Suddenly our family has been thrown into a bucket of frenzied activity....The truth has to finally sink in...I am still at a loss what to say...For so long we had got so used to each other, growing old together seemed like an all inclusive, complete in itself thing. Now suddenly this turn of events, I do not quite know how to put it, and I will take time to react to it, and then perhaps respond to it, and the whole concept of that being a fractured continuum seems lost to me..
I am not disliking it, but I have yet not grown to like it.
May be with our independences and eccentricities the four of us have set higher standards for ourselves than would be required to redeem ourselves. Now its not just Maa, Paa, Apa and I...
And I am not disliking it, but i have yet not grown to like it.
Tuesday, December 15, 2009
Monday, December 14, 2009
The Last Leaf
Its like that story by O' Henry where a young girl has severe pneumonia in a bitter winter and somehow comes to believe that once the last leaf of the fast withering small sapling drops she would die too...And a failed artist creates a miniature leaf on the stem of the plant in the ice cold winter night when the last leaf does fall down. And the girl hoping to see the bare stem in the morning cannot believe her eyes when she sees the same leaf still standing on the stem after the harsh winter storm...It gives her a new lease of life, she lives through her illness and comes out of it.
Do brain dead people see? Do they hear, feel and react? Do they feel the necessity of leaving their loved ones once they realize the love that they initially held for their own has been put to test by the endless chores their resilient unmoving body heaves on the hapless attendants, sons, daughters, brothers? The humdrum of suctioning, of bedsores, of cleaning grime in thigh creases of overweight bodies, of tracheostomy wounds, of periodically deflating and inflating the cuffs, of putting 'body' in left lateral, feeding in sitting, reclining with head end elevation, putting Ryle's tube in flexed head position...and so on... ?Do they also like to metamorphose and leave their present decaying bodies for a better, more ethereal, more eternal continuum that spares their attendants that inaudible sigh of relief they exhale when this person, with an IC Bleed, Left Internal Capsule, with extension into the lateral ventricles and an associated midline shift of 1.5 cm to the right, finally decides to give up the breaths she has been struggling to take.
It surprises me, then to see how the story actually unfolds; from the first day, when the attendants are, by turns, demanding, threatening, cajoling, waiting for that once hair raise from the doctor, when they are prepared to do 'anything', absolutely anything for their patient...they spread the sheets, they complain about leaking iv lines, about dead iv fluid bottles and about suctioning not being done well enough....and ithey are willing too, to get the ABG reports at 2 : 40 in the morning, and show it to the sleep infested doctor on duty...
Equations change...with time, the zeal to do 'anything, absolutely anything' is tested by roughly 5 visits to the pharmacy, 15 visits to the emergency lab, position change, suctioning ( an act, the responsibility of which which by now the doctor has relinquished on the attendants), and not to mention that occasional outburst from their screwed up doctor, who in an attempt to overshadow her own irate temperament at seeing that unmoving body day after day without any progress, or deterioration, and having told their attendants roughly 900 times she wont make it, decides to unleash her anger in more unscrupulous ways....She gives them a BGA at 3 20 in the morning, asking them to collect the report and show it to her in the morning..and watches the attendant bundle past her with shuffling steps on a bitter cold emergency night at Rohtak, a small, dimensionless city in North India....
She (the doctor) changes as well, the lady was a grossly obese 36 year old with 3 kids and a out of job husband...the attendants are, in order of their willingness and love for the patient, respectively the Brother, the Son, and the Bahu. She takes a look at the pallid skin, the toneless chapeless heap into which the body has been confined, the rhythmic swell of her breasts through which the heart sounds seem so faint she confuses if the heart is beating at all....the bed sore on her left butt, that unhealing patch of yellow, red and pink that still doesnt give her fever but that which has festered all this time...She asks about how much they have spent till date on her, and the Son gives a rough estimation: 25,000....with tears in his eyes...
25,000...thats a small number. Going by Haryana's standards, it may even be called negligible, a quick mental mathematics suggests her it could not be so much, with 2 CT Scans and some medications....but there is still a possibility...Her stance softens...She gradually introduces the topic of the famous DOR...Discharge On Request, partly with a guilt ridden heart...She backtracks in the middle...Her ethics don't support her...She once again gives the example of Life support systems and its use in America...She assures the they can, and then, they must take more time to decide....she would tell the medications...the rest in the line of care she would tell them....The guilt pang hits home again...she asks them to stay for 2-3 days more...and walks back to the resident room.
