Friday, September 30, 2016

Just when I thought I had seen it all!

Just when I think I have seen it all and done most things in Lakhnadon,Alok Singh is wheeled into the OPD.He has a history of injury to the heel which was treated in Seoni .Since two days he has severe spasm in the neck and is unable to swallow anything.
I last saw a case of tetanus ten years back in Jharkhand .Here was Alok who went into a severe bulbar spasm as soon as I put my spatula into his mouth.
I had to go through the tedious experience of explaining the natural history to the  bystanders who were already very difficult to communicate to.
Just how do you treat diseases like tetanus in the current scenario?We have long stopped stocking Tetanus anti-globulins.Brought to mind Dr keith Sander whom I had the privellage to meet for lunch during my time in England.he had done some work on tetanus during his stint in Ruxual ,and I am talking about the founders of the organisation !
I remembered our escapades in Oddanchattram where day after day Dr KV during his rounds used to show us different ways of examining the well-being and progress of such patients with such patience.
The incident that stands out is of a patient from one of the Panchalur hills who was brought to Oddanchattram with the full-blown disease.The patient had to be sedated ,kept in a quiet room and had to be bagged with an ambu.We did not have a ventilator then.The tubes started clogging on the third day so a  tracheostomy had to be done.
Every day Dr KV would go through the vitals to look for features of dysautonomia,palpate the abdomen to make sure he was sedated adequately,scan the diet sheet  and go through the routines very calmly while we tiptoed around so as not to wake the patient .
One fine day the relatives decided that they had had enough and they wanted to take the patient home.
When persuasion did not work we sent the patient home with a spare ambu-bag .
A month later  my senior Alex came chuckling into the out-patient.
Much to our amusement and joy the patient had walked into the OPD all the way from Pachalur bagging himself with the ambu.
He must have recovered some time back but had been too afraid to disconnect or do anything about it.
That was good news.
However,managing Tetanus is hard and I often find that the support staffs are not trained or adequately equipped to manage such cases.Add to it I travel out of lakhnadon tomorrow and will be away for more than a fortnight.
I feel tired even as I explain the logistics to the patient and the bystanders.
He is with us tonight.Tomorrow they might have to make a more feasible arrangement.
Just how do we treat diseases like tetanus in this day and age?Sigh!!

Saturday, September 24, 2016

The Concert.

Yesterday we attended the ‘Yeshua ‘concert in Jabalpur.
It  was a group of young boys leading  the  worship with songs which have blessed so many in the 
present generation.
There was a lot of  technical snag I believe (Joseph ,our muscian dentist noticed but  so did he notice the much needed  dental work the lead singer needed,so I don’t know?) because the unpredictable rains ensured a change of venue at the last moment.I, for one ,did not notice anything because I was caught up in the worship.
The concert started with a salute for the king-all of us stiff people were asked to stand in absolute
attention with our salute for the King of kings.
There were banters,there was worship,there was an altar call.My heart’s cry was for the youngsters
on the stage to be broken individually for God to a greater extent and to be poured out even more for
Lord Jesus’ glory.
At the end of the worship all of us were on our knees ,with our eyes closed worshipping with the
team even as the CNI pastor gave the benediction.
It was a ‘Jesus’ show all the way.
I was blessed.

Wednesday, September 21, 2016

Preaching by Mr Ekka in the prayer meeting in my house today.

We are called to be the sons and daughters of the living God.
We are called to purity.'be thou Holy even as I am holy.'
We are called to grow and be lifted up in Christ.
We are called to be taken up in Glory with our savior.

Tuesday, September 20, 2016

Just a day in a mission hospital.

