Near Dead Lady and Nepal Bandh

                                    

Yesterday in the evening, I was with my friends in Okhaldhunga chatting about Nepal’s current political scenario and the insignificance of Nepal Bandh. Nepal Bandh is people’s unwanted theme but still the political leaders launching this in the name of people for the sake of people. It is becoming as if it is the essential part of our 12 month calendar in a year. It is raising false perception that it is our essential one by putting on us the Goebbels’s theory.  I don’t know when will we get rid of it?

I got call from hospital to support on call doctor. I just reached hospital in no time. This was a 19 year young lady who delivered her baby in her home and now in hypovolemic shock secondary to placenta retained in her womb and the womb was not contracted since placenta inside the womb. Literally she was in near death condition. She was in OT table intubated by anesthesia assistant and on call doctor had been trying to remove placenta. I was called for anesthesia support. While observing her vitals and anesthesia support, she suddenly went in asystole (heart not pumping). It is just like the time was paused meanwhile and everybody was shocked what happened to her. I started chest compression and asked anesthesia DD to load adrenaline and give 1 mg intravenous stat. she did it quickly. After 2 minutes CPR, her heart started pumping blood. Blood Pressure came to normal range and but pulse rate was 220bpm suggestive of supraventricular tachycardia so I asked anesthesia DD to load verapamil she gave it slowly meanwhile I was doing unilateral carotid sinus massage .The pulse rate came down gradually in normal range. By this time she had already received 3 pints of blood. The Placenta also delivered and the womb already started contracted and bleeding stopped dramatically. The paused time again started to beat normally and we realized by then that we were in real time.

Today in morning round, her hematocrit was 22 and this is encouraging for stable patient.

‘How are you?’

She smiled,’ I am ok doctor.’

‘This is your second life.’

‘Yeah I know doctor, I am born again.’

She started to take usual meal. She received 1 more pint of blood.

She was brought here in Okhaldhunga Community Hospital 12 hours after baby delivery and placenta retained in her womb and was bleeding from birth canal. We can imagine how much blood she lost during this period. She was paper white with loss of consciousness. She was just 1 hour far from here on vehicle. Because of Nepal Bandh, she was delayed to seek essential health service here and she waited 11 more hours to receive the service. Had she been brought in time, she would not have been remained amidst the life and death situation.

Every moment is critical in everyone’s life; nobody knows when the crucial period for life and death situation is. While writing this, how many patients were deprived of getting emergency treatment and lost their lives. Please do not snatch the right of people to seek their essential health service by launching Nepal Bandh in the name of people.

Have this man got Detox shots…!!!

On my very first night call in Okhaldhunga hospital, attending nurse called me, ‘Bed no. 27 is having unusual behaviors’.  That guy had taken the canula out and bleeding from canula site, I just pinched the bleeding site and asked the nurse to have got dry cotton and the load diazepam shot. He received 50 mg IM shot in subsequent steps and fell asleep and open the vein with canula. On the same night after 2 hours of event, another guy started to show same behavior. I asked him to stretch his hands and abduct the fingers…it was… fine tremor. I said to nurse, ‘Have this man got detox till he sleeps.’

They wake up in the middle of night and start showing unusual behavior to other patients and hospital staffs. They come to nursing station with fluid holding in hands. Some take out the canula and need special FBI kind treatment. This is a cold mountainous place; possibly most of the people are habituated to alcohol to get rid of cold insult. Not the specific ones, most of the tribes do.

The unique finding after 24 to 48 hours admission especially in male patients here in Okhaldhunga Community hospital is withdrawal symptoms. One guy was admitted for wasp bite, very early morning next day he was fighting with his 8 year old son who had been caring him during all night. Another guy admitted for tibial fracture next day started  crying and begging for discharge. One old fella who admitted for ligament injury admitted he wanted to get detox against alcohol consumption. It just comes to my mind to give universal shots of detox for all male patients admitted but I cannot do this without evidence.

The old lady and the kid, part II: I am just moved again

The kid with his grandma

I saw the same kid with smiley face early in the morning while in morning round. It was on the way of hospital’s corridor we faced each other. I was about to cross past him, I asked him.

‘Hey buddy what’s up?’

‘Well she is ok.’

‘Arrright, what’s about you, then?’

‘Me ok since she is ok.’

‘Will you go school tomorrow?’

‘Yeah, I am missing it.’

His grandma looked fine and happy and wanted to go home. She was discharged with subsequent therapy for her Peptic ulcer disease. She had pancreatic cancer though but we could not address it.

I was going for tea in the middle of break, ‘sir sir…’ I heard from back side.

‘Thank you…!’ the kid was right there with his beautiful smile

‘You are most welcome, buddy.’ I just knelt down and poked his chick. ‘I hope we will not see to each other in the hospital.’

‘Yeah you are right but we can meet outside the premises of this hospital.’

‘Definitely dear…!’

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Ahh, he touched my heart…I am just moved again…!!!

The old lady and the kid

Today early in the morning I saw an old lady with small kid presented to ER in Okhaldhunga Community hospital. She had got burning epigastric pain.  While asking about members in family, she is living with that little kid; her husband is no more with her. The elder son, the kid’s father passed away many years back and the daughter in-law, the kid’s mother is far away in Kathmandu who comes once in a blue moon. Younger sons do not look after her. She had been having pain for 3 days and similar episodes in the past though.