Thirty minutes later, the Brother, the decision maker comes to her...they would leave the next day, he says...she is shaken..'No, no, I don't want you guys to leave, I was only telling this because you guys told me just how difficult it had become to feed your hungry mouths...stay here for as long as you want..' , and then with new found insolence in the voice, talk to my seniors, they will tell you....
40 odd minutes, that dead body, listening to their conversation decides to die...She performs an average CPR, takes an ECG out of a machine that only traces flat lines, and declares her dead...None of the relatives make a sound, they are complying almost, they listen silently to her condolence of how her period of torture was fortunately cut short, they ask to keep the body in the hospital for the night, and they move with lightning efficiency to clear the bed and do the necessary.
The only tears are hastily shed by the son, who then moves on too, and a transport certificate ends that 10 day relationship she and her family had come to establish as the IC Bleed patient that was 'still alive'...
Do brain dead people see? Do they hear, feel and react? Do they feel the necessity of leaving their loved ones once they realize the love that they initially held for their own has been put to test by the endless chores their resilient unmoving body heaves on the hapless attendants, sons, daughters, brothers? The humdrum of suctioning, of bedsores, of cleaning grime in thigh creases of overweight bodies, of tracheostomy wounds, of periodically deflating and inflating the cuffs, of putting 'body' in left lateral, feeding in sitting, reclining with head end elevation, putting Ryle's tube in flexed head position...and so on... ?Do they also like to metamorphose and leave their present decaying bodies for a better, more ethereal, more eternal continuum that spares their attendants that inaudible sigh of relief they exhale when this person, with an IC Bleed, Left Internal Capsule, with extension into the lateral ventricles and an associated midline shift of 1.5 cm to the right, finally decides to give up the breaths she has been struggling to take.
It surprises me, then to see how the story actually unfolds; from the first day, when the attendants are, by turns, demanding, threatening, cajoling, waiting for that once hair raise from the doctor, when they are prepared to do 'anything', absolutely anything for their patient...they spread the sheets, they complain about leaking iv lines, about dead iv fluid bottles and about suctioning not being done well enough....and ithey are willing too, to get the ABG reports at 2 : 40 in the morning, and show it to the sleep infested doctor on duty...
Equations change...with time, the zeal to do 'anything, absolutely anything' is tested by roughly 5 visits to the pharmacy, 15 visits to the emergency lab, position change, suctioning ( an act, the responsibility of which which by now the doctor has relinquished on the attendants), and not to mention that occasional outburst from their screwed up doctor, who in an attempt to overshadow her own irate temperament at seeing that unmoving body day after day without any progress, or deterioration, and having told their attendants roughly 900 times she wont make it, decides to unleash her anger in more unscrupulous ways....She gives them a BGA at 3 20 in the morning, asking them to collect the report and show it to her in the morning..and watches the attendant bundle past her with shuffling steps on a bitter cold emergency night at Rohtak, a small, dimensionless city in North India....
She (the doctor) changes as well, the lady was a grossly obese 36 year old with 3 kids and a out of job husband...the attendants are, in order of their willingness and love for the patient, respectively the Brother, the Son, and the Bahu. She takes a look at the pallid skin, the toneless chapeless heap into which the body has been confined, the rhythmic swell of her breasts through which the heart sounds seem so faint she confuses if the heart is beating at all....the bed sore on her left butt, that unhealing patch of yellow, red and pink that still doesnt give her fever but that which has festered all this time...She asks about how much they have spent till date on her, and the Son gives a rough estimation: 25,000....with tears in his eyes...
25,000...thats a small number. Going by Haryana's standards, it may even be called negligible, a quick mental mathematics suggests her it could not be so much, with 2 CT Scans and some medications....but there is still a possibility...Her stance softens...She gradually introduces the topic of the famous DOR...Discharge On Request, partly with a guilt ridden heart...She backtracks in the middle...Her ethics don't support her...She once again gives the example of Life support systems and its use in America...She assures the they can, and then, they must take more time to decide....she would tell the medications...the rest in the line of care she would tell them....The guilt pang hits home again...she asks them to stay for 2-3 days more...and walks back to the resident room.
