Sunday, July 31, 2011

Weekend diary - NJH


The weekend at NJH starts on Friday evening. There are hardly any weekends when it is not busy. And we usually end the week with quite a number of surgery cases which has been inadvertently postponed over the week days to the end of the week.

However, this weekend was different. Friday evening was madness. I find out at 4:00 pm that there are no filled up oxygen cylinders in the store. The reason - the fellows in the store were fighting on who would go to fetch cylinders on Thursday morning. And they kept quiet about it for the next 2 days - inspite of realising that the hospital was hopelessly busy. Both the culprits got a piece of my mind for their slackness. Later, we arranged for oxygen cylinders to be procured from the nearest town, Daltonganj. We usually procure our cylinders from Ranchi. The costs in Daltonganj are more than twice that of Ranchi.

There were a total of 5 surgeries posted. However, the morning started with a sudden discovery of neck stiffness in one of staff kids - who was down with fever for the last 7 days. We had presumed that it was viral in the beginning and later malaria and later enteric. Considering his VIP status, we had to refer him to a pediatrician in Ranchi. The parents were quite upset and all of us took a decision that I should accompany the patient. The OPD looked busy - but there was no other option. Dinesh and me were on our way quite oblivious of what would be happening in hospital. I knew that I had to be back soon as I was on duty.

Nandu started the theatre list with an elective cesarian section which was soon over without much confusion or complications. This was followed by the dilatation and curretage of one of our staff who had a missed abortion. Kindly pray for this lady who had the abortion for a second time over the last year.

However, poor Nandu did not know that it was just the calm before the storm. The next in line was a middle aged lady who had come with bleeding per vaginum. Nandu had looked quite carefully for some clinical or sonological evidence of malignancy. However, to his horror, when he operated, there was malignancy of the uterus extending to the the pelvis.

There is another side story of this lady - when she came to us, we told her of our willingness to do a hysterectomy if everything is fine. Later, she asks us how much it will cost. We tell her that it would be about Rs. 10,000. Later, she tells us that she will have to sell part of her land to pay that much. So, we ask her how much she can pay without selling off her land. She says Rs 3000. So, we agree for Rs. 3000 and we congratulated ourselves that we have prevented her from selling off her land which could be sustaining her family. There has been enough research which shows that medical costs in India push quite a lot of people into poverty.

Unfortunately, it seems now that she has a long way to go. The family is so poor that I wonder whether they would be able to afford any sort of further treatment. Radiotherapy facilities are only available in Varanasi which is about 200 kms from here.

Earlier in the day, Nandu had admitted a little girl of 7 years with intestinal obstruction. She was stabilised by then and was ready for surgery. There were quite a lot of things inside the little ones abdomen. A Meckel diverticulum, a constricted portion of the small intestinal and multiple adhesions of the intestines. All of the problems were taken care of and by the time Nandu was getting out of theatre at 7:30 pm, word came from the labour room that a Cesarian section needs to be done. The LSCS passed uneventfully and he was ready to go home by 9:00 pm.

The hysterectomy and the intestinal obstruction was interspersed by yet another incomplete abortion which needs a cleaning of the uterus. The surgeries had taken up so much time that one of the burns patients on whom we were planning to do skin graft had to rescheduled for the next week.

Meanwhile, I was in Ranchi with the staff's kid. The consultant pediatrician was not very convinced about my suspicion. But his attitude changed when he saw the peripheral smear report - toxic granules with a shift to the left. The little fellow who was feverish and stiff in the morning was sitting quite comfortably in the examination room munching a chocolate bar. The pediatrician decided to do a lumbar puncture along with the routine investigations. The staff called me as I was on my way back - to tell me that the lumbar puncture was confirmatory of bacterial meningitis. The boy has been admitted to the Children's Hospital at Ranchi.

While I was doing the consultation with the child, our engineer was doing shopping for the hospital and ensuring that all the empty oxygen cylinders are filled up. We started back from Ranchi by around 7:00 pm - and reached NJH by 10:30 pm.

I was welcomed back at NJH with a overflowing labour room and a cent per cent full hospital wards. Labour patients were still pouring in. To supplement, a middle aged lady was brought in - bitten by a yellow and brown snake at around noon. Her family had completed all formalities of taking her to the traditional healer and the village quack before they noticed that she was bleeding from her mouth. She came in almost 12 hours after the bite. Her clotting time was much beyond 15 minutes and she is going into oliguria. I've already pumped her with 12 vials of anti-venom. The problem of acute renal failure and the need of hemodialysis was explained to the bystanders. They look quite poor to even pay the costs of the anti-venom.

Meanwhile, I thought that the crowd in the labour room was coming down. I somehow got time to go home. Shalom, my son was sick throughout the day. He had got up at 1:00 am for a snack. He was happy to see me back. Just as I thought of getting couple of winks, there was another call. 2 ladies had simultaneosly arrived in labour. The first one was in early labour and did not need much intervention. The second one was quite complicated. She had 4 episodes of convulsions since morning. But her blood pressure was normal and urine albumin was nil. So, eclampsia seemed unlikely. Later one of the bystanders told me that she had fever and vomiting 3 days back - was treated by some quack. I examined her - there were features of meningitis. We don't have facilities to do CSF examination - that's the first priority after Angel joins from Monday. Therefore, started off on antibiotics. She has settled so far.

I thought that I had enough to write a blog - and started to write this. Within ten minutes, I had my next call. One of the pregnant patients at term in the ward admitted with a low lying placenta for observation suddenly started to bleed torrentially. I had no option but to take her up for Cesarian section. As soon as this was over, another patient who had been in labour room with decreased fetal movements started complaining of absent fetal movements. She was also posted for Cesarian section. By the time everything has sort of settled down, it is 4:00 am.

As I was finishing suturing up the second Cesarian section, there is urgent call from the Emergency Nurse - there is a young man brought in with a krait bite. I ask her to start off the ASV. He is lucky to have come fast. The best part was that the relatives have brought in the culprit snake - the biggest banded krait that I had ever seen - which will be the only snap for this blog - but quite worth it. We are only half way into the weekend and what a day it has been... I wonder what is in store for us today...

4 comments:

  1. Hey Jeevan! Wow, what a day!! Amazed you found time to write this!! God bless you guys. Hope Shalom is better. Btw did you do TORCH for the lady with abortions?

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  2. Encouraged to see all smiling faces of your family in the mission field. Enjoyed reading your day's work. You are remembered. Giftus, CMC, Vellore

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  3. jeevan chetta, your experiences are truly challenging and encouraging... really benefitting from them.. May God continue to bless u and family..

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  4. Do the majority of the snake bites take place at night?

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