Monday, April 21, 2014

An unusual presentation

JO was a 15 year old jovial boy who suddenly took up sick with fever about a month back. He was sick for almost 2 weeks and was treated successfully elsewhere. After discharge, JO’s father noticed that his son was not his former self. He suspected something was wrong.

His suspicion turned out to be true within a couple of days, when JO became unconscious gradually. Even his family did not take the way he became unconscious seriously as it looked more of JO becoming more and more sleepy over the day.

When JO was wheeled into our Acute Care, he was hardly breathing. JO had something very bad in his brain. He was running a high fever and had anisocoria. We had to do a CT Scan. But, JO was hardly breathing on his own.

After almost 2 days of mechanical ventilation, we could wean out JO from the ventilator. Considering the sort of diagnoses that a young boy with anisocoria can have, we were anxious for the CT Scan Brain. With a backup for ventilation, we rushed him to the nearest town for the CT Scan.

The CT Scan showed a hypodense area in the periventricular white matter of the right temporal region.

After he returned, the anisocoria stayed. However, a fundoscopy did not show any features of a raised Intracranial Tension. With a guarded prognosis, we took a decision for a lumbar puncture. The family readily agreed . . . in fact, we had not given them even a day for their JO to survive.

Lumbar puncture was suggestive of a partially treated bacterial meningitis with a higher protein levels than usual. Considering the long history of the illness, we took a decision to come to a diagnosis of Tuberculous Meningitis.

JO has responded well to anti-tuberculosis treatment. However, he’s yet to be completed fit for discharge.

We’re blessed to be a blessing in the life of JO and his family. Kindly pray that this young boy will be completely healed. 

Long haul ahead . . .

It’s been more than a month. BY, a 28 year old young man with a young family was brought to us for care after he had been in a tertiary hospital for a condition which did not have a diagnosis. He’s had couple of brain surgeries including the placement of a ventriculoperintoneal shunt was made.

BY is quite dependent. He has a tracheostomy, a very badly infected pressure sore on his back and badly wasted muscles of his limbs. He was being fed through a nasogastric tube . . . The family had spent about 800,000 for his treatment. They had sold quite a lot of their land for his treatment.

Before BY’s admission, his father came and talked to us. He told us of his predicament. 

BY had gone for giving an final exams for his graduation. In the exam hall, he had become unconscious. He was brought to NJH from where he was sent for a CT Scan. The CT Scan was normal. But, they did not come back to NJH as his condition was deteriorating. 

Someone suggested that he be taken to Ranchi. They went to the best hospital possible. 

After spending so much for the treatment, there was a danger of the family losing all their possessions if they continued treatment in the tertiary hospital.

However, we've also been at a loss to come to a conclusion about his diagnosis. 

By God’s grace, BY made quite amazing progress for the state he was in when he was brought in. He’s since been shifted to the general ward from Acute Care. Even the pressure sore looks much better than how it was when he got admitted at NJH.

There is quite a lot more for him to progress before the family can think about taking him home. The family’s expectations are quite high. We’re a loss when the family enquires about how things will turn up. Couple of weeks back, while BY was in Acute Care, his wife delivered their second child few metres away in our Labour Room.

Everytime I see BY, I’m reminded of how helpless we are in spite of all the amazing amount of medical research that’s happened so far. However, I’m assured of a Saviour who always heeds the call of the helpless and voiceless. We at NJH can only show the family the nail pierced hands of our Saviour who is the Master Healer. In fact, that’s the best that we can do for BY and his family.

We’re absolutely sure that BY and his family needs a divine intervention . . . and for that, we request prayers. 

Bringing in the sheaves

Today, on Easter morning, we harvested the wheat crop . . .

Snaps of the harvest . . 

We wait to thresh it and find the quantum of harvest . . .