A sixty years old lady was brought in with a history of being bed-bound for better part of ten years with a gradual mental decline.She had her left leg flexed and would not let anyone touch it.She looked considerably pale but had a comfortable haemoglobin of nine and would struggle with pain day in and day out.We got an ultrasound of her abdomen incase she was tracking a cold abscess in her psoas.It showed hyperechpic kidneys bilaterally and a gallstone.In the evening when we went for the rounds we noticed that the painful legs were unusually cold as compared to the right side so we made a note to send her for doppler of the left feet the next day.Her chest X-ray showed extensive haziness on the left side which to our unsuspecting eye looked semi-homogenious.We tried unsuccessfully to get some sputum and was somehow not settled with her because we were missing something beyond the dementia which the relatives claimed she had.
The next day I was in the chapel and the worship was going on and while the worship was going on I saw the old man,her husband standing in 'the middle of the corridor just outside the chapel door with his eyes closed,an unusual sight for a patient or a bystander while the worship was on '.I was deeply touched and so I told the Lord,'I will go back and relook the case Lord.'
We went back and re-examined the lady.I had reprimended the staff about the patient's hygeine the first day and was promptly told that they had done a good PV care in the morning and the patient was on a diaper but I still got a stench.We got the fetal doppler and we went through all the vessels in the lower limb.Her dorsalis pedis was missing on the left side.She was throwing an emboli from somewhere so we auscultated the heart,there was no murmur.The other thing we had to consider was marantic endocardites( non-infective) in which case she would have to have an advanced malignancy.Her USG did not show anything but at this point I walked up to Dr Cecily our visiting obstetrician to do a PV/PS.Which she did promptly with a lot of protest from the patient who was making animal sounds by then.Her cervix was irregular and she was bleeding PV on touch.
In the meantime I had already reviewed the X-ray and I could see faint shadows of cannon ball in between the semi-homogenious shadow.
So within fifteen minutes of my talking to the Lord we had a diagnosis in hand and then we got our wonderful palliative care team involved who were more than willing to cart her to Tata institute (Homibhaba)which is by God's grace half way to Benaras from kachwa.They were not only going to accompany them but also help them with paperworks and government machineries with Ayushman,etc.
Even as we talked to the patient and the bystanders and arranged the paperworks,I just sat down put and thanked the Lord for his grace.I could visibly see a sense of humble acceptance in the eyes of her husband and the son.
The diagnosis was nothing to write home about but the Lord helped us to come to the diagnosis so that we could help the family in what way we could ,given the circumstances.
(The lady was difficult to examine and was very hostile towards anyone touching her in anyway. )
The next day I was in the chapel and the worship was going on and while the worship was going on I saw the old man,her husband standing in 'the middle of the corridor just outside the chapel door with his eyes closed,an unusual sight for a patient or a bystander while the worship was on '.I was deeply touched and so I told the Lord,'I will go back and relook the case Lord.'
We went back and re-examined the lady.I had reprimended the staff about the patient's hygeine the first day and was promptly told that they had done a good PV care in the morning and the patient was on a diaper but I still got a stench.We got the fetal doppler and we went through all the vessels in the lower limb.Her dorsalis pedis was missing on the left side.She was throwing an emboli from somewhere so we auscultated the heart,there was no murmur.The other thing we had to consider was marantic endocardites( non-infective) in which case she would have to have an advanced malignancy.Her USG did not show anything but at this point I walked up to Dr Cecily our visiting obstetrician to do a PV/PS.Which she did promptly with a lot of protest from the patient who was making animal sounds by then.Her cervix was irregular and she was bleeding PV on touch.
In the meantime I had already reviewed the X-ray and I could see faint shadows of cannon ball in between the semi-homogenious shadow.
So within fifteen minutes of my talking to the Lord we had a diagnosis in hand and then we got our wonderful palliative care team involved who were more than willing to cart her to Tata institute (Homibhaba)which is by God's grace half way to Benaras from kachwa.They were not only going to accompany them but also help them with paperworks and government machineries with Ayushman,etc.
Even as we talked to the patient and the bystanders and arranged the paperworks,I just sat down put and thanked the Lord for his grace.I could visibly see a sense of humble acceptance in the eyes of her husband and the son.
The diagnosis was nothing to write home about but the Lord helped us to come to the diagnosis so that we could help the family in what way we could ,given the circumstances.
(The lady was difficult to examine and was very hostile towards anyone touching her in anyway. )
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