Sunday, April 19, 2009


Yapa was an old guy who was transferred in from Mathara somewhere in December last year. He had spent so much time in the ward that he used to joke that he had been added to the ward inventory. Always greeting me with a sweet smile, he would say, every morning without fail, "no need to check my blood pressure Nona, there's nothing wrong there... see if you can fix my lung".

And that was precisely what was bothering us. His left lung was virtually non existent as the left side of his thoracic cavity was filled with fluid. This had been drained 5 times in Mathara, only to fill back up again. We were reluctant to stick a needle in again - this type of collection usually meant either cancer or TB, both which need specific treatment but no matter how many tests we did, no diagnosis was reached. So poor Yapa was bounced around, from our ward, to the Medical Investigation Unit, to Chest Clinic Borella, to Chest Hospital Welisara and back to our ward and no one had a clue what was going on. X-rays, bronchoscopy, bronchial washout, CT scans etc. etc. Even Dr. House, MD would have been impressed by the thickness of this guy's file.

And every day he'd get a little more breathless. Each night, he'd have more difficulty in breathing. And each day I'd get more concerned at how little he was eating. Finally the decision was made to put in a tube and drain the fluid... and for a couple of weeks he was walking around carrying the tube and bottle as if it were a special kind of handbag and looking absurdly happy about it.

Then one day, he just deteriorated. Hands were cold and clammy, blood pressure was low and breathing was irregular. We pumped in saline and plasma, nebulised him with everything we vould think of, gave high dose oxygen and he pulled through. That evening as I did the round he told me, "Nona, I'm going to die in the night... the forms I have filled to donate my eyes (coreal transplant) are in this little bag under my pillow, don't forget". I pooh poohed at his statement, patting his arm and reassuring him that he was now on the mend.

Yapa survived the night... but he died at 8 am the following morning. His last words to me were once again, not to forget the forms. He sank into a stupor and then died peacefully a few minutes later. He died not screaming and begging to be saved, but convinced that his time on this earthly plane was over and his last wish to help someone in his death.


May he attain Nibbana

What's with these women...?

Hi, y'all!

OK... it's been a very long time. Needless to say, I've overworked, underslept and been in a generally foul mood for the last two months. Many thanks to all of you who dropped by to see if the blog was updated... and to those who sent kind wishes during the Avurudu season, which alas, I spent in hospital.

Ah well, 41 weeks down... 11 more weeks to go...


I work these days in a female ward... the one and only house officer. The complaint rate is generally higher than in a male ward, but then, when males are sick, they are really really sick. Most of my patients are wheeled in on trolleys and chairs, looking like death warmed over... A bottle of saline and a night in an uncomfortable bed later, they're just begging to go home. They remember the kids, the washing and the shopping. Sometimes all they need is a break... one sweet old aachchi actually admitted that she came to hospital for a nice rest away from her chaotic household and I didn't have the heart to boot her out until the following morning.


A recent admission to my was was a 19 year old girl who worked in a small shop at Pettah. She complained of fever for 6 months (mind you, 6 months of feeling unwell and she turns up at 12.45am - go figure). This is what we call "fever of unknown origin" a clinical mystery to which both myself and my registrar delved into with great interest. Blood tests, ECGs, x-rays - and then we find she has very high blood pressure and that her kidney function is miserably poor. Is the high pressure the cause or the effect, we mused, and ordered more x-rays and gave several different types of drugs in order to control the BP. Finally, a scan was done and what that report said freaked me out like nothing else... 16 week single live fetus seen in the uterine cavity.

Holy shit! That little idiot was pregnant!! And she lied to me about her period!! And the pregnancy test was negative because it was an advanced pregnancy!! AND I had taken 3 x-rays and given her a bunch of drugs that are virtually guaranteed to harm the baby!!! I was so mad that I actually slapped her across the arm and and yelled at her, asking whom she was trying to fool!!! Turns out that the guy who was responsible is married to someone else and has two kids from that marriage and all he wanted was an abortion. She wanted the kid - more I think because she couldn't contemplate the thought of abortion.

Cue Angel calling up her sister (both parents had passed away) breaking the news, stopping the sister from committing physical assault, arranging for counselling and finally transferring her to a specialist maternity unit that would take care of both the kidney problem and the baby. Sigh... I swear that whole episode took years off my life!


A friend of mine works in the adjoining ward and she has a far more suspicious nature and more experience, having worked in a maternity unit on her first 6 months. The very next day she points out a new patient to her side, a rather chubby young girl, and said "Angel, she's complaining of body swelling for 6 months... can you make a spot diagnosis?" The girl is 22, unmarried and looks thoroughly bemused. I hazard guesses of hormonal problems and connective tissue disorders. My friends shakes her head... "can't you see the pigmentation on her face?? She's definitely pregnant." Examination of the tummy shows a wriggling baby, scan confirms a baby and girl continues to deny that she has had sexual contract, or a boyfriend or has even seen a man before... Her parents are equally skeptical. "No no, our daughter is a good girl. there's no way she can be pregnant, she never even talks to boys, you are educated people, why do you lie to us??" etc. etc.

She delivered a bouncing baby girl 2 days later.


Such incidents never fail to surprise the continuously naive Angel, but my friend says that 6 months in a maternity ward and nothing would make her so much as raise an eyebrow. She told me of how she was called to the ward one night to see a heavily made up young woman who was complaining of abdominal pain. A closer look confirmed that the said young lady was in her bridal outfit and - you guessed it - in labour. Apparently it was some shiny puffy garment that was swathed around to hide the bulging belly and she had come straight from the reception when the pains had got too hard to bear.

So the blushing bride was rushed into the labour room and gave birth within two hours. By dawn the next morning, she had signed herself out of hospital, saying that she needed to be on her honeymoon, and that anyway the homecoming outfit would now need adjustment. Her mother was left in charge of the kid and later took the kid home once all the vaccines were given. It was all my friend could do to stop tearing her hair out - and since nothing was actually illegal (only very fishy) there was nothing much she could do about it.


Now, I too have cultivated a suspicious nature. All women are sharply questioned about their period... a stock of pregnancy tests are kept on the emergency trolley (easy access, heh!) and tummies are poked more often than ever. And I recall with great fondness the words of wisdom quoted by an old Prof. 4 years ago "every woman between 5-75 years is pregnant until proven otherwise".