a life threatening condition on Sunday has miraculously vanished as the date on the calendar changed.
Sunday is over. Now her private doctor is available.
Case 2:
The Eye of the Storm (March 29, 1:00 AM)
An 8-year-old is admitted with a high fever and a terrifying-looking red eye (subconjunctival hemorrhage). By 10:00 AM, the parents are already in “full “negligence” mode.
“Why hasn’t a doctor seen our child?” they roared. In reality, the casualty doctor had seen him thrice, consulted an eye specialist, and even sent a WhatsApp photo of the eye to get a prescription started.
“Why hasn’t a doctor seen our child?” they roared. In reality, the casualty doctor had seen him thrice, consulted an eye specialist, and even sent a WhatsApp photo of the eye to get a prescription started.
Unsatisfied, the father called a union representative, who then telephoned our ophthalmologist, at home on his day off. When I arrived, the bed was empty—the child had been whisked away to the eye clinic on a Sunday for the “manual” exam. The diagnosis? A common seasonal viral fever. The prescription? Exactly what was sent on WhatsApp hours earlier.
The moment the specialist offered reassurance, the father’s mission shifted instantly. He began chasing me for a discharge—the child had an exam on Monday, after all.
The Anatomy of a Weekend Admission
In my sixteen years, the “Odd-Hour” weekend admission has become a predictable science:
The Arrival: Always between 1:00 AM and 5:00 AM on Sunday.
The Monday Escape: By sunrise on Monday, they are desperate for discharge.
The Arrival: Always between 1:00 AM and 5:00 AM on Sunday.
The Monday Escape: By sunrise on Monday, they are desperate for discharge.
The Private Catalyst:
Most have been primed by a private doctor who didn’t want to work their Sunday.
It’s a fascinating phenomenon. The same patient who will wait patiently for three hours in a private OPD becomes abusive and impatient to our staff on a Sunday morning. Once their fear is soothed and they feel “safe,” the medical urgency vanishes into thin air.
It’s a fascinating phenomenon. The same patient who will wait patiently for three hours in a private OPD becomes abusive and impatient to our staff on a Sunday morning. Once their fear is soothed and they feel “safe,” the medical urgency vanishes into thin air.
Every Sunday is a busy day in the children’s ward. It’s not just medicine; it’s a weekly theatrical performance where the script never changes.
Dr Ramakanta's Ideas 