A Tale Of Positivity

Born in times of a raging pandemic,

Amidst the distress within his mother's womb,

Emerged a little one pink and cherubic,

Yet handled through plastics and gloves.

While his mother harbored the virus within her,

The little one remained hanging in limbo,

Away from the warmth of his mother,

He found comfort in the hesitant touch of his father.

Over sleepless nights and enduring days, 

A bond forged between the father, uncle and the young son,

As nervous hands held him upright,

Indeed it was a heartwarming sight.

As the virus sweeps across the country, cases are turning positive at the drop of a hat. While the mother delivered this baby at a Covid hospital, the baby waits for its  RTPCR Report, whilst being tended to by his loving father and dedicated uncle. Amidst the uncertain times we live in, here's a glimmer of hope and happiness! 💫

Summer Notes..

Three months in the neonatal inborn ICU and I'm now finally in the general Paediatrics side.

It's been tiring, what with the constant reshuffling and modified rosters popping up in the middle of the month but the saving grace is seeing some babies get well and go back to their mothers.

With the high sepsis rate in the NICU and lack of some of many essential features of a tertiary level NICU, it gets disheartening to see salvageable babies succumb after a couple of days. But once in a while, a few babies, by their sheer strength and will to survive, backed by the faith of its parents and spared by the sepsis of the ICU, are discharged with a long list of followups.
Particularly heartening is to see an extubated baby make it out of the critical phase and get discharged.
The interesting part is that I would often get to see these babies again in the HRB clinic (High Risk Baby Clinic for follow up of discharged NICU/ SBW babies) and we could see if they were on the road to catch up growth or sometimes, deteriorating further and needing interventions.

Unfortunately, unlike the previous months, single duties in the NICU were so hectic I barely had time to open my books. There were a couple of interesting cases like the Congenital Diaphragmatic Hernia that was diagnosed almost 2 weeks later, the Colloidian Baby with a midline skin defect, the Hydrocephalus with myelomeningocoele and the probable Prune Belly Syndrome. There were of course CHDs which were either referred to Jayadeva Bangalore, mild enough for management here after consultation with the paediatric cardiologist at Jayadeva Mysore and some babies which deteriorated before evaluation.

In the midst of all this, we also managed to take breaks, laugh a little and of course, binge on cold coffees!

Towards the end of the month was the much anticipated wedding! I literally begged for leave by coordinating with my batchmates and giving them the time off that was due in order to do my replacement. At long last, after night duty mom and I set off to Bangalore. It felt good to be back after nearly 9 months except of course for the traffic! The first halt was Ajji mane where I caught up with the family and then Mama and I set off for our respective wedding receptions.

There's something overwhelming about seeing your close friends get married. Especially if you've seen them since class 1 and managed to keep in touch despite all the highs and lows, despite the distance and differences in profession.
It kind of hits home that, adulthood has finally set in, like it or not. Nevertheless, it was lovely to see the beautiful bride and groom dazzling on their big day! I also caught up with Mani after ages and had a lot of interesting JJM stories to hear. :)

Back to Vasanthnagar after this, Nidhz and I took a drive down to Sadashivnagar and had some Gelato in a laid back cafe with a lively vibe. The next morning we were up at the crack of dawn and headed to Lalbagh were Pinki joined us. We ambled around the gardens while Nidhi whizzed by and completed 5km. After some Idli and filter coffee at Brahmin's Coffee Bar (who knew they don't serve sambar with the idli there? :( ), it was time to head back, get dressed and rush to the wedding! The bride was simply stunning and there was an aura of grace and elegance that was inimitable. After catching up with the school friends and a quick lunch, it was time to head back home to 338 (only to find my beloved room in an utter state of disregard), say a quick hi to Mittu, Kittu and Kirpaapa and then head towards to the all too familiar Railway station where Pa dropped me off (as always) and waited till the train chugged out of the platform....

The past 2 weeks in General Paeds has been exciting, for the variety of cases I get to see and we had a good balance of hectic duty (36hours) and free time (ward work) that gave us time to read/ spend with the family. Unfortunately, the resurgence of Covid has only thrown us back into the mess that we were in last year with 5 day schedules in Covid, SARI, PICU wards and basically no unit system.

Sometimes I don't know what is it I look forward too, each morning but I tell myself that it's going to be worth it at the end of of day.

 
Here's hoping the days ahead are brighter,
The Covid cases are fewer,
The learning process is smoother
And Life is lived to the fullest. <3

Ecological Equations

  

Tender rays of sunshine upon the forest floor,

The glistening leaves glowing amidst the misted veil,

A peacock screams looking at the rising sun,

While tiny parakeets flutter out of their nests.

A faraway langur calls out from the treetops,

A herd of deer look out in vigilance,

A fawn grazes amidst the grass blissfully unaware,

While stealthy footprints mark the predators entry.

