Fresh out of the insulated NICU, I began my stint in the Paediatric department with alternate day OPD and ward duties. This meant that I had about half a day and a night off on the ward days and alternate day night duties.
On my first OPD day I reported on time and when I was on my rounds (prior to the actual rounds with the consultants), the recently admitted patient Kishan, a 11 month old boy on ventilator had no cardia and his family attenders began mourning. We quickly did the emergency resuscitation but to no avail. We called the duty doctor who verified the same and informed the family. It was only later that I realized that it was a case of Retroviral infection also present in other family members that was the main factor leading to all other complications.
There was Umme Kulsum, a case NS1 positive Dengue fever of Unit 1 that I monitored because I saw how she progressed from throwing up over a glass of water to half an idli to a full meal. On my subsequent night duty, she had platelet counts around 40,000 , abdominal pain and hypoproteinemia leading to some edema. Over the next few days, her counts dropped further necessitating transfusion after which she made a gradual recovery. It was indeed a happy moment when this little girl gave a broad smile, a shy thank you and made her way out of the wards. The next such happy moment was when Saniya Banu (who was in the PICU for a while) and her elder sister Hiba Tehreen were also discharged upon recovery and they left after a thank you from their mother.
Dengue cases are on the rise this season and they usually present with the primary complaint of fever, sometimes associated with myalgia and vomiting. The management is not specific but mainly consisting of fluid therapy (Ringer Lactate), regular BP monitoring, daily platelet and haematocrit verification. It's when the platelet counts drop further that the crisis deepens with abdominal pain and bleeding as the next set of manifestations. But so far, the dozen or more cases admitted have all made a successful recovery.
The next case that's worth mentioning is a case of hydrocephalus and subgaleal hematoma that was brought to us for a short stay after which we referred it to NIMHANS for a VP Shunt and further neurocare. There was the standard running around for a free ambulance under NRHM (National Rural Health Mission), some reassurance to the parents that NIMHANS would provide quality medical and surgical intervention at affordable prices and Krushi baby was sent packing.
Along with Krushi came B/o Mani who was brought one afternoon after she had 4-5 episodes of convulsions the previous evening. While the mother was extremely emotional and burst into tears at the slightest question/ explanation, the father was rather demanding and expected 24*7 presence of the consultants. This otherwise adorable cherubic little one also had fever and we got a CT and EEG (Electroencephalography) done which again pointed towards a neurologist for further reference (Query: Viral Encephalitis) but then she aspirated on her feed (probably the mother's enthusiasm after a week of keeping the baby on NPO (Nil Per Oral)) and had some respiratory distress, much to the anguish of the parents. At this point, I was some kind of interface between the NICU sisters who were viewed with hostility and the parents who simply wanted to hear that everything was going to be fine; something we cannot guarantee once a child is brought to the NICU. Luckily enough, she made a satisfactory progress, was shifted to the PICU and then was sent home after she regained her active joyful state. Here's hoping she makes a remarkable progress with no recurrence.
After this came two cases of mesenteric lymphadenitis presenting with pain in the right iliac fossa and some vomiting. The management involved initial NPO, fluid therapy, antibiotics and fat free diet. There was also a case of what appeared to be paraphimosis which I promptly referred to the surgery department. Samarth was born out of a precious pregnancy and was brought for complaints of breathlessness and cough. He recovered in time but M Sir asked for an Echocardiogram which revealed TAPVC (a type of congenital heart disease) and the cardiologist contacted me citing that he needed further intervention because he was likely to go into right heart failure in the near future. He was referred to a higher centre while his family remained apprnehensive and distraught upon hearing this news. Perhaps he is now at Jayadeva receiving the right treatment. Then there was Deekshitha with multiple enlarged infraclavicular lymph nodes which slowly regressed with antibiotic therapy and Rizwanoor, a four month old with bright kajal lined eyes who had been fed 'Nandini Milk' by her foster parents who spoke nothing but Hindi and Assamese and here I was trying to communicate with them with my not so fluent Hindi. Well, it did lead to some heated moments but nevertheless, she too made a satisfactory recovery.
