Saturday, August 20, 2011

TIRING THURSDAY . . .

We had a comfortable journey back from Delhi. The Garib Rath reached Daltonganj on time. After the rush in Delhi, it was a bit unthinkable for me to take first call on Thursday. For most of you who may not know about the weekly schedule in NJH, Thursday happens to be a half day. The major reason for this is to allow staff to do their weekly shopping and banking. Being far away from the town, this was very much needed in the olden days. However, most of the patients do not remember about this and still keeps on coming even in the afternoon. So, anybody on duty on Thursdays ends up seeing quite a lot of OPD patients in the emergency.


My day started quite interestingly. First of all there was DD, a G3P2L2 with a big baby in breech position. She had normal deliveries both times earlier at home and the second delivery was a breech delivery. However, the local dai who had taken her delivery both the initial times was not very confident about this one delivering normally. Even, we thought the same. But, by the time she reached NJH, she was already about 8 cms dilated and with good contractions. We posted her for a cesarian section but in theatre we realized that baby was quite on its way before we started. I was quite surprised that we could do a breech extraction without much difficulty. The poor family was quite overjoyed that a Cesarian was avoided.


After that we had SD. SD was having an uneventful pregnancy till yesterday midnight. At around 11 pm she threw a fit followed by a number of them. The family lived quite remote and by the time they got some sort of conveyance it was dawn. The reached a hospital in Garhwa by around 6 am from where they were referred to Daltonganj. The private hospital in Daltonganj again referred her to us after giving few injections which included Diazepam and she reached us around 10 am. She was unconscious, but the baby was alive. We had to deliver the baby fast. Unfortunately, the baby came out quite sick – was not breathing and had to be ventilated for almost two hours. Probably the diazepam and the Magnesium Sulphate had done the damage. The baby was improving but over the night, he became quite sick and is again on mechanical ventilation. SD has improved but she is still groggy and it would take some time before we can confidently say of her complete recovery.


Immediately afterwards, we had CD who was a previous cesarian and also had a cholecystectomy before. I’ve known surgeons who would be very hesitant to open the abdomen a third time. But, we did not have much of a choice. CD had scar tenderness. We had her opened up in no time and she was lucky. The scar was giving way and we were just on time. CD and family were quite happy to get a boy baby – her first one was a girl. The issue of not having a male heir in the family supposedly creates a major crisis in Indian families. I should have mentioned that for the earlier patient, SD has 3 girl children.


After the 2 surgeries, I was lucky to get some sleep after lunch. My next call was a bomb. RD, 22 years with a twin pregnancy and 36 weeks gestation, with at least one ante-natal check up every 2 weeks had landed up with history of multiple episodes of seizures since 2 in the afternoon. She was also straightaway referred to NJH. This family was very rich and could afford the best treatment in the country. But they were at least 4 hours away from the next tertiary centre. And, she was unconscious with phlegm clogging all over her lungs. The Blood Pressure was an astounding 230/150 mm Hg and Urine Albumin was 4+. She had also received some injections which included Inj. Diazepam. I was worried about the babies.


Meanwhile the family was juggling the option of taking her onto Ranchi. I told them about the pros and cons. Ultimately, the agreed for a emergency cesarian section with all full risks explained.


The Cesarian section was uneventful. As expected, both the babies were heavily sedated. We had to ventilate them quite a bit before they started breathing on their own. Unlike SD’s babies, KD’s babies have improved quite a lot and are doing well. Even, KD is doing far much better. KD’s story is a clear demonstration of how much the family needs to be educated on the danger signs of pregnancy. Later, I found out that KD had her last ante-natal check up 2 weeks back and there were no problems. However, after about a week, she had started to swell up which the family did not take seriously.

As I finished suturing up KD, I got a call that there was a polytrauma. More about that in the next post. . .

2 comments:

  1. Dear Dr Kuruvilla, I don't know whether these blogs are in close group or not. People like Maneka Gandhi may pull Dr Sisir into much trouble for killing a cobra . According to the Wild Life Conservation act , 1972 , Cobra is a reserved species like Royal Bengal tiger and Black buck deer.

    ReplyDelete
  2. Daltanganj District Recruitment 2017 – palamu.nic.in 3068 Sales Manager/Trainee Posts:- Government of Jharkhand is going to organize the Daltanganj Rozgar Mela in the district to fill the 3068 posts.

    ReplyDelete