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.

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