DUTY DIARY – THURSDAY

I was on duty on Thursday. As I had mentioned in my earlier post about Thursday (http://jeevankuruvilla.blogspot.com/2011/08/tiring-thursday.html), I hope you know the peculiar position the doctor on duty gets into.

The day started off with two quite well off portly ladies (AS and PK) in labour made their presence in the Labour Room. I hate when private patients come for delivery in our unit. Of course they bring in extra revenue – but I’ve always felt that they extract far more attention from all staff which actually robs you of sleep and concentration that ultimately divert the attention you give to the rest of the patients. From the time they came in, I had an inkling that both will go for Cesarian Section.

And of course, both of them ended up with Cesarian Sections, AS in the midnight and  PK on Friday early morning. In addition, there was a mother with polyhydramnios and a malformed baby (AD) who was not responding to any induction. She was induced thrice - first time with oral misoprostol followed by vaginal misoprostol, the second time with oxytocin drip and the third time with a higher dose of oxytocin drip. She had been leaking since the last two days and we tried a fourth time with a higher dose of vaginal misoprostol, which she ultimately responded to. The baby was quite malformed with the eyelids sealed shut, bilateral cleft lip and palate, cardiac lesions and a enlarged liver and weighed just about a kilogram. We decided not to resuscitate him - he came out with only a heart beat. It was AD's seventh pregnancy - but, she had only 3 live children.

Below here, is the list of other patients we had. I’m not going into greater detail about each patient – but shall try to provide them in a later post.

1. SD, who had come in labour with a Hemoglobin of 1.8 gms and expired at around 10:30 pm (http://jeevankuruvilla.blogspot.com/2011/09/maternal-death.html).
2. SB, a 14 year old girl was brought to at around 5:00 pm with a history of Krait bite which happened in the morning. She was hardly breathing and had aspirated quite a bit. Her saturation on arrival was 55% and she got hooked straight into the ventilator. We had to pump in about 20 vials of Anti-Snake Venom before she made a remarkable recovery.
3. FA, an 8 year old boy who came in a history of Krait bite at around 8:00 pm. He came in quite fast considering into the fact that the bite took place at around 5:00 and he lived couple of hours away by jeep. The signs of envenomation had just started and he was quite lucky to have escaped from the ventilator.
4. RK, a 9 year old boy had come in with a very short history of fever and seizures. CSF examination did not yield anything. He was going on having fits and we had to give him quite a lot of anti-seizure medications. We started him on empirical antibiotics and antimalarials – but there was no improvement. He arrested yesterday (Friday) morning and was hooked onto the ventilator. However, today (Saturday) morning the parents decided that we had tried enough and wanted the boy taken off from the ventilator – following which he died.

There was couple of sick patients in ICU (admitted earlier) which kept me occupied.

1. GS, a 70 year old man who was admitted about 4 days back with a long history of fever which was being treated as malaria had become sick suddenly. The previous day, we had found couple of apical lesions in the lungs and had concluded that he had tuberculosis. I’m not sure, whether the anti-tuberculous treatment actually made him sicker. However, he responded well to steroids.
2. PB, a 12 year old boy was a very atypical case. He had come on the 30^th August with history of high grade fever and seizures. Initially, he looked like a case of tetanus – his jaws were clenched tight and he had opisthotonus. But, there was no wound. The other diagnosis was meningitis – but the CSF examination did not yield anything. This was when I thought about tetanus. And he responded to treatment for tetanus. There is already medical literature about tetanus occurring without a visible wound.

My duty spilled on to Friday with a whole lot of serious patients coming that I could leave for home only by Friday evening. We had about 90 patients in OPD and by the end of the day; the beds in the wards were all full. I will narrate the quite eventful happenings on Friday in another blog. However, Dr Johnson who was on call later in the day had an uneventful time.

Today (Saturday) has been quite busy. And having the hospital management committee meeting did quite a lot of damage to patient care. But we did not have many options as it had been due for quite a long time. By the time we finished OPD it was 5:00 pm – something which has not happened at NJH for quite a long time. Dr Nandamani is on duty today. He is having a tough time. I’ve been on and off been out there helping him out. I would be on duty tomorrow. If time and the internet connections permits, I shall keep you updated about happenings here over the weekend. And mind you, of late, Sundays are never dull at NJH.