Saturday, June 11, 2011

Once upon a time... Part 2

In case you haven't realized yet, the lady mentioned above was a case of post partum ecclampsia following a home delivery. We treated her with Magsulf and she goes home tomorrow. But the story doesn't end there.
The 'tel gaadi' aka govt oil truck went back to the village with the news that sheela bai has been cured. So they decided to send another dying patient to our doors.
Uday Lal presented later that day with a one month history of jaundice and black stools. Honestly when they brought him in, I thought it was a corpse. 'White as a sheet' was literally what he looked like. All my medical sense told me to refer him. The relatives told me, "You are God. Only you can heal him. If you can't then we will take him back home".
Investigations revealed a hemoglobin of two. 2?!!! At first I thought the lab guy was pulling my leg. After checking and rechecking, my fears were confirmed. He had a hemoglobin of 2 and he was still alive and I had the job of keeping him that way.
With all of the advancements of India shining, there is a downside. It becomes more and more difficult for mission hospitals to function. To standardize treatment, there is a law passed that allows a blood bank only with the presence of an MD pathologist or a radiodiagnosis department only with an MD radiologist.
Thus the poor relatives go to the government hospital and wait an entire day to get two pints of blood even after donating and paying. Meanwhile I start treatment for Iron deficiency anemia which is the most common in the region. The blood finally comes and we transfuse him. His hemoglobin comes up to 4 and he finally sits up. They don't have money for any more blood. So I give him some more parenteral iron and refer him to a bigger place for further evaluation, knowing full well that they will go back home and the referral letter I give will come back to me in a few months. But all I can do now is pray.
However tonight there is rejoicing in Bagrekash...


  1. And the cause of his anaemia was.........?

  2. I have no clue... Iron deficiency is what i can treat for and I'm doing just that....

  3. No endoscopies available to prove...

  4. One addition Lydia, if you want. Check for e/o CLD. Like splenomegaly/spiders/paper money skin/etc etc. If present add on Propranolol, may be of value. Also add Ranitidine. Both are cheap and easily available. Ask him to stop tannifying in case he is.