Thirty minutes later, the Brother, the decision maker comes to her...they would leave the next day, he says...she is shaken..'No, no, I don't want you guys to leave, I was only telling this because you guys told me just how difficult it had become to feed your hungry mouths...stay here for as long as you want..' , and then with new found insolence in the voice, talk to my seniors, they will tell you....
40 odd minutes, that dead body, listening to their conversation decides to die...She performs an average CPR, takes an ECG out of a machine that only traces flat lines, and declares her dead...None of the relatives make a sound, they are complying almost, they listen silently to her condolence of how her period of torture was fortunately cut short, they ask to keep the body in the hospital for the night, and they move with lightning efficiency to clear the bed and do the necessary.
The only tears are hastily shed by the son, who then moves on too, and a transport certificate ends that 10 day relationship she and her family had come to establish as the IC Bleed patient that was 'still alive'...
Saturday, December 12, 2009
Jesus!!! Google Chrome sucks!!!
I decided to yet gain tamper with my browser that I decided to give up my Firefox for good and installed Google chrome on my ailing 248 MB RAM Compaq Presario C500. Though Google chrome promises to be faster than Firefox, I was disappointed to see the interface, its simplistic, set in rather large letters that makes you think you are running it in safe mode, doesn't have Google homepage incorporated into it. So that makes the onus of typing in Google every time you want to look something up....And this doesn't suit me who opens browser chiefly for looking things up on the net.
Browser speed is claimed to be fast in Chrome but to be honest I did not find it appealing. I remember using Firefox six years back from Internet Explorer on the insistence of my computer mechanic and falling in love with it the very first time I used it.. Now though we have 8 to 10 browsers all consuming some space in the market, almost none of them are a big departure from the earlier standards. I opened Orkut in Firefox and then in Chrome, it opened in a jiffy in Firefox. Plus the restoring previous sessions option in Firefox is a boon for those unwanted crashes when Firefox stops functioning. Even if a site doesn't open, or Firefox takes some time to load a page, the green rectangles somehow look good at the bottom of the screen. The same cant be said of Chrome. It looks like a single simple web browser with no extra features.
Am now downloading Apple Safari in Chrome and lets see how does it do...Morale of the story...Firefox is powerful, relatively hassle free, fast web browser with very satisfactory download and browser speeds with good anti virus protection and lots of add ons that make viewing, downloading and sharing fun. If you want to change it you should have good reasons for it....
And if you still use Internet Explorer, the next thing you should do is get Firefox....
I decided to yet gain tamper with my browser that I decided to give up my Firefox for good and installed Google chrome on my ailing 248 MB RAM Compaq Presario C500. Though Google chrome promises to be faster than Firefox, I was disappointed to see the interface, its simplistic, set in rather large letters that makes you think you are running it in safe mode, doesn't have Google homepage incorporated into it. So that makes the onus of typing in Google every time you want to look something up....And this doesn't suit me who opens browser chiefly for looking things up on the net.
Browser speed is claimed to be fast in Chrome but to be honest I did not find it appealing. I remember using Firefox six years back from Internet Explorer on the insistence of my computer mechanic and falling in love with it the very first time I used it.. Now though we have 8 to 10 browsers all consuming some space in the market, almost none of them are a big departure from the earlier standards. I opened Orkut in Firefox and then in Chrome, it opened in a jiffy in Firefox. Plus the restoring previous sessions option in Firefox is a boon for those unwanted crashes when Firefox stops functioning. Even if a site doesn't open, or Firefox takes some time to load a page, the green rectangles somehow look good at the bottom of the screen. The same cant be said of Chrome. It looks like a single simple web browser with no extra features.
Am now downloading Apple Safari in Chrome and lets see how does it do...Morale of the story...Firefox is powerful, relatively hassle free, fast web browser with very satisfactory download and browser speeds with good anti virus protection and lots of add ons that make viewing, downloading and sharing fun. If you want to change it you should have good reasons for it....
