A moment of weakness

Phone conversation recently, a couple of hours after I got to work.

Angel : darling, I just made an impulse buy...

Darling : oh? And how much did this little impulse cost you?

A : ummmm... Rs. 2,500/-

D : huh? It's your money, but what could you have bought that cost so much?

A : mumble mumble, darling

D : what?

A : (sheepishly) an eye make up set...

D : (bewildered) but I thought you were at the OT today... how did you manage to acquire something like that?

A : (even more sheepishly) a male nurse sold it to me while I was at the theater

D : .....

D : .....

A : Honey?

D : I am truly speechless... we will talk in the evening.





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Those who have read my earlier posts may notice a trend....

The death of rats...

With apologies to Terry Pratchett


Picture from here.

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I'm tired.

A casualty to handle, a week end on-call, and personal emotional turmoil.

But all that's besides the point of this post.

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I walked into a medical ward yesterday... sat down near the house officer (an old friend) and started a random chat. I can't explain the difference I felt... was the air somehow heavier in this ward? Was there somehow less light than the one I worked in, or was it just the generally overcast day?

These musings at the back of my mind were cut short by wails and screams of agony. Over and over again... now high pitched, now low... different voices... different levels of torture ripping through souls. At times a confused babbling.... at times just incoherent moans. Over and over again...

I listen for a full minute, mouth agape... "what is that?" I ask, horrified. My friend looks glum. "Them? They're the lepto patients..."

Leptospirosis.

The farmers call it mee una (rat fever). The spiral like bacteria lives in the kidneys of rats... and when they pee, get passed into drains and canals and paddy fields. Unwary farmers go sloshing around... and get infected through the cuts and scrapes on their feet. The fever sets in and chills shake the bodies of these young, strong, healthy males. Blinding headaches. Uncontrollable vomiting. Delirium. And the complications are killers : inflammation of the heart and brain, liver failure, kidney failure, relentless bleeding tendencies.

It is "Lepto season" again in Sri Lanka. There is an epidemic going on... but I don't have the statistics or the numbers yet. Many many are transferred to Colombo... from all over the country and they die like flies... young men, reduced to moaning shells of their former selves. Women die too... young and old... some who have only stepped into the paddy field to help a friend during the sowing.

There is hardly enough space in the dialysis unit for patients with chronic kidney disease. The unit is full of lepto cases, their blood being fed into machines in a desperate attempt to clean out the toxins that are poisoning them. The wards overflow with the infection... the systematic removal of bodies is only matched by the relentless inflow of even more patients.

Antibiotics can cure... if given early. As soon as there is even a faint suspicion of the presence of Leptospira. Before the complications set in. I believe there's an island wide awareness programme going on. Cut off as I am from newspapers, TV and other mass media that is available to the normal population, I haven't a clue as to what they're saying. But please listen, and take care.

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It was close to 9 pm as I walked to the flat, the full moon radiant overhead. I bump into another friend, moodily making her way to the canteen.

"Heavy weekend eh?"

"You have NO idea. Three early morning arrests today"
(cardiac arrests... not good, obviously)

"How many survived?"

"None."

"Damn! Poor you... hope the rest of your day was better..."

She looks at me... tiredness, and something else I can't define seeming to ooze out of her very being.

"I got a call from the dialysis unit at about 10, a patient had arrested during dialysis. While giving CPR, I got a call from the ward... another arrest."

I didn't have much to say after that. Obviously her weekend was a helluva lot more shitty than mine. I only had one question.

"All lepto?"

"Yup, all lepto."

Going home

Last week, we sent a man home to die.

Cancer had ravaged his body. His abdomen was swollen with fluid, taut and tense and shiny. Each day he became a little more breathless. Each day he would eat less... finally able only to take water, squeezed into his mouth from a soaked piece of cotton wool. Each day we would infuse albumin, plasma and blood, trying desperately to replace the proteins being leached out of his system. Each day a large needle would be inserted through the abdominal wall as we tried to drain out the malignant collection of fluid. 4 liters on the first day, 2 1/2 on the second.... after about a week, less than 1 liter coming out as the fluid started clotting in the tubing system.

He was a farmer, from a rural area far away from Colombo. His relatives traveled long distances to see him. Father to 5 children, many expenses were met by the employer of his eldest child. They were a devoted family... someone was at his side 24/7, medical instructions were meticulously followed, some sign of recovery anxiously awaited.

Tissue taken from the ugly mass in his abdomen was examined by pathologists. High grade sarcoma... a particularly aggressive liver tumour. Surgery was not possible. Chemotherapy and radiotherapy have not been shown to work much. The plan was to refer to an oncologist, and then transfer to the Cancer Institute, Maharagama. That would take a few days... the patient was deteriorating day by day, slowly dying.

We spoke to the relatives, to his wife and her sister, to the sons and daughters. Gently we told them not to expect too much. How can you ask a fellow human being not to hope? Yet we cannot falsely reassure...

They came to us one day, tears brimming in their eyes. Could we transfer him to M..........., a base hospital close to their home? They were prepared to arrange a vehicle... a van would cost them 5 thousand rupees... a hearse would cost 50 grand. Is it not pathetic? Can you imagine what was going through their minds as they made that request? I stifled my own tears while my colleague assured them that we would try our best.

Permission was granted by those at the top - yes, transfer to local hospital on humanitarian grounds. We may not be able to relieve their emotional distress, but maybe we could ease their financial burden. The patient was in no condition to travel in an ordinary van. The rules are such that to transfer a patient from NHSL for such a purpose, we need to wait for an ambulance from the relevant hospital to come to Colombo. An ambulance from M.......... would take days, if not weeks to come. This patient didn't have that long.

Private ambulance services were called up... the tab was Rs. 10,000/-. The family was seen outside the ward, pooling and counting the money from their purses. Orange notes and blue ones. Not many green notes to be seen. Dr. E then had his brainwave... could we not ask the Director to authorize an ambulance for this patient? The letter was carefully composed, highlighting the desperate situation. The authorization came in less than an hour and before evening, the patient was on his way home. His young son called later that night to say they had reached the local hospital safely.

The second call came the following morning. Our patient had stopped breathing... the end had come. That 18 year old boy who had watched his father die could not stop his sobs as he spoke over the phone. He understood that we are all destined to live a certain span of years and that when the ayusha (life force) runs out, we all have to leave. His last words before he returned to the sad duties of last rites and burials were "Doctor, waattuwe hamotama godak pin. Budu saranai".

A postscipt to the last...

A patient grabbed my bottom yesterday.

To be fair, at that time, I was grasping his penis (while inserting a urinary catheter).

When I slapped his hand away, he yelled "you dirty bastard" with quite unnecessary vim.

In his defense, he's 83 years old, confused and probably thought he was being molested.

Ah well... c'est la vie! My life, at least...