The “chance factor”: responsibility, risk and ethics in medical practice
Alik Sukh, Producer: Atanu Raychaudhuri. Directors: Nandita Roy and Shiboprasad Mukhopadhyay. Bangla. 2 hours, 20 minutes. 2013. Based on a novel of the same title by Suchitra Bhattacharya.
Without lapsing into a black and white portrayal of the world of the bad doctor who is indifferent to his patients’ well-being, Alik Sukh (Ethereal Bliss) evokes subtle nuances in exploring the issues of medical negligence and the doctor’s responsibility.
Dr Kingshuk Guha (Debshankar Halder), a renowned gynaecologist, practising in five nursing homes/hospitals for over nine years, is a dedicated professional. The film begins with him performing a caesarean section on Kabita Mondal (Sohini Sengupta), the wife of a peon. The day happens to be his wedding anniversary and he leaves the hospital as soon as the operation is over. But the patient’s health deteriorates; the resident medical officer phones him repeatedly, but Kingshuk gets delayed at every turn and, is able to get back to the hospital only after the patient has died and the mob has gone on a rampage.
At home, tension brews between him and his subdued, yet upright wife, Rammani (Rituparna Sengupta). He denies that he was in any way responsible for Kabita’s death, arguing that there are “chance factors” in surgeries; that the patients’ relatives always sign a bond; that a human body is, after all, a machine; and that the doctor is also under immense stress. Yet Rammani is unconvinced. Her dilemma comes alive through the figure of Kabita, who keeps haunting her, never vindictive, but relentlessly egging her on to look beyond the logic and justifications offered by Kingshuk.
The medical council forms an ad hoc committee to investigate the merits of the case. One of Kingshuk’s ex-teachers (Soumitra Chatterjee) is on the committee. In a meeting between them, the latter points out that the problem is actually a systemic one, and much more menacing than this particular mortality suggests. When he asks why Kingshuk performed the caesarean section when it was not medically indicated, the otherwise-confident doctor mutters something about time constraints. Kingshuk, we learn, sees a minimum of 50 patients and performs at least five surgeries a day. The senior doctor asks how Kingshuk can ever expect to understand the patient’s perspective when he can hardly spare three to four minutes for each patient. Kingshuk has no reply to offer.
“Realisation” dawns on Kingshuk after Rammani meets with an accident. He rushes to the hospital where she has been admitted and learns that she, too, has suffered an abdominal haemorrhage (like Kabita), and that the anaesthetist is “on his way, stuck up in a traffic jam” (the exact explanation he had given to defend his own case). He loses his cool and manhandles the surgeon, hurling the same profanities that Kabita’s husband had hurled at him. Waiting outside the operation theatre as the “patient party”, Kingshuk, for the first time, comes to understand the other side of the divide.
Kingshuk is not portrayed as the overtly irresponsible, arrogant doctor; he is a sensitive, efficient and good surgeon. The conflict emanates from the way he prioritised his professional commitments and private desires. It is an issue of ethics in practice, but it goes beyond just personal ethics to ethics built into a system. The film does not make any sweeping moralistic judgment about the class of private practitioners. In fact, it brings out the stress doctors undergo on a regular basis, the threat of mob violence, and the growing lack of trust between patients and doctors. It is not hard for a private practitioner to identify with Kingshuk – his angst, loneliness, insecurities and performance anxiety, besides the weaknesses and faults that define him.
Besides a taut storyline, good acting and editing, the film deserves mention for highlighting the immensely pertinent and delicate issue of ethics in medical practice. Negligence is not always gross or intentional; it can be circumstantial and accidental. It might be argued that Kabita could still have died under Kingshuk’s care, but the point that keeps eluding Kingshuk till the end is that, for the patient and the relatives, the assurance that the doctor tried, that he was present and that he was equally concerned matters almost as much as the patient’s well-being. The film touches upon several issues – such as breaking bad news, the question of who breaks the news, drawing the line between a doctor’s professional and personal lives, performing of caesarean sections that are not indicated, and the practice of doctors receiving cuts and commissions from pharmaceutical companies – without overt moral underpinnings. A very timely film, Alik Sukh deserves to make its way into the medical humanities curriculum.