The rustling leaves betray a hint,

The blowing winds waft a deceptive scent,

The majestic carnivore marks his entry with grace,

While his dainty prey dash ahead on this deathly chase.

Elsewhere a bluewinged beauty takes flight from the treetops,

The sloth bear ambles around for termite treats,

Meditative gaurs graze with their feathered friend perched upon their back,

And a solitary mongoose scuttles across the track.

Noisy rustling and heavy footfalls precede the next entry,

Led by the matriarch, the pachyderms trumpet their way through the forest,

Nestled in their midst is their little one,

To protect their own, they stop at none.

And just like that, in a world of their own,

The creatures of the forest lived in harmony.

Untrampled by man, away from civilization 

Nature exists as a balanced equation. 

Quarantine Quibble

 After almost a fortnight of home isolation, it's time to get back into the familiar routine.

What began with a lot of confusion, trepidation and general anxiety slowly settled down into a routine of activities while being at home with the family.

While the past week or so has given me time to recharge and rewind, it's also made me realize how, as much as we are merely a resource to the establishment (and thus a burden or a liability when we are indisposed to work), every individual is a crucial part of the fragile system that we've built for ourselves.

While I definitely missed being around the babies (and even asked for updates from my co-PGs), I also had this time to:

• spend with my family (more so, my sister who barely gets to see me even though I technically stay at home since my usual routine is to leave before she rises and get back long after she's asleep),

• catch up on exercise (though it left me with sore limbs),

• Reconnect with my artistic side. (And thus also inspiring Di to do the same [in fact quite literally the same things that I did])

• Check out some tunes on my newly acquired Ukelele. (Although I'll admit this needs a lot more effort).

• Reinstalled Netflix and caught up with a few movies and series. Currently watching 'Anne with an E' and absolutely in love with the show. The innocence of childhood, that quirky spirit of Anne, her enthusiasm, love for life and her ever imaginative thinking make for a wonderful series. I wish I had read the books when I had the time!

• I also dabbled in a bit of cooking even if it wasn't for the basic stuff. It was good to bond in love for food and Madagascar chocolate (Shhhh!)

• Read a little everyday. Knowing how hard it is to get any time to sit down and read in PG life, this was actually a good time to open topics of my choice, read and make some notes. I also tried working on my synopsis although I'm still not sure if that's going to be the final version. :O

• And last but not the least, get back into that cursed habit of taking an afternoon siesta and waking up like it's tomorrow. (So wrong, yet so right! <3 )

So here's to the fortnight that basically brought forth what we'd managed to stay away from through last year. Here's hoping we've finally got the natural immunity against this disease and that we have no major sequels in future!

Adios!

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.

Smiling In The Rain.

 Behind the veil of innocence,

Lies a heart of steel and resilience.

Behind the tantrums and tears,

Is a child facing its worst fears.

Innumerable pricks from labs,

A childhood scarred with needles and jabs,

Alien to the scientific terms of the specialist,

Yet human enough to understand the grave tone of a realist.

Some children have ambitious dreams and reach for the stars,

While some wish for a healthier day and infrequent scars.

Childhood is all fun and frolick,

Unless it's a little one who has to endure being sick.

Smiling through the rain.

Working with children over the past few months has been an experience unparalleled. Every child has a story and a lesson to be learnt in management of a condition.

But there are also times when you realize that some children will have to live with their condition all their life, be it Thalassemia or Diabetes Mellitus or Chronic Kidney Disease, to name a few. 

It made me realize how their childhood is never the same as others, more often spent in between hospital visits, affecting their education and social life, more often than not.

Yet, these children come and go with a smile on most days, aware of the reality and facing it with as much courage as they can muster.

Little Treasures.

 

If there was, perhaps, a way to measure
The love of a parent for their little one,
Their wellness is the only treasure,
And in this pursuit, they would stop at none.

Amidst barriers big and small,
No length too far for a sign of hope,
Wishing for recovery in the long haul,
Sometimes clutching at the ends of a thin rope.

To watch the joy in their eyes at last,
When the critical phase has been surpassed,
To watch the smiles of the family intact,
Makes every busy moment, immensely memorable, in fact.

Loss.

A tiny miracle that grew within her,

Nursed with all the love and care she could muster

Arrived earlier than anticipated on a monsoon night,

Yet she knew, it did not feel right.

A little too soon, they told her and whisked the little one away.

Amidst beeping monitors and mangled wires he lay.

While artificial warmth and breathing tubes were applied,

Out of the comfort of her womb, he struggled to cope with the outside.

One evening, he forgot to take his breath,

They say when you're born to soon, that's bound to occur,

As he was hooked on to a bigger machine in a blur,

Perhaps she realized he was inching closer to death.

She prayed for his strength, a tiny miracle,

But to aid his breath, his lungs were atypical.

They said they tried, with all the clinical care they could provide,

But none could hold back as the young mother cried.

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.