While going through previous report, she found to have pancreatic cancer. While asking about socioeconomic status, there is virtually no one earning and supporting them. She has grandson, the kid who helps her make food and feed her.  They have some fields to grow foods. This time she came with Peptic ulcer disease (gastritis).

While asking kid, he had his eyes full of tears, burying his face with his hands, ‘I study in class 2. I go to school regularly but this time; I am not able to manage to go school because my grandmother succumbed to sick.’

 ‘Wont you go school now?’

‘How can I leave grandmother in this situation, sir?’

It just touched my heart. A nine year kid thinks that way and always there to serve his grandmother in every possible aspect. I was moved with his manner. 

मसंग थोरै पैसा छ ( I have less money)

Two middle aged couple with their somber faces came to Okhaldhunga Community hospital. They look like they are from lower class family. They have one small daughter aged 8 years who had some cloths wrapped around her right arm. They came from extreme part of Solukhumbu walking on foot for 5 days. I am very much surprised that people come on foot to this hospital very far from here.

This child has fall injury over her right arm and it was deformed. She underwent x-ray and found to have shaft of humerus fracture (bone of arm) which is partially displaced. She was planned for hanging cast.

Father said to us, ‘Ma sanga thorai paisa chha, chhori ko upachaarko lagi pudaina ki ? (I have less money, maybe it’s not enough for treating my daughter.)’

One of us asked, 'how much do you have?'

Reluctantly, he looked at us, ‘Just twenty thousands.’

'Twenty thousands…! One thousand is quite enough…!' Our paramedics said.

The Couple surprisingly looked at us and they could not smile for their happiness, maybe they were Super-HappY.

Introduction

National academy of Medical Sciences (NAMS) in Kathmandu conducts 6 mandatory training to its residents during their 3 years’ Postgraduate degree in different disciplines. One of them is Medical Education that is all about how to teach people especially patients and how to prepare class to the students or juniors and learning techniques. Others are Advanced Cardiac Life Support, Research Methodology, Basic Surgical Skill, Trauma Life Support and Palliative Care. This is the beauty of NAMS. We were privileged to get the 4 days’ training on Medical education getting it in brief way out of its vast contents. Some of them about teaching learning activities were knowingly unknowingly followed by us during our life and so many new things were revealed they were never been  in our mind.

Teaching is not one way but it is two way or multiple way and it should be dynamic not the static.

Lectures were given by the experts about medical education and they were worthy to take. One of the interesting parts of this training was introduction of participants. This was for how they can present them to audience.

Many funny things and interesting things were shared during introduction session about their professional life before entering postgraduate program.

Experience during professional life:

One OBGYN resident thought that Obstetrics and Gynecology will be funny and enjoyable but he found it actually was not.

A Male resident from same discipline mentioned, while he was is in district posting, a pregnant lady  in labor was crying in the middle of night and he requested her to not cry making loud sound hampering others’ sleep. She replied, ‘you will never go through the labor pain doc, and how will you realize what’s labor pain?’ That doc mumbled on his own, ‘padhe pachhi realize garaula ni’ He almost finished his II year residency in OBGYN and he said, ‘Still he yet to understand the labor pain.’

Some of them showed their patriotism. One of them mentioned almost half of country he has gone through during his professional life.

Answers about why they chose the particular program?

Some of them chose their program by their choice, some by their role model in that discipline, some by influence of people in rural area and some of them have no choice other than that.

One of residents from Psychiatry mentioned, he wanted to understand the complexity of brain of human being and he felt it’s extremely complex. One of the GP residents said, ‘General practice chose me, not I.’

Some of them were not determined what to do and still enjoying what they are doing.

Some of the Pediatrics and Orthopedics people mentioned, they did not need to go for further study like DM or MCh.

Query about Achievement:

Got the residency….got married….yet to get….found someone especial….single ready to mingle….!!!

This introductory program was done for how effectively a person can deliver his content in understandable and effective way. It’s quite a good strategy.

Man in Wheel Chair and Woman in Metal Stockings

While I was on line for my morning breakfast after hectic night duty in Patan hospital, I saw a man in wheel chair and I could see the happiness in his face. I asked him, 'How is your wife?'

He smiled me back, ‘Oh she is fine and I became a father, doc.’

And I formally said shaking his shoulder, ‘Congratulation, god bless you both and your child.’

‘Thank you, sir.’

I just casually asked him, ‘Where are you from?’

‘Kalikot’

Kalikot kaha?

‘Rupsa’

‘I have been there many times’

 He just paused and surprisingly asked me, Are you sure?’

‘Yeah I have been there many times’

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Yesterday one woman happened to me for regular check up in admission room of maternity ward at 6PM. She had shorter stature and had metal stockings on her leg for her club foot. She went through non stress test to estimate the health status of her baby inside her womb. It was turned out be reactive suggesting good status of baby.

I asked her, ‘Can you go through vaginal delivery?’

‘I dont know but I prefer to, doc.’

The mouth of her womb is opening and ripening. We put her on vaginal delivery trial and meanwhile we counseled her and her hubby that there is high chance of cesarean section for her.

Surprisingly she delivered her baby at midnight.

This lady was beautiful wife of this guy whom I met today morning while in line for my morning breakfast.

God bless them forever;  may their life be showered by world’s best possible happYness.