And if you still use Internet Explorer, the next thing you should do is get Firefox....
Wednesday, December 9, 2009
Indian Point Of View....
Having a hands on experience for the last 6 months in one of the busiest hospitals in the country, and one where the cost to benefit ratio for a patient would be undoubtedly be pegged the most favourable, the experience of working under the Haryana Government Post Graduate Institute of Medical Sciences has been both rewarding and frustrating. And the virtues do outshine the vices.
Foremost is the facilities that Rohtak has included to be given free or at negligible costs. So we have Lab tests like ANA, CRP, D Dimer, FDP, HBA1C, RA Factor, HbF, Osmotic fragility, Coomb's, Trop I, CPK-MB and so on... and to include CDs to be incorporated soon. None of these are done in any state medical college...And are charged every cent even in a college like PGI Chandigarh...To get these tests done here, in the batting of an eye lid, for every single patient, regardless of his/her income, is awesome...The sheer number of patients getting treated and followed up in this manner has been pegged to be the highest in the country, in AIIMS treatment is restricted to a limited number of people, in other state colleges, people are lost to follow up.
In terms of therapeutics, the scene is better. Government servants, be it a Primary school teacher, or a university Professor are given 100% insurance coverage...So we have Multiple Myeloma patients receiving bortezomib every 4th day and a patient of panhypopituitarism receiving somatotropin, not to talk about IFN-gamma, and CSFs and what not occuring on a daily basis. The work that the government is doing in this regard is undoubtedly, commendable and aweinspiring. The amount of traffic in terms of medications procured and dispensed, the system of follow up is easier than a central institute chiefly because the beneficiaries are a state popuation and in terms of a state, Haryana is cosy, small and neatly packaged between Punjab and Delhi...So transport is easier, people are more aware of their rights and status than perhaps any other state. Hence its heartwarming to see patients actually coming with a BPL card and asking the investigations and medications to be made poor free....And, even when these people do come from a BPL background, their affordability VIS A VIS the rest of the country, is quite favourable.
In conclusion, I feel every state machinery, if it functions as efficiently as this one state, could bring about a paradigm shift in the way health care is disbursed in India. I shall deal with it in subsequent articles. To be honest, as of now I am beginning to get my language correct and frame of reference more analytical than emotional....The rest, learning from this set-up where I work presently, upto the point where I shall make the best use of all resources, will be a journey I shall grow wiser with.
Trouble with other state systems is manifold and unique. I am not aware of the functioning of states like Maharastra yet, and what I have heard upto now about the way healthcare functions in Maharastra scores pretty high, though the private system like Seven Seas, Breach Candy and others there yields more power. But when I compare PGIMS, Rohtak with SCBMCP, Cuttack, the diferences loom large and outline for each individual institutes' advantages and disadvantages.
( to be continued....)
Foremost is the facilities that Rohtak has included to be given free or at negligible costs. So we have Lab tests like ANA, CRP, D Dimer, FDP, HBA1C, RA Factor, HbF, Osmotic fragility, Coomb's, Trop I, CPK-MB and so on... and to include CDs to be incorporated soon. None of these are done in any state medical college...And are charged every cent even in a college like PGI Chandigarh...To get these tests done here, in the batting of an eye lid, for every single patient, regardless of his/her income, is awesome...The sheer number of patients getting treated and followed up in this manner has been pegged to be the highest in the country, in AIIMS treatment is restricted to a limited number of people, in other state colleges, people are lost to follow up.
In terms of therapeutics, the scene is better. Government servants, be it a Primary school teacher, or a university Professor are given 100% insurance coverage...So we have Multiple Myeloma patients receiving bortezomib every 4th day and a patient of panhypopituitarism receiving somatotropin, not to talk about IFN-gamma, and CSFs and what not occuring on a daily basis. The work that the government is doing in this regard is undoubtedly, commendable and aweinspiring. The amount of traffic in terms of medications procured and dispensed, the system of follow up is easier than a central institute chiefly because the beneficiaries are a state popuation and in terms of a state, Haryana is cosy, small and neatly packaged between Punjab and Delhi...So transport is easier, people are more aware of their rights and status than perhaps any other state. Hence its heartwarming to see patients actually coming with a BPL card and asking the investigations and medications to be made poor free....And, even when these people do come from a BPL background, their affordability VIS A VIS the rest of the country, is quite favourable.
