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 . . . 

Maybe, we should have send her home . . .

Couple of days back, we had a very sick pregnant lady being wheeled in.

As DD was wheeled in, we were quite sure that we were dealing with a very sick patient. She had been in labour for more than 4 days. It was very obvious that she had been through a tough time. She was in a terrible shape; all bloated up; the birth canal was so edematous. The baby was obviously dead. The head was so high up and appeared to be stuck. The abdomen had a very abnormal contour which is quite commonly seen with those who sustained a rupture uterus.

There was a high chance that the bowel and the bladder were all ischaemic because of the abdominal massage she had over the last 4 days. There was only a 4-5 centimeter diameter of the birth canal. Even if we tried a craniotomy, there was high chance of severe birth canal injuries. There was also a chance of a rupture uterus.

She was also in severe sepsis.

There was only one thing that we could think about . . . to operate and remove the dead baby. The family were very very poor. They had not even a single rupee to take. They had been to couple of other places. The travel from their home to the various centres and lastly to NJH had taken up all the money they had.

Considering the chance of a rupture uterus and bowel injury, we decided to operate. On hindsight, the decision was a ill thought one. The uterus was not ruptured. But, the lower segment was like mincemeat. Putrefaction had set on the baby. On opening the uterus, there was a gush of pus and foul smelling gases.

The bladder was distended and edematous. So was the bowel. There was no necrosis or ischemia . . . but it was obviously unhealthy to look at.

I somehow closed the uterus and came out of surgery.

She did well for the first 24 hours. Then, her condition just deteriorated. She was running high grade fever round the clock. We had to hook her to the ventilator. There was foul smelling material coming out of the uterus. Her urine output was fine, but it was getting bloody and brownish. Her creatinine is about 6.

Today evening, she is all puffed up.

The costs of the treatment has been on the house. However, we will not be able to give her high end antibiotics like Piperacillin-Tazobactum. We helped the family arrange one pint of blood. We’re quite sure that we would not get any payment for this patient. The family had a RSBY card. We’ve blocked her under the scheme.

Please remember DD in your prayers . . .  

Alarm Clocks

Over the last couple of weeks, we've been woken up quite a few days by . . .

Well . . . where did  they come from . . . Another snap of the quartet getting ready to sleep . . .

The kids have a great time feeding and watching them .. .. ..

I hope you remember the 'turkey poults' that a fly-by-night salesman' sold me in January. I had been suspicious all the time. However, the guy had done a good job shaving off their necks and coloring their heads. He would have got them by paying some broiler hatchery worker for the roosters. The male chicks are usually killed in broiler hatcheries. 

I'm not complaining though . . . In a couple of weeks, we'll have some good meat on the table . . . .  

No second choice

(This is a purely medical post. There are images which can be quite revolting to most of you. User discretion advised)

Couple of days back, we had a very interesting patient in labour room. RD, a 30 year old mother of three came to us with the complaint that she had a spontaneous abortion early morning. She was in her fifth month. The problem was that she was diagnosed couple of weeks back that she had a twin pregnancy. Only one baby had come out. According to her, the second baby has not yet been expelled. 

I wish I had taken her snap when she was wheeled in. Her abdomen looked as if it contained one term pregnancy. On palpation, it was quite funny. There was a good fluid thrill and the abdomen contour was quite uneven. 

On ultrasound, she had huge ascites and there was a solid mass inside the abdomen. We got the ascitic fluid drained out. It was obviously a malignancy. She gave a history of 5 months . . . and she had attributed the gradual onset of her abdominal swelling to the pregnancy. And the ultrasound done couple of weeks back gave her a report 

Then the problems started . . . We discussed about referral and further treatment. She was quite young. She had little children. The family was very very poor. 

The husband and her mother made it very clear that they are taking her home to die. Both of them came and met me today morning and told that if we could do anything to relieve her pain. 

We discussed on what could be done. We took help from Dr. Hilda, our gynecologist colleague in Chattarpur. Considering the huge swelling, I was sure that some amount of debulking of the tumour would do her a lot of good. Of course, there could be secondaries. An ultrasound and X-Ray showed that the lungs and liver were clear. 

After a long interview with the family we decided to go ahead with the surgery. 

It was a huge swelling . . . certainly the largest we had recently. The mass weighed 3.6 kilograms. Thankfully, the mass which originated from the ovary did not have much adhesions. The sad thing was that she had seedling in the peritoneal cavity. 

Kindly pray as she recovers. We've send the mass for histopathology . . .  We would also like to people contributing for her treatment. The total costs would be about 20,000 INR. 

Angel practising her skills of 'grossing'

The cross section of the swelling

Finger Millet-Corn Meal Chocolate Cake (Gluten Free)

As we have been working with propagation (rather re-introduction) of millets in our region, we’ve had some excellent support from agriculturists, academicians and researchers. When we came up with the recipe booklet of traditional madwa (fingermillet/ragi) food-items, quite a few of them encouraged us to come up with original recipes of food-stuffs which are more acceptable to an urban population. 

Of course, there are quite a lot of recipes for making cakes etc. However, we thought of developing our own recipes. Over the last 6 months, few of us have been working quite hard on this and we’ve come up with 3 recipes for cakes.

This recipe has been voted the best by our kids.

Ingredients:

Unsalted butter: 1 cup

Sugar: 1 cup

Corn meal: ¾ cup

Ragi/Fingermillet flour: ¾ cup

Unsweetened cocoa: ¼ cup

Eggs: 3 large ones

Salt: ¼ teaspoon

Vanilla extract: 1.5 teaspoon

Baking powder: 1 teaspoon

Boiling hot water: ¼ cup

Method

1. Separate the whites and yolk of the eggs.

2. Whisk the whites.

3. Sift the corn meal, ragi flour and cocoa powder along with baking powder and salt.

4. Add ¼ cup of boiling hot water to the above flour mixture and mix it well. Keep aside to cool.

5. Cream the butter and sugar.

6. To this, add the yolk of the eggs and vanilla extract and mix well.

7. Add flour mixture (item nos. 4) to the butter-sugar-egg yolk mixture to get a medium consistency batter.

8. Fold the whisked egg whites (item nos. 2) to the batter.

9. Bake at 170 degree Celsius for 50-60 minutes.