Probably a case I will always remember is that of Prarthana, a 4 year old from the interiors of Arsikere who was referred here for focal seizures. She presented in status and had been given a diazepam earlier. I was in the ward when she was brought in so I asked for her to be started on Eptoin stat and left to contact Sir. The seizures continued so he started her on Lorazepam and then Gardinal followed by Eptoin again. She remained disoriented after which she began feeds, small conversation and was on her feet after a few days. We got the necessary blood investigations and CT scan and somehow her progress wasn't satisfactory since she was still not completely oriented and had some motor incoordination but since they were insisting on a discharge, M Sir did a Lumbar Puncture and we sent the CSF samples to the Micro, Patho and Biochem department and the reports were not obvious but suggestive of albuminocytologic dissociation. I did tell the mother (her father had met with an accident and was admittedly elsewhere) the need for further monitoring and that she was not completely okay yet and this was only a Discharge on Request. Probably because the little girl addressed me as 'Akka' or because she actually responded to me or that the mother was expressed her gratitude that 'Jayashree Doctor' helped them, I wanted to see Prarthana back to her playful state. I sincerely hope she too makes a complete recovery. It's only upon seeing cases like her and others that I've realized the extent of poverty in the patients here. While most of the services are at very nominal rates, it is still a dent to many families. God forbid, when we tell them that the child needs further treatment at a higher centre in Bangalore, I have literally seen the fear in their eyes as they imagine the exorbitant cost of treatment in Bangalore. It requires much reasurrance and restoration of faith before they muster the courage for the next step.
Several cases not in my unit but noteworthy of a mention are a snake bite (cobra) that was promptly treated with ASV (Anti Snake Venom) and he made a complete recovery from near nil saturation and cyanosed state back to his naughty brat state, a case of Acute Flaccid Paralysis (GB Syndrome?) that presented with classic ascending paralysis, late involvement of respiratory muscles and bladder dysfunction. Their vague history and travel history from Mangalore initially created a Nipah scare that was duly dismissed and he was then referred to a higher treatment for specific treatment (IVIg) and cases of cerebral palsy that also have seizure disorder.
When I'm not prescribing drugs after (struggling and) calculating the pediatric dosage, I've given stomach wash, learning cannulation in little ones which can be especially tricky when the concerned patient is a fidgety yelling kicking toddler who will glare at you and screech at the top of his voice for hurting him. So I'm currently practising on the older variants and will hopefully work downwards. There are nights when the duty is fairly uneventful with just a few admissions giving you atleast 4 hours of undisturbed sleep and then there are nights when every complicated case ranging from poisoning to respiratory distress to febrile seizures lands up at regular intervals making sleep an inevitable myth.
Now, I'm in Unit 2 and I have some really good professors who are friendly and are very clear in their instructions. They also respond to all queries leaving no room for ambiguity. There is A ma'am who is approachable and always responds in case of emergency. She has an advantage with the language and hence communicates better with patients from different communities. B Sir is probably the earliest to appear in case of crisis, also responds even when he is not in charge, calm and composed in all emergencies, never takes risks when it comes to a critical case and ALWAYS makes it a point to explain the prognosis to the patient attender. M Sir is probably one of the sought after paediatricians in Hassan with people coming from far specifically to see him. His speed of consultation is actually terrifying. His ability to detect something abnormal in a short period of inspection and auscultation is truly something inspiring.
So with a week more of Paediatrics to go, I have nothing but interesting experiences to share, memories of parents gratitude, anger and frustration are things you will have to become accustomed to. When you've seen many cases with the same illness, you will know it's an uneventful prognosis but to the parent, it is the first and hopefully the last time their child is afflicted with this illness so they will need all the reassurance that in due course of time, their child will get better.
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