In conclusion, I feel every state machinery, if it functions as efficiently as this one state, could bring about a paradigm shift in the way health care is disbursed in India. I shall deal with it in subsequent articles. To be honest, as of now I am beginning to get my language correct and frame of reference more analytical than emotional....The rest, learning from this set-up where I work presently, upto the point where I shall make the best use of all resources, will be a journey I shall grow wiser with.
Trouble with other state systems is manifold and unique. I am not aware of the functioning of states like Maharastra yet, and what I have heard upto now about the way healthcare functions in Maharastra scores pretty high, though the private system like Seven Seas, Breach Candy and others there yields more power. But when I compare PGIMS, Rohtak with SCBMCP, Cuttack, the diferences loom large and outline for each individual institutes' advantages and disadvantages.
( to be continued....)
Saturday, December 5, 2009
I AM
A woman....in every sense of the word.
Out of plans for life, where its gonna take me, whats gonna become...
Someone who has dualities in everything...I contradict myself the self same way I convince myself...
Not aspiring to be the best doctor on this planet, I merely want to do good work and save some lives when everything else seems to fail.
Tired of Hindi movies with mindless plots involving drop dead gorgeous male and female stars...give them a chance....
Still crying at the softest movie spots with a little bit of emotion...(so I dont watch good movies with other people, I watch them alone)
Planning to stay sane.
Have been and perhaps will be, always hopeless and hopelessly in Love.
A survivor. I have come out of it...yes...if not with flying colours, then not with a pallid face either..
Planning to be a great cook...
Hoping that one day I will be able to type with 10 fingers without having to look down at the keyboard....
Hoping that if I stay single all my life, at least I dont become bitter like all those loony women I have seen.
Hoping I will end up not so bad.
Hoping I will write a book...2 books or more actually...some on academics, and only one personal that I hope I will publish before I die, not caring whether it sells or not...
Collecting ecgs and hoping I learn to read those lines decently well...
Hoping that I go all over India, with a nice companion, and take a lot of time out...not in a pricey way but just like average normal people go about....
Learn to read fundus, MRI, CT Scan and ECG.
Hoping that even if I may not fall in love again, I should not make others think Love doesn't exist.
Hoping someday to be a mother.
Hoping to start a helpline or web page to tackle some health related issue on a regular basis.
Hoping to lose all those flab I have gained.
Hoping to be fit at forty.
Hoping to be there for my momma and dad when the time really comes for it...Lotsa times, life doesn't give you that much time.
Planning to own a Blackberry in the next 5 years.
Build a web site in the next 3 years....
Collect medical trivia...
Read all the computer books I have collected...
Learn to make chocolate-rum cake....
Watch meaningful cinema...not movies...
Stop watching every Hindi movie for time-pass...write instead...
Go to meet those very few people I did not meet when it was needed...
Have nil expectations from others....
Have nil expectation from life....
Learn to play the Hotel California on a Spanish...
Get a second hand car and learn to ride it before I stash it for a good, clean new one.
Own a golden haired Labrador....Call him Lui, again.
Hoping to be able to appreciate Bach and Subbulaxmi the same way as I do, Pink Floyd, or Kishore.
Planning not to burn down this blog again..but write better articles....
Dedicate this blog to the same child with a yellow t-shirt and black glasses on.
Hoping I am not wrong in thinking that if a person is right, he/she always ends up well...
Only hoping that all the time there is to be had, once its been had, I should still be smiling at the end of it...
Yes, I am
Me.
Out of plans for life, where its gonna take me, whats gonna become...
Someone who has dualities in everything...I contradict myself the self same way I convince myself...
Not aspiring to be the best doctor on this planet, I merely want to do good work and save some lives when everything else seems to fail.
Tired of Hindi movies with mindless plots involving drop dead gorgeous male and female stars...give them a chance....
Still crying at the softest movie spots with a little bit of emotion...(so I dont watch good movies with other people, I watch them alone)
Planning to stay sane.
