Sunday, April 19

A girl named Lalitha (posted on Feb 10th, 2009)

It was only eleven in the morning but I was already annoyed. The air conditioning was not working, and patients kept on coming like an endless stream of ants that found breadcrumbs on the floor. A middle-age patient, working class from his faded shirt and well-worn cream pants, was describing me his list of woes when one of my nurses came in to interrupt his litany. "Doctor," she said. Her tone was urgent. "You'd better see this patient." She glanced at an Indian couple in tow, the man carrying a little girl in his arms. I cut short my consultation when my eyes locked on the girl. The man left after I scribbled his prescription. He looked hurt, but at that moment I couldn't care less. I pointed at the vacated chair. But the man wouldn't sit. The little girl, whom I assumed was his daughter, had her back arched, and her neck and limbs contorted awkwardly. Even the father was having a hard time carrying her. After a few seconds of silence, the lady sat down. Her eyes were wide and wild. My nurse placed a thick file onto my desk and left the room without saying a word. "Doctor, help. My daughter. Help." "Tell me what happened," I coaxed, injecting calm in my voice. "She couldn't wake up this morning. We tried. She wouldn't wake up." I skimmed through the notes, but from the corner of my eye, I saw the father shifting the girl's weight in his arms. He was still silent, but he had the same look as his wife did. aged four...our patient since birth...congenital hydrocephalus - she was born with abnormal fluid collection in the brain...we had inserted a shunt to divert the flow of the was revised once due to blockage...the new shunt was infected when she was three, and it was removed...she was under close observation but she seemed fine for almost a year...I glanced at the mother. She was slowly rocking on the chair. I locked my hands together, fingers intertwined. From what I saw, and heard, and read, I came up with a quick clinical diagnosis. "Look. Most likely your daughter has hydrocephalus again." It was difficult not to use medical jargon. But she understood. "So what are we going to do now?" I finally heard the father's voice. It was deep, but lined with cracks. "I'm going to admit her and arrange for an urgent scan. We need to put her to sleep so she won't move. We may need to operate on her today and insert a new shunt." Everything was arranged within two minutes. I didn't tell them not to worry, as it would be a lie. I was worried for Lalitha. My nurses helped speed things up, and before long, the family boarded the lift that led to the ward. Before another patient took the now empty seat, a colleague of mine poked into the room. "They came here two weeks ago," she said. "The girl wasn't this bad, but we offered shunt insertion." "And?" "The parents refused."
I was walking with my friends to a food corner just outside the hospital for lunch. My phone rang. It showed the hospital's number. I contemplated on not picking it up. I wasn't on-call, and it was lunchtime. I pressed the green button anyway. "Doctor, this is Staff Nurse from Peds ward. Please come. Quick." "I'm going out for lunch. Anything?" "The girl you admitted just now. She stopped breathing." Shit. "Have you contacted the MO on-call?" My friends stopped walking and looked back. I motioned for them to go ahead. "He didn't pick up the phone. Please doctor!" I disconnected the call, pocketed my phone, and. Ran. I was panting when I finally reached the ward. It took me maybe about two to three minutes, but it was already three minutes too long without breath. I silently gave a prayer of gratitude when I saw the nurses already pumping air into the girl using a mask that covered her mouth and nose. Her oxygen saturation was maintained at 98%, which was good news, but she wasn't breathing on her own, which was bad. Her heartbeat was a flutter. We had to intubate her, but I wasn't confident in intubating small children. "Call the Pediatric ICU doctor. And call the specialist on-call. I need help." By that time I had already taken over the pumping. Squeeze. Pause. Squeeze. Pause. Squeeze. Pause. My heart was beating wildly, partly from exertion, but mostly from dread. The nurse came back shortly. "The Peds ICU doctor said call the General ICU people. They're nearer." "Fuck them," I muttered under my breath. "Call GICU then. Quick." I turned my gaze to the other nurses surrounding the bed. "We intubate her. Now." Their movement seemed sluggish. Like they were unsure what to do. And my time counted in breaths that Lalitha didn't have. "Now!" I grabbed the small tube from my nurse. I made a mental note to apologize later. I gave another silent prayer, this time to guide me. I inserted a laryngoscope, a special metal torch with a long blunt blade that helped to depress the tongue and upper airway to visualize the vocal cords. I managed to insert the tube - with difficulty - after my second try. I listened to her lungs as one of the nurses pumped air through the tube. "It's in. Anchor it." Another nurse proceeded with securing the tube. At that time, two GICU doctors finally came and exclaimed, "Oh, you intubated her already." I was too annoyed to even look at them. My specialist came some minutes later, with the on-call medical officer behind him. My specialist felt the girl's scalp for a telltale sign of the spot where her shunt used to be, and decided to try draining out some of the excess fluid by poking a large needle through the scalp. Lalitha started breathing on her own after he drained out a few syringes worth of clear fluid. The on-call doctor took over from that point, and he pushed the girl downstairs to do the CT scan and then straight to the operating theater. I was suddenly tired and hungry.
Two days later Lalitha was running around in the ward like a little butterfly fresh out of its cocoon. This I learned from the nurses. I didn't go check up on her myself. This is because I found out from the nurses, when I was busy fighting for Lalitha's life, her parents were blaming us for what had happened to their daughter. That we were slow to do the CT scan, that there was a delay in operating her. All these came from the same people who refused operation when we strongly advised for it two weeks earlier, when Lalitha showed signs of early hydrocephalus, when this complication could have been avoided altogether. I could not face them without taking the risk of having to answer to the hospital director for battering a patient's parents. Some people are just bad parents. At least Lalitha recovered. That was all that was important.