Tale of 2 ladies . . . and a third one

(This post was done on Monday, 7^th October, 2013. Our internet connections are back to a very poor state of affairs. With Supercyclone Phailin on the way and the Dussehra festivities on, it looks a remote possibility that we would have fast internet connections for the next week too)

My yesterday’s Sunday duty (6^th October, 2013) was quite a light one. There were only 2 women in the labour room throughout the day. One of them was rich and the other poor.

However, both of them shared the characteristic that they were not taken very seriously by their families. The reason? Both of them were high risk pregnancies. And neither of the families was bothered about it.

The first one RD, was quite well off. This was her second pregnancy. The first one was quite an eventful one. She had severe pre-eclampsia and she had delivered a pre-term small for gestational age baby. She had come four times for antenatal care of her second pregnancy. 

Each time, she was told to come more often so that we could ensure that we make an early diagnosis of any high blood pressure. The first 3 visits were in the first and second trimester. 

Her last visit was 3 days back. She was almost nearing term and she had a blood pressure of 150/100 mm Hg. We had advised admission.

She went off home and came today after she started to contract. The blood pressure remained high. I just received news that she delivered.

I would say that her family should have been more careful with her treatment. They’ve got away with very lazy approach to her present pregnancy.

The next patient, SD was not that well off. Her blood group was O negative and her last haemoglobin was 8.5 gm%. We had seen her in outpatient more than a month back. The doctor who had seen her had well explained need for blood as well as absence of a blood bank in NJH. Of course, the difficulty of getting a O negative donor was also put across well.

The patient came in labour. There was no sign of arranging for any blood. Rather couple of male relatives vent their anger at us for not telling them things early.

SD was lucky. Being her second delivery, she progressed so fast that she delivered soon. Gladly, there was not much blood loss. The mother and baby are doing well.

Again, one more case which could have gone awry.

Well, there was a third lady too. She was not that lucky. I hope things will turn out well for her in the couple of days.

This was her 5^th pregnancy. We’ll call her CD. She has only 2 live children . . . both girls. 2 of her babies had died. The urge to have a boy child resulted in this pregnancy.

I’m not sure about her regular antenatal care. But, the relatives told me that she was not doing well since the last 3 days. And she is just into her 8^th month of pregnancy.

Her complaints . . . headache and blurred vision. They had gone to 4 hospitals over the last 3 days. In fact, they returned home after a circuit of hospital visits only on Friday evening. She was given a clean chit everywhere.

Today morning around 9 am, CD had multiple episode of seizures. The family rushed her to a hospital in the nearest town. The doctor told the family that she is very sick and only NJH can do anything. The reached around 2 pm.

Blood pressure was 210/140 mm Hg and Urine Albumin was 4+. The family had lost count of the number of seizures she had. In fact, when I reached to see CD in labour room, she was continuously seizuring.

She has not yet gone into a HELLP Syndrome. But, she is very sick. We’ve induced her. Please pray that she will deliver soon.

The first two cases were outright instances of ignorant and careless family members.

But, what about the third case? The medical fraternity had failed her. A typical complaint of pregnancy induced hypertension, headache and blurred vision, was totally ignored. The shocker. . . 

The family was very sure that nobody in the four hospitals had checked her blood pressure!!!

I have only one prescription in my hand. There is no measured reading of any blood pressure.

How long will we tolerate this sort of management?

PS: CD delivered the next day (8^th Oct, 2013). She got discharged couple of days back. 

IWD . . . 3 stories . . . No, 4

(This post was done yesterday. But, I was too busy to post it)

Today is International Women's Day. We had quite a few programs lined up for the week.

Like many of my previous mails, stories of 3 women I saw in the hospital today which epitomises the state of the nation's women.

The first one, A. A 50 year old lady who had come to me about a week back with vague complaints. She attributed everything to her high blood pressure. I thought that there was more than hypertension in the diagnosis. I had asked her relatives to get her admitted for a day or two so that we could observe her.

Her vague complaints varied from feeling fearful, perception of something trying to attack her, someone trying to squeeze her head. She attributed everything to the high blood pressure. 

We admitted her and found out that she did not have any major problem with her blood pressures. Today morning, I got her relatives and talked about something more than blood pressure that she could be having. 

They agreed to allow me to start psychiatric treatment and counselling. As she was getting discharged, the husband came to me and asked whether he could take her to a psychiatrist. I had already given them the option. Then I suggested one of the psychiatry institutes in any of the nearby cities. 

To my horror, he told me that she was on treatment 10 years back in a psychiatric institute and now he did not want to have the stigma of being attached to a psychiatric institute. However, he never thought about revealing the same to us even after we had enquired about such a history many a time. 

The second patient, B. Diagnosed to have Pulmonary Tuberculosis at NJH 4 years back, we had referred her to her nearest DOTS Centre. She had come to us about a month back. It was a hopeless case. Her lungs were quite eaten off. My colleagues wanted me to take a second look. Below is her Chest X-Ray.

There was nothing we could offer. The history was horrible. She claimed that she never got regular medicines from the DOTS Centre that we referred her. Later, she went to another place from where she took irregular medications. The sequence went on for 4 years before she thought about coming back to us. 

Pulmonary tuberculosis continues to be a big killer in our part of the country. And women are no exception. 

The third patient, C. We first saw C about 2 months back. She had come with very high blood pressure and seizures. We tried to refer her. But she never went. And she refused to terminate her pregnancy . . .  Rather her husband refused permission. She was discharged with anti-hypertensives . . . and she had improved quite a lot. 

Patient C came again . . . she had stopped her medicines. And she had one more episode of seizures. Again the same sequence of events repeated. I felt we could not do anything. To make matters worse, the husband got a discharge against medical advice and left. 

And she came yesterday . . . in full fledged HELLP. And anuria . . . This time, it was a bit different. She was accompanied by her father rather than the husband. As my colleague explained the situation, the poor father was aghast. It seems that he was totally in the dark about her daughter's condition. 

The patient went referred to Ranchi . . . Do pray that she will make it . . . 

3 stories . . . 3 instances where the women was left in the lurch one way or the other. The consequences are terrible and something which cannot be fathomed in a civilised society. 

However, towards the end of the day, I had another patient . . . Patient D . . . She was in labour for more than 36 hours in one of our neighbouring district headquarters hospital. 

The issue here is that the healthcare personnel left the family down. 

To make the story short, the baby was obstructed in the birth canal. We had to rush her in for Cesarian. The baby's head looked as if it was put in a tube press. He was lucky to be alive. 

However, the parting shot was that of one of the relatives' of patient D . . . 'We're glad that the baby is a boy and not a girl. We feel that our efforts were not wasted'. 

Speaks volumes . . . Don't they? 

Hope my readers would values the women in their life . . . mothers, daughters, sisters and of course their wives . . . I cherish them. May you do the same too . . .