It's diarrhoea season at our place now. Patients of all ages are coming in various stages of the disease. So far, the good Lord has healed everyone.
Yesterday, we got the sickest of the lot. Around late morning, an elderly lady was carried in with a history of high volume rice water diarrhoea along with severe vomitting. We could not palpate any pulse.
We were blessed enough to get a vein on her. After about 2 litres of fluid, we could measure her blood pressure.
By teatime, she was up and talking. However, she appeared so tired. During evening rounds, she wanted to go home. I told her that considering the state in which she was brought in and it being evening, it would be better for her to go the next day. I said to her that she looked tired and would benefit from a day's rest.
She told me, 'I'm not able to close my eyes to get some sleep. The moment I close my eyes, I only see my goats which I had to leave as I was brought here. They are still on the hill. I need to ensure that they are back safe'. One of her sons told her that she needn't worry about the goats as someone had already brought them back home.
Amazing . . . even when she was so sick, the only thing she could think about was her goats. In rural areas, animals are the major asset for everyone. That was their bank balance. But, you had to regularly take care of them, unlike a bank account where you are assured of the money which was deposited there. Anytime they need some money one of the animals was sold.
In the changing scenario of the country, when there is a push towards vegetarianism, I can only wonder at the fate of the poor who will have to look for other avenues of income. Or maybe, there will be no more poor . . .
Elderly patients with diarrhoea who have intractable vomiting we found ,have severe acidosis which responds to treatment for it dramatically. Fluids of course is the mainstay but we have also resorted to very slow bicarb corrections for ph below 7.Bicarb tablets (chew)is advised.
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