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Thoughts...just thoughts...



This fortnight has been different from any other.I am anticipating a tough summer but I am sailing in by the grace of God.I have developed a new interest in eating fish with whiskers fried just right and as have been advising the patients thus far,I hope my haemoglobin takes a kickstart.I already feel so much better.
In the work front ,it is getting busier,more interesting and after a laboratory and x-ray closure imposed on us has been lifted I am enjoying medicine as I should
.We had a freak viper bite come in with local swelling,AKI and a prolonged CT.He is on the road to recovery.The last I saw a viper bite was fifteen years ago.
A day earlier another lady was pushed into the casualty with a history of having consumed insecticide.We asked them to show us the pictuere of the poison and the son had a picture of Cypermethrin in his mobile.Apart from the smell which was strong enough to give me a headache her saturation was in the seventies but she was bright and awake scolding her relatives.We tried giving her O2 witha reservoir mask but her saturation would not budge.We decided to intubate her but decided against it since she was too awake.I asked a junior to take an arterial blood gas,she drew what looked like a venous blood twice although she did feel the second time round the syringe had filled up easily.I had a go with the needle and came up with another dark sample but decided to run it nevertheless.The dark blood had normal gas inspite of the low saturation.This was a mystery .One of our juniors barged into the casualty and exclaimed,'Mam,this is not cypermethrin...it does not smell like this...so we caught hold of the son and enquired if she could have eaten something else?It was then that he decided to tell us that the patient .had mixed it with 'glitter',sodium benzoate to be precise.
Thus the mystery was solved,she had methaemoglobinemia and inspite of the high flow oxygen and normal gas she was rapidly desaturating.Her O2 dissociation curve was shifting to the right.She needed urgent methylene blue infusion and we did not have it so we packed her up with the high flow oxygen to BHU.
In one of the rooms,V ,all of fourteen years is awaiting death with his entire family in attendance.His osteosarcoma has metastasized to the lungs.Every day we enter his room with a sense of dread,this is something even years of dealing with never makes it easy.Everytime we go in he picks his head up from his pillow and looks at me with some kind of expectation..al I can do is wordlessly pat his hair.My colleagues have shared the gospel with him but only the Holy spirit can convict him.So far the mother was dead against letting the child know the truth so he would demand a lot of things from us but today it was different.We can see visibly that he is losing his fat but he looked at peace.Like he does everytime when we enter he lifted his head from the pillow and he sat up and asked me 'Can you do something to help me with my breathing problem?'We have been tapping his pleural effusion every other day,it being haemorhagic it is quite traumatic for the person doing the procedure so we started him on steroids as well,hoping it will make his symptoms tolerable.We don't have morphine and so every breath is a struggle but one can feel his intelligence as he participates in the conversation for his well-being.Today his two younger brothers four and seven and his sister who must be twelve were sitting by his bedside along with his parents and his granny.I asked them if they were vegetareans,they said naught.I asked them why they were not feeding him non-veg food and V quietly informed me they were having fish that evening.He had also expressed a desire to have gajar ka halwa which had been given to him.V looked so much more open to us and so much more comfortable mentally.He had expressed a desire to go back to his village for a day,our palliative care team has offered to make the arrangement with an oxygen cylinder tomorrow.
We walked out a lot light hearted then usual when the father came running behind us and said with a defeated expression,V knows that he is dying ,we told him.While we felt relieved he looked more cast down.Having this child with us to care for ,sobers us down every day.
The two younger kids had come to see the fair in the market but I saw a shadow of sadness in the eye of the youngest.
Just one more day before I catch the flight home for easter...leaving behind this scenario of sadness,grace,suffering,healing ,God's goodness in good measure, riches one would never find in world's greatest pastures.
To Christ alone be all Honour and Glory.

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