Ashish Ram literally hobbled into our casualty supported by his relatives.His complaints were severe palpitation and giddiness.His heart was racing as was visible from his carotids and his pulse was hardly there.We fitted a cardiac monitor stat and there was a ventricular tachycardia on the run.This fortyfive odd years man had walked with that VT from God knows where?
We traced out an ECG ,got our defibrillator into our casualty and I got my colleague going with the
machine even as I got the settings in place.The nurses were quick in getting the consent from the relatives.The man was sedated quickly and shocked.He reverted to normal sinus rythemn by God's grace .
The second ECG we traced out showed a nice WPW syndrome,the earlier ECG also had a prolonged QTc which had normalised in the second one.The electrolytes which were quickly done through the ABG showed significant hypocalcaemia so we gave him the slow calcium gluconate intravenously with our eyes on the monitor.
To make sure that the VT would not revert we had to put him on bolus amiodarone and mantainence for the next twenty-three hours.
Ashish Ram responded very well to the emergency treatment ,but now the definitive management with all the expenses loomed in front of him.The least I could do for him was put him on a protective treatment till he could make the necessary arrangements.
I sent a quick facebook message to my friend Amos in Cardiff who is a cardiologist with special interest in VTs.Amos was a colleague from our Oddanchattram days.He had come to ODC as a student elective from Malaysia.An extremely God-fearing and humble individual,I don't ever recall Amos not smiling.He was an active member of the junior doctor's fellowship.
In between putting his little baby Annie to sleep ,he was quick in responding.Flecainide was what he suggested,with an alternative of digoxin and beta-blocker carefully.
Flecainide ,we did not have.Since we had already started him on tapering doses of Amiodarone ,he suggested going with it for the next three weeks and then changing over to the above drugs carefully.
The next morning ,when I went for my rounds Ashish Ram  was happily sitting up in bed eating an apple with such gusto that he looked different.
Ashish Ram would not understand what had gone into saving his life.
Lizi,our dentist having left Lakhnadon, sent me a message from the US saying that she wanted to facilitate buying an equipment for our hospital .Being a physician ,I shuddered each time a myocardial infarction patient landed at our doorsteps,praying hard that the patient would not go into a life-threatening arrhythmia .
Predominantly a surgical unit,I remember sitting in the OPD and praying for patients,the immediate response as soon as we finished praying was an old couple who came huffing and puffing into my OPD with chest-pain.They were poor but they were an answer to our prayer.She had an anterior wall MI. We treated the patient with a lot of gratitude in our hearts.We are friends and greet each other with much happiness whenever we meet.
Lizi helped us buy the defibrillator.
DVN made arrangements for us to buy a cardiac monitor and helped us build the ACU.
Amos gave me the assurance and the support I needed then.
Ashish ram got the gift of life.One never knows the the extent of impact of one's genorisity.
The beauty of it all is Ashish ram is oblivious of it.

Monday, September 12, 2016

Hail the Lion of Judah!

Eight o'clock in the morning while we were having our morning prayers,a patient with chest pain came to the casualty.The young nurse during the ward prayer prayed that not I, but Christ would come through to minister to all the patients.
The patient was in severe distress with pulses hardly palpable.Max had done the prelimanaries and by the time I reached, the ECG had just chugged out from the machine.the patient had extensive anterior wall myocardial infarction.
I started barking orders as usual.The monitor showed a sinus rythemn and the blood pressure was just about holding.We went ahead and thrombolysed the patient.
The streptokinase was in ,the analgesics were in and so we expected the patient to settle down,but suddenly he started sweating profusely and went into a ventricular tachycardia,following which he became extremely restless.
The man who had so far been relatively controlled gave a blood curdling scream and I thought that was it.I haven't seen too many men with chest pain who scream like that, live.
My hands tied, we started him on Amiodarone and called the staff and the relatives and asked them for permission to pray for his healing.They gave us the permission albeit a little dubiously.
We prayed,and the man settled.It was as simple as that!
No chest pain after that ,he calmly slept like a child and his four hour ECG showed a reversal.We sent him off to Nagpur for intervention(Angio,etc).They could afford it.
All of us in that room knew the Lord had come through for us.In His mighty compassion He had come through for all of us the patient,the staffs,and the relatives..
I could only marvel at His compassion for everyone in that room.

Thursday, September 8, 2016

A season of blessing indeed.

What an amazing season of reaching out to women especially mothers, it has been.We had our women's conference in the last week of August as scheduled.Thirteen ladies sat at the Lord's feet like Mary with our two senior resource persons who have been through it all but carry that 'precious wonder' in their heart which touched our lives in different ways.I find myself so much more calmer and rested and more in touch with myself these days.
The vocational training centre has ten women from different walks of life being taught sewing by our very own Mrs Zakir who not only excels in the craft but gives 101% of herself to the task.
Since yesterday thirty strong ladies from the village,namely ASHA workers are being trained in the campus in different government modules and will be here for the next three days.This is just the first batch this season and it fills my heart with joy to see these mothers take time off from their busy mothering schedule to attend classes and just hang around in the garden .They start chirping around in the park in front of my house from five in the morning.A little unusual for a person who likes the quiet the first thing in the morning but nevertheless we feel extremely privellaged to host and train these women folk from the villages.Some of them have children and so are accompanied by their mothers who look after the babies during the sessions.
We feel blessed just to have this opportunity to be part of the process of involvement with the cohort which actually may define the future of our families,of our villages,our institutions and our country.
Thank you Lord!

