Friday, September 6, 2013

Complicated . . .

Yesterday night, we had a very obviously sick obstetric patient wheeled into the labour room.

SSD looked quite old for an 18 year old lady. She was all puffed up. The blood pressure was quite high. And she was quite breathless.

The history was very vague. The only aspect I could latch onto was that she had a blood transfusion at Daltonganj. The outside investigations showed haemoglobin of 8 gm%. Urine albumin showed 2+.

On clinical examination, it was obvious that she was into early cardiac failure. I was left wondering about her cause of cardiac failure. It was good that we have a Medicine consultant now. As usual Dr. Roshine was quick to arrive and assess the patient.

It seems that SSD was always breathless since her childhood. Dr. Roshine suspected valvular heart disease.

The investigations in the morning confirmed our diagnosis.

The management was easy now. Refer . . . refer . . . refer. Of course, she needed more evaluation.

Pregnancy in its last leg . . . with pre-eclampsia . . . valvular heart disease, most probably a mitral stenosis with regurgitation . . . there were features of pulmonary hypertension too . . . would have been the most critical patient in a high risk obstetric care set-up.

But, the relatives were quite certain that NJH was the best they could provide for SSD. Travel beyond NJH was something that they could not fathom. The problem was the necessary finances.. .. .. there was a fear of the big hospitals and the funds needed.

I tried all the tricks in my bag to somehow refer them . . .

Nothing worked . . .

We request prayers as we manage SSD.

As I mention about SSD, I also would like to put a word for help we would appreciate in the month of October and December. Quite a few of our doctor colleagues will be on leave. It would be a good opportunity for new graduates in medicine to have a feel of work at NJH.

Especially for those who dream to do a post-graduation in Internal Medicine . . . All the more when Dr. Roshine is around. But, more about that, in another of my posts. 

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