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Friday, January 12, 2007

Cruel diseases to kill your heart

This is the same day as the two abdominal injuries and stuff happened last emerg.
We had this female child around 6 yrs or so with a huge swelling around her R armpit.
She had been diagnosed with Full blown Tuberculosis which was resistant to treatment. She had taken treatment for 6 months with no improvement and was here with us because of the abscess.
She also was malnourished (Grade II PEM) with just skin and bones and a cry that was so sad it isn't even funny. To complete the setup her mom is dead and she is being taken care of by ber grandmother who also looks after her 3 healthy siblings (get the point)

We took her in the ot and she wept so much begging her grandmother to just keep her hand on the child's face so she could get some support since she could not be given anaesthesia as her lungs were fired and would not stand the anaesthetic. We drained the abscess under local coverage and she wept and begged for it to stop and we could do nothing since it was necessary to get this done. Oh and by the way Tubercular abscess once incised rarely ever heal but its still done anyway as there is no other option

At the end my registrar said something that will stay with me forever, "Its better if she dies"
The family is too poor to affort her treatment. She most probably will fall ill many times again since she is malnourished. Since she will fall ill her nutrition will never improve. She goes to the 2nd standard. And she's cute as a button.....

Its heartbreaking, its tough but its what we face almost everyday at this shithole of a hospital I work in. I guess its all a part of learning but all I felt at that point was that if she was my daughter and was suffering like this I wouldn't be able to take it.

I give that old grandmother credit for somehow managing to get 10 Rs for the paper she needed to come to the hospital. I give her credit for making that child smile in the ward inspite of the illness. I give her credit for being stronger than I ever will be.

New Unit New Issues

Hello hello.
I am back and I wish I could say new and improved but lets just stick with new for now.
I was transferred to another unit as a temporary measure since they have a shortage there.

Emerg yesterday got this intresting case to us in the morning around 11 with a moderate head injury, he was unconscious, with haemothorax (blood in his chest) and ? Haemoperitoneum (blood in his abdomen) on USG.

Now our USG dept failed to mention which organ they thought was bleeding with the result that there was major confusion regarding whether we should open up this patient or not. He seemed to be haemodynamically stable so we decided to conserve him but we had to do a CT for his head to refer him to neurosurgery.
Dr. Cellular (my junior colleague) calls me and tells me that I have to take the patient for a CT and transfer. I plainly refused saying that he was out of his mind if he thought that I would take a transfer of a patient after completing 4 posts against his 1...After all I am the senior resident.

Anyway the transfer didn't happen in the morning because we tapped his abdomen and got blood to confirm the USG and then it was a matter of stabilising his pulse and BP so that he could live and probably open him up in case he did not improve.
At this point let me add that the lecturer in this unit didn't really help by asking for a CT Abdomen. This pt was an unknown and to get money for the CT abdomen would be really difficult. The evening passed with minor ot which will be another blog after this but at night I was instructed to write to the administration for the money while there was another patient being operated for a stab wound in the abdomen to check if he too was bleeding inside ( I tell you its hectic doing emergencies but ppl refuse to believe)

Anyway that pt was fine and we closed him up and got the news that I was called by the AMO (Administration) for the sweet note I had put down on paper regarding the CT

He quite blew it and couldn't think of how to respond since our poor box fund is just that POOR
There was no money in it for the unknown pt and he couldn't admit that cause this was a medicolegal case and if anything happened to the pt it would be the admin's fault for not doing a CT.
He advised us to transfer the pt to Maike (Larger Hosp) and we told him that when we tried calling them they refused to take the pt if the abdomen was not looked into. He called the head of our unit and asked him what to do and was promptly told to make arrangements for the transfer as he could not be managed here.
So the AMO calls Maike and gets the royal boot from the CMO Amo and TR (Trauma Reg) and finally manages to con them into accepting the patient which my colleague had to take at 1.30 in the morning.

Moral of the story - Don't ever go to a municipal hospital if you have a choice!

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