Laxman came to us at the middle of the night huffing and puffing.He belongs to the local tribal community.He did not have an iota of money on his person.He had this abscess in the chest wall with Empyema on the same side.He basically had empyema necessittans and we did not know where it extended.He had been all over the place for more than a month.
We requested the local radiology to do a HRCT of the chest for fifty percent of the charge which they promptly agreed to do.As expected he had empyema necessitans and better stil, it had extended all the way to the diaphragm and the heart.
By the time he came back with the CT he was huffing and puffing.It would be fair to say we put in a needle twice but just drew blood which made me a little nervous about putting in a chest tube blindly.
Once we had a HRCT in hand we advised the relatives to travel a little further to the prestigious BHU where he would probably need a thoracoscopy but ofcourse they refused.
We did an open thoracotomy and put in a chest tube.He brought out oodles and oodles of thick pus but the tube got blocked by the consistancy of the pus by the next day.So we tried our hand .at putting in some streptokinase into the chest through the tube as suggested.The lungs were showing signs of expansion so our Community health staff carted him to BHU for a cardiothoracic opinion where they reinserted the chest tube of a bigger size and the pus started pouring out freely.
Laxman was a gentle guy but his relatives were a different cup of tea alltogether.Every evening a bunch of tribal men,his relatives, would visit him and generally upset the staff.They would be drunk.
When we tried to be strict their first response would be we will take Laxman home.This see-saw between the relatives and the staff went on for sometime so I had to call the father and give him a stern talk.Four days into admission when things were looking well for him suddenly the father came to us and insisted that he wanted to take Laxman home.I knew that if he went home with the tube it would not bode well for Laxman .I tried my best to explain things to them,I thought he had agreed atlast when another of his family member joined the chorus about taking Laxman home.
The staffs were pretty upset with the lot.Everything was on the house including the meals and they just did not seem to understand.
Laxman was in his twenties, had children.The thing that kept me doggedly going was the fact that that young man who would perhaps have to do manuel labour all his life to support the family would lose one lung and would not be able to support the family.
The last request to go home was .pretty strong....one of the staff had even brought the discharge summary to my table in the OPD.I waved it back and just waited to see how things would turn.
Some sample from the pus in his lungs had to be carted to BHU that day .So one of the CH staff was duely deputed to do the needful.As a last resort I requested the CH staff to try and talk to them.
Prem came back to me with a breakthrough.One of the patient's relative had encouraged the bystanders to take the patient to see a doctor in the adjacent district,apparently a jhola chap who dealt with abscesses and apparently did the needful with just a nick of the blade whereas Laxman was still pouring pus on the fifth day.It was their understanding of the situation.
Prem had to sit and explain things to them and by God's grace he got through.
Today we got a check X-ray done and his lungs are almost fully expanded.
We, as a team, are understanding the missions and the heart of God a little better,thanks to Laxman and his tribe.
Comments