Doing the math with my patients.

Prashant was ill when he came ,required intensive care.He recovered albeit slowly but surely.The father realised how ill he was and requested me to do all I could do,his words were ,'Don't worry about money'.Needless to have said that because we never worry about money when we treat a patient.
I was away when it was time for Prashant to go home.There was no usual asking for charity here.The father quietly disappeared and appeared one fine day with half the sum.We wrote off the rest.He had arranged for six grands.I wondered how?He showed me the papers.He had leased out his land to another person for a year,sealed,stamped and approved by the local tehsil.No interest ,nothing.
Considering how uncertain it was for farmers anyways I thought it was smart.
Shitiiz brought in his mother to the out-patient.He went to the local Sahu ,left his mother's silver anklet and got a fifteen hundred rupees for her treatment.He has to pay an added interest of fifteen rupees per month.If he goes to Nagpur or Jabalpur to work,he and his brother would earn around six hundred rupees between them.I do the calculation and he says it will take them a year to release the anklet.I am not sure how the calculation works because I thought a week should see them out of the debt.The market price for the anklet is twenty-five hundred I am told.
That is a way of life for Prashant's and Shitiz's of the world.that is how their world ticks and there is a certain amount of dignity in the way they go about it.Especially the poor,they will never ask for charity.

Thursday, September 1, 2016

Forgetting Shyam!

I had been in a woman's conference for two days and then in Lalitpur to see my good friend Sheba.Coming back to work ,it was ward  rounds with my juniors as usual.In the male ward ,a young boy gave me an unabashed heartfelt smile and told me 'my father is coming today'.I was taken aback wondered if the boy was a little behind in the growth milestones?
When I asked Max to update me the history,I realised it was Shyam.How could I possibly not have recognised him.
On one of my duty days he was wheeled into the casualty cold and clammy ,unconscious with a heart-rate of thirty beats ,ECG showed a complete heart block and a barely recordable blood pressure.
I thought we had a case for pacing but just a dose of atropine saw the heartbeat returning to normal sinus rythem and that gave us some time for some history and basic bloods.His ABG was nothing to write home about.
Shyam had followed a truck driver to Mumbai was what the father said.The truck driver had dumped an unconscious Shyam into the government facility from where the father had picked the boy up in that sorry state and brought him to our hospital.He had no other history.
His counts were as low as can be with the total counts in hundreds and the platelet at thirty thousand with borderline renal failure.The boy had a GCS of 7/15 which did not revert with correction of hypoglycaemia.We hit him with antimalarials , covered for sepsis and arranged for a fresh pint of blood to be transfused.I was a little concerned he might have bled into his brain but there was no knowing since the bystanders were not happy to take him for a CT scan .
From then onwards it was a slow but a vigilant recovery.
Over the next four or five days Shyam's GCS improved and he started responding to our queries albeit a little unclear.I would make it a point to call his relatives inside just to strike a conversation with him.He mumbled umpteen number of unclear words much to the chagrin of his relatives.His maternal grandmother was the only person who could get through to him.
One day two sturdy men entered the ward and Shyam's face brightened when he saw them and he raised his hand in greeting.The feeling was mutual.
My hunch was he was on the way to recovery.Four days I was away I presumed he would have gone home.
I was overjoyed to see him so well ,he looked much younger now that he was sitting up and swinging his legs from the bed.I asked him if he recognised me and he shyly nodded his head in an affirmation.I asked him the other question all of us were dying to know.That was if he remembered what happened to him and where had he gone without informing his family?
He said he remembered everything and he had gone to Punjab to pick apples?On his way back he had fallen sick.
Little do our patients know how much joy they bring into our lives when they give us beautiful surprises the way Shyam did.
Doctoring has it's heartaches but it has it's own share of wonderful rewards,like an unabashed heart-felt smile from a patient who has been through hell with you and back .