Have been and perhaps will be, always hopeless and hopelessly in Love.
A survivor. I have come out of it...yes...if not with flying colours, then not with a pallid face either..
Planning to be a great cook...
Hoping that one day I will be able to type with 10 fingers without having to look down at the keyboard....
Hoping that if I stay single all my life, at least I dont become bitter like all those loony women I have seen.
Hoping I will end up not so bad.
Hoping I will write a book...2 books or more actually...some on academics, and only one personal that I hope I will publish before I die, not caring whether it sells or not...
Collecting ecgs and hoping I learn to read those lines decently well...
Hoping that I go all over India, with a nice companion, and take a lot of time out...not in a pricey way but just like average normal people go about....
Learn to read fundus, MRI, CT Scan and ECG.
Hoping that even if I may not fall in love again, I should not make others think Love doesn't exist.
Hoping someday to be a mother.
Hoping to start a helpline or web page to tackle some health related issue on a regular basis.
Hoping to lose all those flab I have gained.
Hoping to be fit at forty.
Hoping to be there for my momma and dad when the time really comes for it...Lotsa times, life doesn't give you that much time.
Planning to own a Blackberry in the next 5 years.
Build a web site in the next 3 years....
Collect medical trivia...
Read all the computer books I have collected...
Learn to make chocolate-rum cake....
Watch meaningful cinema...not movies...
Stop watching every Hindi movie for time-pass...write instead...
Go to meet those very few people I did not meet when it was needed...
Have nil expectations from others....
Have nil expectation from life....
Learn to play the Hotel California on a Spanish...
Get a second hand car and learn to ride it before I stash it for a good, clean new one.
Own a golden haired Labrador....Call him Lui, again.
Hoping to be able to appreciate Bach and Subbulaxmi the same way as I do, Pink Floyd, or Kishore.
Planning not to burn down this blog again..but write better articles....
Dedicate this blog to the same child with a yellow t-shirt and black glasses on.
Hoping I am not wrong in thinking that if a person is right, he/she always ends up well...
Only hoping that all the time there is to be had, once its been had, I should still be smiling at the end of it...
Yes, I am
Me.
Always...
What is it about relationships that don't last ? A lot think in the protocol mode of starting on with a new one to save one self from the sorrow of the one that did not work out...but to be honest, does it work that ways?
Any of the relations that i have been through..friendships, love, partnerships, which did not turn out quite the way I would have liked them to, each have seemed to have taken away a piece of my soul with them when they went...I ascribe every single one of them to be unique in their own ways, though not completing me, yet in that moment while they lasted, they almost neared that definition...so that, now that when I don't have them, I feel a lot of those lumps having been taken away from me....
But that doesn't make me a bitter individual..only it makes me more cautious...
Thing is, I still think it is better to be bitter...the soft underbelly persists in that person but is somewhat dead in one who never prepares to trust another person or accord another individual the same status in her/his life as the previous ones where he/she was so unjustifiably not requited.
Any of the relations that i have been through..friendships, love, partnerships, which did not turn out quite the way I would have liked them to, each have seemed to have taken away a piece of my soul with them when they went...I ascribe every single one of them to be unique in their own ways, though not completing me, yet in that moment while they lasted, they almost neared that definition...so that, now that when I don't have them, I feel a lot of those lumps having been taken away from me....
But that doesn't make me a bitter individual..only it makes me more cautious...
Thing is, I still think it is better to be bitter...the soft underbelly persists in that person but is somewhat dead in one who never prepares to trust another person or accord another individual the same status in her/his life as the previous ones where he/she was so unjustifiably not requited.
Tuesday, December 1, 2009
Tomorrow you will be free
I have begun to fear these words more than anything now.my morbidity tracker shot up through the sky and sailed in free air on its way to glory as I entered my 4th month of residency in Unit 10/II, the most feared of all units because of the Godzilla of a Unit Head it has. True, I did not take up the Male Emergency cabin any single day, but to be honest there was no such thing as a male emergency cabin.....sick patients were every where, and that one month, we had more people coming with CVA's than anything else. To my credit, I handled 80 percent of all the deaths in that unit that month.....
