Monday diary

We start Mondays in NJH with much anticipation and preparedness. Usually, they are very busy and it would be very difficult to find any of us sitting doing nothing. I knew that today was going to be tougher than usual as Dr Nandamani who was on duty on Sunday was running a very high fever with body pain and Dr Johnson was on leave.

As soon I finished the rounds in the Maternity Ward and before I started rounds in the Male ward, I managed to peep into the OPD and was surprised to find it quite empty for a Monday morning. I took things a bit lightly and did a very relaxed round in the Acute Care Unit and the Male Ward.

Well, silly me. It was just the calm before the storm. As soon as I finished Male ward rounds, I got a call from Dr. Nandamani requesting me to review a patient in OPD. KD who had a LSCS about a month back had come with pus pouring out of her vagina and pieces of catgut too. The patient was otherwise doing fine. She had come quite sick for her delivery. She was unconscious and having continuous seizures following which we had do an emergency cesarian section. She was in the ventilator for 4 days. The relatives had given up hope. Somehow, she had lived. I asked for an ultrasound. She was quite pale. I’m yet to follow up on the investigations.

As I came out, there was a call from Labour Room. There was CD, a 27 year old G3P2L2 with leaking since early morning. The duty nurse requested me to come fast as the abdomen looked abnormal. One look was enough to suggest that it was either a transverse lie or a Bandl’s ring had formed, the former more likelier than the latter. There was more in store. I did a per vaginal examination and to my horror, a good 2 inches of the umblical cord was hanging out of the cervix and it was pulsating well. The patient had started to contract and there were no membranes. I was not sure if the baby was alive. The nurse was sure she heard the fetal heart.

I took CD for an ultrasound abdomen. Thankfully, the baby was alive. The question was how much longer she would hold on. The only saving grace was that the baby being in a transverse lie, there was nothing putting pressure on the cord.

I rolled her straight from the ultrasound room to the theatre where a call from the laboratory put me in trouble. Her hemoglobin was only 6 gm%. I had no other choice but to operate immediately if I wanted a live baby. With a prayer that the Lord will protect the mother and the baby and very high risk consent from the bystanders, we went on with the surgery. The mother and the baby are doing fine. By evening, the bystanders had arranged couple of pints of blood.

There was more happenings going on elsewhere. Shazia, our community health staff was helping us take the delivery of a Nycocard reader in EHA Central Office in Delhi. The person from the company had called me just before the surgery on CD and had told me that they did get any intimation of the NEFT transfer of the required funds for the purchase of the machine. I explained that the transfer has been made and requested that the machine be handed over. I’m glad that the machine was given although the confirmation of the transaction of funds is yet to happen.

As soon as CD’s surgery was over, I went over and scanned a copy of the NEFT transfer slip and send it over. Later, there was a problem in the pharmacy as it turned out a batch of Ranitidine tablets were becoming semisolid like - almost  liquid-like. So, I had to officially intimate the suppliers as our requirements are quite voluminous.

I made my way to the OPD, where Angel was having trouble with a patient with hallucinations and delusions. The patient was quite poor. From the history, it was obvious that the patient was going into Schizophrenia. I told them of the option of going to Ranchi, but it was quite obvious that it was going to be difficult. So, I had to call up my friend, Dr Raja at Burrows Memorial Christian Hospital, Alipur and soon I had put in a plan of action for the patient and they were quite relieved. That’s telemedicine for us.

Soon, we had our next obstetric emergency. EE, a 34 year old G3P2L2 who had been in labour elsewhere had turned up in the OPD. She had an abdomen like a pear. We had a similiar patient couple of months back. It was obvious obstruction. The only question that remained was whether she had started to rupture. Once again, I was not sure about the baby’s status. The ultrasound showed a fine baby. I had to operate her.

She looked sure anemic. My only prayer was that she would be at least 8 or 9 gm%. She was 7 gm%. But the severity of obstruction she had made me to take a decision to go ahead with the surgery as soon as possible. After sending the relatives to somehow get hold of 2 pints of blood I took the baby in. Once I opened the uterus, I wished I had put in a midline vertical incision rather than a Joel Cohen Incision. The bladder had been pulled quite high up. I had to reflect the upper flap of the abdominal wall quite high to reflect the peritoneum down.

My prayers were answered when we delivered a live girl baby. She had a poor Apgar initially, but was well resuscitated by the theatre team. When I went in the evening to review her, she was bawling out. And oh my, the only time you feel so happy to see a child cry out.

I had staff from the hospital where EE was admitted for the last 3 days. It seemed that she was asked to go to a higher centre on Saturday night as the doctor had felt that the baby had not rotated properly and she could need a Cesarian Section – but the family had not taken it seriously. And having waited for quite long – they had taken a very high risk.

As soon as I finished surgery, Sr. Bharati, the Nursing Superintendent had news for me. Dr. Nandamani could hardly sit, leave alone work. He had told me that he was feeling quite sick in the morning and I had told him to take sick leave if he finds things difficult. Dr Nandamani had left OPD and there was quite a large crowd.

As usual, there was a bunch of tuberculosis patients, couple of patients with bronchial asthma, two patients with long duration of fever with typical features of dengue and a low platelet count whom I ultimately admitted.

However, I need to tell you about a patient who I felt so bad about. She was SD, a 65 year old lady with a swelling over her right cheek. It was obvious oral malignancy which was spread locally. There was nothing much I could do. As soon as I told the husband that he needed to take his wife to the Medical College under Banaras Hindu University, both of them started to cry. I asked them about their children. More tears rolled down their cheeks – there was so much of hopelessness in their eyes.

I told them that I’ll help them to obtain help in going. They sat down and talked for a long time. It seemed that their children were doing well. But, they had no time for the parents. I gave letters for them to give to the local government authorities so that they could request help.

Like the many malignancies which we have been seeing of late, most of these poor people have nowhere to go.

In between, we had a elderly lady with electrical burns. There was only about 10% of burns and most of it was quite deep. Since electrical burns could be quite deep such that it could involve even the bones, the patient was quite elderly and the family looked quite well off, I gave them the option of taking her to Ranchi which they promptly did.

By the time, we finished OPD it was 5:30 pm. As with each day, we had learnt quite a lot. There are concerns which I would share in my later posts especially about the prevalence of anemia which is responsible for quite a lot of morbidity and mortality in this part of the country.

I also realized that Dr Shishir, Dr Nandamani, Dr Angel and I had dealt with quite a number of sick patients whose management could have resulted in quite a number of complications and I acknowledge the grace of God in whatever we did during the day. My prayer is that our patients also realize the same in their lives.