Tiny Steps Forward.

It's been over a week now since I've started off and it's been very very interesting so far. Everyday had been about learning new things, meeting a few people and getting adapted to how things work around here.

Just like every other government hospital, KR and Cheluvamba Hospital receive a heavy patient load from the nearby taluks. At present, along with a moderate patient load, part of the workforce has also been deviated towards Covid duties. Separate wards have been made in most departments to treat the Covid-19 suspects and once the test reports arrive, they are either sent to the District Hospital (solely dedicated to treating Covid patients at present) or shifted to non Covid wards here to continue their treatment.

One of the oldest medical institutions in Karnataka (1924), it bears a facade that retains its old royal glory. I've never been one to marvel architecture as such, but there is regal look to these buildings that slowly unravel once inside. While I'm yet to discover the hospital complex for the most part, it seems to be a blend of the old and new and a touch of royalty in contrast to the common folk that throng the premises.

My first day began a little later in the day after reporting to the HOD in the department. I was initially posted to the Recovery ward where the senior began guiding me on the basics. The cases here were all with non Covid related symptoms and they had to be worked up as well as monitored regularly.

Currently we are told not to go to those wards where suspect cases are being treated but we will eventually work there as well. We were told to take utmost precautions at work. Currently the ward wise work is not being followed due to Covid so we will probably get a fixed roster after the state PGs also arrive. Ma'am has finished second year (now in 3rd year) and she guided me throughout the day. I observed ma'am with cannulation and tried one myself. It is an art to put cannulas on minimum tries and also be unfazed by the babies crying at the top of their voice. 😅

Ma'am told me about the cases in the ward and the workup for them. We had a baby I of 10months with convulsions due to low Calcium. Cannulating her was a real challenge since she was a chubby roly poly baby but at long last it was done in the PICU. Just a short while later, she again developed convulsions so we gave lorazepam and then started her on IV Calcium gluconate (to be given very slowly under monitoring since sometimes the heart rate can drop).

There was also a case of a girl with palpable purpura and joint pains and h/o fever (and history of snake bite 10days, treated with AntiSnake Venom) so several possibilities were being considered for a probable diagnosis such as late serum sickness. There was a case of Henoch Schonlein Purpura who had the symptoms of pain abdomen, palpable purpuras and also joint pains. There was also an adolescent girl who presented with convulsions but detailed investigation and observation suggested it was more likely to be a case of malingering than the stereotypical seizures.

By evening ma'am got us some snacks and after 7.30, I was told I could leave for the day and come back by 8.30 tomorrow.

The next day brought about some new things to learn in the wards. We learnt some basics of acute diarrhoeal disease, its presentation and management since it is one of the most common cases here and it is There was a case of Wilson's disease who had come for his followup. He had initially presented with an unusual complaint: bleeding from the umbilical stump. And Ultrasound of the Abdomen had revealed a cirrhotic liver. This had led to portal hypertension and esophageal varices too. Further workup pointed in the direction of Wilson's and a 24Hr urine Copper estimation made it a definitive working diagnosis. Though better seen on slit lamp, he also had Kayser Fleischer rings in his eyes. A bright young boy, he was updated about all his blood tests! So the plan was to start him on oral Penicillamine but the side effects and adverse reactions were also being considered before starting with the treatment.

There was also little Y, a nervous young boy of 6 with Type 1 Diabetes Mellitus. He had poor glycaemic control so he was admitted to monitor his GRBS and fix the dose accordingly. Faithfully the little one withstood the regular pricks of GRBS and jabs of insulin but he would cry even if his mother disappeared for a few seconds!

So after 2 and a half days in the wards, a few successful blood draws and maybe one or two cannulations with assistance, I was asked to shift to the NICU. The NICU is basically for all the inborns at Cheluvamba Hospital while the Sick Baby Ward is for the outborns that are referred here (from nearby taluks) and for inborns that have been discharged and sent home. I was initially apprehensive since I was slowly beginning to settle down in the Recovery wards when this shift happened but the NICU has been another overwhelming yet exciting experience in itself so far! 

With tiny babies brought straight out of the labour ward, there is always the joy of a new life, the resilience to fight against the odds and the strange shortness of life when you realize the available resources you are working with. But despite the deficiencies, there are fighters who make it out, against all odds. That's the silver lining, at the end of the day.