Friday, July 22, 2011

Fighting death

Yesterday a young boy came. A 20 year old with sickle cell disease post splenectomy now in intense pain. He was one of our regulars who came for pain relief and hydration and then got discharged. The only son of a mother with father living in another village.
Tonight at 6 pm, I got a call from the ward. 'Madam ji, ek baar dekh lo. Uska saans theek se nahi a raha'. (Literal translation - Madam ji, please come and see once. His breathing isn't coming properly) So I went to find him breathing hard and fast. Lungs with harsh breath sounds. My diagnosis was a massive pulmonary embolism. So I started him on anti coagulants, nebulizations, steroids et al.... And yet his oxygen saturation kept dropping. 70... 50... 40... We started CPR. His last words were, 'Call my father'.
We don't have any ventilators. So I intubated and bagged.
Saturation yet dropping... 30... Nil... And I kept bagging...
Pulse went from feeble to non recordable.... Still I kept bagging....
Till his heart stopped beating.....
Till his pupils fixed and dilated....
Till my boss came and declared him dead....
With his mother's cries filling my ears....
I bagged...
Hoping... Praying....

He passed away in front of my eyes.....

Saturday, July 16, 2011

Perfect timing

Here in North India, timing is everything. Births, deaths, weddings, business transactions, sale and purchase all are deemed auspicious according to when they occur. Thus sale and purchases, weddings etc are conducted after the pundit announces the date and the time. But imagine modifying the time of delivery!!!
I had heard some horror stories.... 
About the woman who went into labor during an 'evil' time. The midwife hung her upside down so the baby wouldn't be born. 
But then I encountered it first hand. A lady who insisted on having her baby on the 15th of november, 9:11 am. And left the how to us. The baby had to come out by then, by hook or by crook. So we posted her for caesarean. Indication : Maternal request.
8:30 am : The lady was wheeled into theatre.
8:45 am : Anaesthesia
9:00 am : We started
9: 05 am : We entered the abdomen
And then we waited....... 
9:11 Baby out
So everyone lived happily ever after....

Tuesday, July 5, 2011

Bad times

Yesterday a lady came in. Not someone I saw. But the daughter in law of a very prominent family. She was the second of three deliveries in a row. She arrived just when I was stitching up the first one. As a result, I saw her one hour after she arrived.
One look and I knew we were in trouble.Primi with preterm labour. Fetal heart rate abnormalities. I told the relatives to take her to a place with better facilities. But by the time I had finished wheeling her into labour room and examining her they had made up their mind to stay. It was 1 pm.
I told them we will try our best. Started her on IV fluids. The heart rate picked up. I told the relatives we might have to operate which they were very much against. I told my boss. It was 2 pm.
Heart went wonky again. Decided for Caesar and called my boss. He came and we started. 3:30 pm.
Baby out 4:30 pm.
Cried at birth. But some labored breathing. Referred the baby to higher center. 6:00 pm.
Today the family came in. Their friends and followers. The baby is on ventilator. 11 am.
The baby died. 5 pm.

They brought the body. The mother was told. The distraught father took the body (it was a boy) away to be cremated. The rest stood outside the hospital. Anger. Grief. Shock. All searching for an outlet.
Inside I sat, hiding, with the same feelings. Minus the anger. Plus a lot of fear.
I was the one who saw her. Was there delay? What did I do wrong? Did I do wrong? What should I have done?
Outside the mob stood. Murmuring. Complaining. Bottled rage. Naked anger.

Friday, July 1, 2011

Labouring on....

Let me tell you the story of Miss S. My first private patient and what a story at that. A primi who all through her pregnancy demanded to see only me over and above any senior doctor around. :) That was not so much of an issue. But then came her delivery....
Three days past her date, there was still no sign of the baby. So we decided to induce the process with misoprostol.
10 am First dose - no sign still.
4   pm Second dose... All is well
6   pm This perfect angel went raving mad. She sat up, rolled around, pulled out all her lines, got up and started walking... where?... home, apparently. Two staff, one doctor, one relative and one burly watchman couldn't hold her down. In return, I received a well aimed kick to my lower abdomen and my nurse a flying back hand. Finally we called the husband who begged, pleaded, threatened and then literally manhandled her back to labour room. Where she stubbornly sat and then lay on the ground. All the while the hapless doctor (read me) was trying to monitor and maintain fetal heart.
8 pm Finally, madam S did get on the bed and wonders of wonders, the baby was fine. Just a lil higher than before.
9 pm A beautiful big baby girl.