And every single CVA patient who had come, and trust me these are so difficult to give nursing care to, with bed sores and thrombophlebtis...was taking a toll. I remember this one female with a large IC bleed in her Right Frontotemporoparietal region, with a midline shift of 1.8 com to her left who somehow managed to open her eyes and accept food....I looked after her day and night, and her 2 sisters and mother were very cooperative as well. To the point that she was even managing to do some active physiotherapy herself. I was happy with the result..I hadn't seen so many managing to so much as breathe properly on their own with an IC bleed.
Life was hectic those days, I used to reach ward before 8 in the morning, and it would be often that I would return after dinner to work there till 12 in the night as well. Somehow, she went through the first week and though her thrombophlebitis was beginning to show, her vitals remained stable and she was passing stool normally. Slowly that week dragged on and I had a crazy night at emergency with over 37 admissions...The next week it wasn't possible to be ther everytime her sister called me. Often, I would tell her that I would come but then go away as something or the other always kept me. They did not complain much, seeing how busy we always were. She started runinng a brief fever but that went down after sometime...I honestly did not think too much about it.
On her 14 th day of admission, Professor finally decided to discharge her withh advice for physiotherapy and follow up. That night, I told her sisters " Tomorrow you will be free." Her sister asked me some trivial question about her ryles tube and I came back, not paying much attention.
Next day morning, with packed bags, she arrested.
Bottomline is: How many IC Bleeds can actually make it? I havent yet managed to find time to go through the literature. Neurosurgeons had ruled out any surgical intervention as a possibility. She had extensions into the ventricles as well. Then apart from Decongestants and Physiotherapy is there no other treatment for these people?
None of the IC bleeds I have seen so far has survived. They always collapsed. And it totally saps the energy of the resident managing them because they take so much time, planning fluids and ensuring physiotherapy and that terrible smell of unclean mouths....
Lesson of the day: Never encourage attendants into believing the patient will be back to normal. In our setting, with our pitiable nursing care, and limited resourses for personalized care, where the resident doctor has bags under his/her eyes catering to these people, its more sensible to keep watching without commenting much on future aspects.
And every single CVA patient who had come, and trust me these are so difficult to give nursing care to, with bed sores and thrombophlebtis...was taking a toll. I remember this one female with a large IC bleed in her Right Frontotemporoparietal region, with a midline shift of 1.8 com to her left who somehow managed to open her eyes and accept food....I looked after her day and night, and her 2 sisters and mother were very cooperative as well. To the point that she was even managing to do some active physiotherapy herself. I was happy with the result..I hadn't seen so many managing to so much as breathe properly on their own with an IC bleed.
Life was hectic those days, I used to reach ward before 8 in the morning, and it would be often that I would return after dinner to work there till 12 in the night as well. Somehow, she went through the first week and though her thrombophlebitis was beginning to show, her vitals remained stable and she was passing stool normally. Slowly that week dragged on and I had a crazy night at emergency with over 37 admissions...The next week it wasn't possible to be ther everytime her sister called me. Often, I would tell her that I would come but then go away as something or the other always kept me. They did not complain much, seeing how busy we always were. She started runinng a brief fever but that went down after sometime...I honestly did not think too much about it.
On her 14 th day of admission, Professor finally decided to discharge her withh advice for physiotherapy and follow up. That night, I told her sisters " Tomorrow you will be free." Her sister asked me some trivial question about her ryles tube and I came back, not paying much attention.
Next day morning, with packed bags, she arrested.
Bottomline is: How many IC Bleeds can actually make it? I havent yet managed to find time to go through the literature. Neurosurgeons had ruled out any surgical intervention as a possibility. She had extensions into the ventricles as well. Then apart from Decongestants and Physiotherapy is there no other treatment for these people?
None of the IC bleeds I have seen so far has survived. They always collapsed. And it totally saps the energy of the resident managing them because they take so much time, planning fluids and ensuring physiotherapy and that terrible smell of unclean mouths....
Lesson of the day: Never encourage attendants into believing the patient will be back to normal. In our setting, with our pitiable nursing care, and limited resourses for personalized care, where the resident doctor has bags under his/her eyes catering to these people, its more sensible to keep watching without commenting much on future aspects.
Subscribe to:
Posts (Atom)