Urrgghh . . . UDBT

From today, we start a unique experiment with regard to first calls in NJH. It's just Dr. Shishir and me for taking first calls for the next one week. The arrangement is that we are going to do alternatively 12 hours of first call . . . The reason being that both of us in the wrong side of 35 seems to do better with periods of 12 hour rest. 

May sound a bit hilarious, but I thought that the harsh early winter and our poor respiratory systems would benefit from such a system of taking calls. 

Leave that alone . . . I wanted to talk about UDBT again. Oh . . . how I wish that this was legal? 

The story was that we had a lady with a rupture uterus today afternoon, KD, who had a hemoglobin of 7 gm%. She was hemodynamically stable. We got assurance from the relatives that they would arrange for blood from Daltonganj as soon as possible. 

The relatives were quite a few and therefore we thought that we would get the blood soon and we decided to take her up for surgery. Dr. Shishir did the surgery and the post-operative period was uneventful. However, the promised pints of blood never came. 

As soon as KD's surgery was over, we had another lady with a rupture uterus, SD, who also a very similar history. 

The team on duty was busy managing SD. It was only late evening that we realized that KD's blood never reached. Then, our nurses started asking them about what was happening about the pints of blood. Then to our chagrin, we found out that KD's relatives have not even gone to Daltonganj for getting blood. We had given them a request at 2:30 pm and while this was going on, it was past 8 pm. 

I came to know that there was a problem at around 10 pm, when the Acute Care nurse called me saying that there was fellow shouting and threatening everybody. 

I reached the Acute Care to find out a burly middle aged man in a agitated state. He wanted to know who ran the hospital and who the doctor was. He said to me that he will ensure that we drew blood. He then threatened to file a case against me for obstructing blood donation in the hospital. 

He went on ranting. I thought it was a matter of time before he hit me. I thought I'll give him a chance to slap me. Maybe, this was the moment I would get to bring up UDBT into the headlines of the country's media. 

That was when the whiff of country liquor clouded my senses. The fellow was drunk. The sniffles of winter had kept the smell of alcohol in his breath away from me. 

I remarked to a onlooker on how a drunk can be allowed into the hospital. The mention of the word 'drunk' had him make a hasty retreat. 

However, I'm still in a quandary. I've a rupture uterus lady with 7 gm% hemoglobin operated upon without a chance of getting even a pint of blood in the next 12 hours. I can only pray that she'll make it through the night. 

After the drunk relative was gone, I called another relative who was thankfully sober and explained about the problem. He apologized for allowing the drunk fellow come in. But, it was too late into the night. The dipping temperatures and the possibility of being looted ensured that no vehicle owner was ready to ply till early morning. 

Before I end, the common history of SD and KD. 

Both of them had delivered by Cesarian sections before. Their families were attempting home deliveries since yesterday night. In fact, KD's relatives told me that her abdomen was been regularly massaged since the last 2 days and it was so surprising that the baby did not deliver normally. 

I told KD's relatives that I find it surprising that KD is alive. 

Please pray that the relatives will get blood by early morning. 

And also a wish that UDBT would soon be legal for hospitals such as ours . . .

NS – story of ignorance and apathy

NS, a 4 year old boy came the next day after the 2 sisters were admitted. NS was quite sick. The history was more suggestive of acute intestinal obstruction with severe anemia. And interestingly his mother was also quite sick. The only difference being that NS looked very sick and was almost unconscious.

NS’s blood tests were terrible. Hemoglobin of 4 gm%, 40% of the RBCs filled with the falciparum parasite and a platelet count of 20,000/cu mm. We needed blood fast. A peripheral smear showed all signs of hemolysis. NS reminded of Shalom, my son. He was almost of the same age.

NS was from Phulwaria – a village along with banks of the river nearby. Phulwaria is a common name for villages in this part of the country. The basic characteristic of all Phulwarias I know of is that they are usually the name given to the outer neglected part of the country side. And it is the same with the Phulwaria that NS’s family came from.

Families living in utter poverty and neglect. The only attraction for them to live there is the river that flows nearby. Most of the families live on some odd labourer jobs and most of them are at the mercy of the local landlords. The women live collect wood from the forest part of  which is sold and the rest used to cook whatever they can afford to buy. The perennial river ensures that there are collections of pools of water at many places away from the area of water which flows constantly. And this supposedly is the place for breeding of mosquitoes spreading all diseases which the mosquito spreads.

I told the relatives that if we need to save him, we needed blood. Off the 3 male relatives went off to get blood. It was then I realized that I was fit for my next donation and our blood groups matched. And I did not have to give much for a 10 kg child. Off went the donation and the blood was being transfused in no time.

I was with the child for about half an hour as the blood was being transfused. I was looking at the possibility of intubating NS and ventilating him. The other option was to put him on CPAP. But his saturation was maintaining well.

I thought of rushing home and getting freshened up. I had just reached home when I got a call from Acute Care that NS had arrested. Nandamani was in the next room doing a cut down on FD. He had NS intubated but he was not responding to any resuscitation.

By the time I reached ACU, there was nothing we could do. It was not surprising that NS collapsed so fast considering his hematological parameters.

The next day, Angel reviewed the peripheral smear of NS where she found out evidence of severe hemolysis. Most probably, NS had gone in a state of auto-immune hemolysis which is commonly seen in severe malaria.

The saddest part of the story was that the male relatives came almost 3 hours after NS had died. I told them that we had tried our best. As I was conversing with them, I realized that all 3 of them very stinking alcohol and I was talking to 3 fully intoxicated men. I realized the futility of my talking and left them to take the dead boy home.

It was sad. NS was the only child of his parents. As with almost every family in Phulwaria, NS’s family also had a hand to mouth existence. Everybody drowned their sorrows in alcohol which was available plentiful. If the local women did not make the country brew, it could be brought in the nearby Satbarwa village or they could always buy a bottle of ‘English liquor’ which was a bit more expensive. The story about alcohol use would distract you from the objective of my post.

Malaria continues to ravage in parts of Jharkhand in an almost vengeful manner. There are multiple factors which would continue to ensure that the parasite would remain in the communities we serve. Unqualified medical practitioners also compound the problem.

I could only watch helplessly as the nurses removed the almost full pint of blood. They asked me what to do with the rest of the pint. I told them to keep it in the fridge. Maybe, if I got someone else with a A positive group, I could transfuse the rest of the blood. I wish I waited to donate blood for another patient who had a better chance of surviving.