Crest and Trough.

Aches and pains that grew by the day,

A pill to ease fatigue, they gave in hope,

Alas, it backfired and he had much more agony coming his way.

The teenage boy now began sliding down a fatal slope.

He came to us, anxious and in despair,

Routinely we worked towards a methodical repair,

Yet some jigsaw puzzles only fit together at the last

And this was a picture we saw only after the mortal die had been cast.

Rallied around by silent supporters,

His was a case familiar to all,

A breathless bout and a hypertensive heart,

His breathing was now by a machine falling apart.

Out of the grim ordeal he emerged one day,

If it was light at the end of the tunnel one couldn't say,

Yet it was a small victory to see the boy breathe,

But one could say he was still ill at ease.

Ravaged on the inside by the viruses unseen,

It was a battle brewing in his own bloodstream.

His anxious parents watched his tumultous path

And wondered why he had incurred medicine's fatal wrath.

At long last, the sun set on the young man's life,

His parents watched as he struggled with multiple wires and tubes in strife,

His doctors wondered what else could they have done

While the virus wreaked havoc, yet seen by none..

 A teenage boy from the nearby taluk referred to Cheluvamba Hospital. He had a history of fever and myalgia for which he had been prescribed Nimesulide ( a banned painkiller) at a local PHC (Primary health Centre where the grassroots of medicine begin). Karthik developed an adverse reaction to the drug the form of severe rashes and itching, swelling of his face and some breathing difficulty.

He was stabilized here and his angioedema subsided over the course of a week but his fever and myalgia were persistent. When we worked up for the cause of fever, Dengue serology came positive. One night he developed high blood pressure and breathing difficulty and was shifted to the PICU. The following morning, his respiratory efforts were strained and he was electively put on mechanical ventilator.

From then on, his issues multiplied and he developed myocarditis, intrinsic renal failure, convulsions  rhabdomyolysis and even a form of polyradiculoneuropathy as sequelae of Dengue. Suspecting something else to be acting in sync with this, we also tested him for Covid Antibodies which also turned out to be positive (although he was RTPCR negative). As this could be a case of the recently emerging Post Covid Illness (MIS-C) among paediatric population, he was given steroids and immunoglobulins in hope of improvement.

He did show some promise and was extubated from ventilator but then he took a downhill course after that. Multiple attempts failed to revive him and after almost 2 weeks of hospitalization, it was the end.

Puzzles to Decipher!

It's been almost 6 months in Mysore and every month has brought about changes. From the first 3 months in a PG and working in NICU and SBW to the transition to living at home with my parents and sister and working in General Paediatrics, every month has had new stories, new lessons to be learnt and new patients to bring a smile.

When in the Newborn side, the hours were long and there was a lot of procedural work like cannulation, blood draws and UVCs along with intubations. There was also the need to monitor much more closely since these little ones often deteriorated rapidly if not recognised at the right moment.

The night duties allowed for some breathing space in the day but either way, I would be pretty drained out towards the end of my shift.

While in General Paediatrics, the variety of cases was baffling, the uncommon presentation of common cases was intriguing and sometimes, some scenarios had most of us scratching our heads for a diagnosis. General Paediatrics involved a lot more interaction with the staff and required us to read up more for the rounds.

Emergency ward was where we get the maximum exposure of immediate management of a case and requires prompt initiation of treatment of every case after taking relevant history and doing a proper examination. Case sheet writing would often take upto midnight for slowpokes like me and December was a particularly busy month given the absence of colleagues.

But the best part was not rushing back home at 11.30 PM racing against the chilly wind; it was the simple joy of watching a once sick child recuperating, or the wave of relief wash across the parents after the critical phase had passed or the subtle satisfaction after learning a procedure.

General Paediatrics made us more acutely aware of how a child was actually "feeling" rather than just the investigations and values. It also sensitised us to the other factors contributing to a child's physical, mental and emotional well being such as the environmental socioeconomic factors.

In the midst of all this, we've had to look into statistics for the wards we are posted in, present a few cases and attend online seminars as and when time permitted. Although the pandemic has largely affected the way we learn in a classroom, these sessions provided an orientation to the kind of reading expected.

While most children made a slow but steady recovery, there were always some, who presented late or deteriorated faster than the resources could handle here.  It is always painful to deal with loss, more so when it is of little ones. We could only offer words of comfort and advice on seeking medical care sooner in future.

On the whole, every day has taught a new way to look at the cases, interact better with patients and their attenders and learn a bit more of the concerned diseases. 

Here's to a new year with lot more challenges and uncertainty ahead and memories to cherish.