The five legged cow, the deathly dwarf and other stories

I have seen my share of the weirdest things on earth during the past few weeks, and thought I would enlighten the readers with some of them. On doing so, I would also like to add some of the stuff I had seen earlier and was hesitant to post hitherto. So brace yourselves for the blog of the month.











I would like to start with a cow I saw a couple of weeks back as I was returning from a weekend trip to Birgunj. Now, cows are commonplace in India. And everyone knows there are more cows than there are vehicles on the streets of Bihar. But this particular cow had all my attention for the few minutes I could have it in my field of vision while speeding past on a cycle rickshaw. This monster cow had five legs! I'm not kidding, and this image is not photoshopped. The thing on the back of the cow is an extra leg. So much for the first occurence of the month.



Allow me to tell you this one. The other day they called me to resuscitate a baby in the labor ward. The lady had not had any antenatal checks and had arrived in the second stage of labor. The head of the baby was out, and the shoulder was stuck. By the time I arrived at the scene however, the baby, or rather the babies were already out, though it still baffles me how it happened. Take a look for yourself. This is not what you call a 'normal' baby. Had there been a heart beating, I would have been at a loss as to which one to resuscitate first. But they were born dead.















Three hands, two legs, two heads, one umbilical cord and a male genitalia... That explains the Siamese twins.



Now the next one may not be that dramatic, but it highlights an important point I had made in one of my previous blogs about the village doctors. This kid was brought to the outpatient department with a history of multiple episodes of loose stools and vomiting. This had been going on for about five days and the child was treated with all kinds of antibiotics by the village doctors. I should mention that the child was just a couple of months old.



















Today I received a call from the labor ward again and was told that a baby had just been born and had not cried after birth. I rushed in to find this tiny baby with tinier limbs and the nurse hovering over it trying to resuscitate. The baby had a steady heart rate and though we promptly intubated her and bagged her for some time, we couldn't save her.



















The next picture is of a baby brought to the out patient department about four days after birth. This condition, I learned is known as exstrophy of the bladder. We had to refer the child to a higher center.



















One night in the emergency room, a patient arrived, all alone. He was apparently crossing the international border in the evening and had fallen on a metal object, hurting his head in the process. This had happened about five hours prior to his arrival, and he had struggled on to the hospital despite being injured. I wasn't actually prepared for what I would be seeing under the turban on his head.



















A child with mouth full of candidiasis. This baby couldn't feed from the breast. On treatment it improved drastically.













The next couple of pictures are old ones which I hadn't put online. The first one is of an anencephalic baby, which was born way before term.



















This next one was taken when I was still in Obs and Gyne. Was called upon to do a dilatation and currettage for a lady with severe bleeding one day and this tiny little baby was born.

This baby was brought to the out patients department with history of some rash on the face. Probably hadn't been given a bath since the day he was born.

And last of all, well since I am running the doctor's mess here now, a weird potato..

Work

Working in Peds is fun, much as I thought, and I am enjoying every bit of it. Got peed on twice. But trust me, that is nothing compared to getting your underwear soaked in blood during a c-section. Plus I would do anything to see those toothless smiles. Have been doing nursery rounds by myself of late with a lot of help from Rimi. We had some really sick meconium stained babies who were resuscitated properly and did well in the nursery. Most of our pre-terms in the nursery are also doing well and I am so thankful there have been no deaths in the nursery this month so far. That is rather unusual here. Last month we had problems with the 'meconium' babies. Some of them had aspirated so bad that no amount of resuscitation and care with the facilities we have here could keep them alive. The labor ward was overflowing and babies were booming.

Casualty duty
What scares me is the emergency room responsibility. I am required to attend to any case other than an obstetric case that comes to the hospital at night. On call duty starts at 6:00 pm and goes on all the way till 7 in the morning the next day. Most patients who make it to the hospital are awfully ill. And it takes a lot of effort for me to come to the right diagnosis, and I have goofed up; thankfully, not in a major way. We have about fifteen admissions on an ordinary night... that is when the doctors at the district hospital across the border are not having a party and the hospital is functioning. Apparently they did that a couple of days back and we had a huge inflow of partially treated patients. All very ill. And also we have all these medico legal cases coming in on most nights. My last night on duty, I attended to a gunshot wound; entry wound on the left side of chest, exit wound on the right. The bullet had then penetrated the inner part of the right arm and was palpable just under the skin on the lateral surface of the arm. There was no lung injury and the patient was stable. So after providing basic resuscitation we referred the patient to a higher center.

Snake bite
I get to see on an average one snake bite a day. Snakes here are usually elapid - cobra or krait. I have noticed that those with cobra bites are the ones who develop signs of envenomation most of the time. Not that krait bites are safe, but most of the time they are not very disastrous.

Assault
We get to see this in plenty here. People come with bleeding scalps and broken bones. The entry is the scariest part. Everybody is so charged up and wild, yelling at the doctor to do something. It is not unusual to have a crowd of twenty people with one patient and all may be very loud. I thankfully haven’t come across a burns patient yet, but we do see cases of burns. What is interesting is that if you are from Nepal, there is no medico legal case registered where as if you are from Bihar every case gets reported. All poisoning and attempted suicide cases from Nepal thus find their way here.

AGE in Shock
From last month we have been seeing a lot of Cholera cases. And I see about two to five people with AGE in shock on any given duty night. The other night a group of people brought a lady who had been dead for a while. She apparently had been passing loose stools only for the past one and a half hours. Another gentleman who was brought gasping with a history of passing loose stools sat up and talked after we rushed in 6 bottles of ringer lactate.

The Village-doctor
Most of the patients from the village get some medicine from the local doctors before coming here. These are guys who prescribe medicines for most illnesses in the villages, and also in towns. They are not qualified by law to prescribe medicines. But they give everybody who approaches them a shot of two medicines... probably the only ones they know: Dexona; trade-name for dexamethasone, and Monocef; trade-name for Ceftriaxone. No matter what the illness is you can rest assured your patient arrives after shots of these two medicines. So you have to scramble for a higher antibiotic at times. The way they give IV fluids is worth mentioning. They just pump in as many bottles as the patient can afford through a peripheral vein, which is accessed by a large bore metal needle. You have to see it to believe it. They come most of the time with the needle half out. Some times a doctor would accompany his patient posing as one of the family. And he would hang around you just to watch how you treat other patients. Once I had one of these guys come up to me and say, "Hum bhi medical line ke hain." Translation; I am in the medical line also. Talking with him proved to be a very good exercise for building up my patience.

Children

Well the fact is I love kids. Here are some snaps of children, from Raxaul.

Christine and Ashish on a swing…

Stagnant water behind houses makes an ideal fishing spot.



















A baby who was brought to the Out patients



















Pre-term twins in the nursery… they were in for quite some time.



















One day, while making rounds, I came across this irate patient who just wouldn’t talk.




















This one was frantically trying to pull out his NG tube.





















Spikey






Confiscated milk bottle… this step probably saved a life.



Little girl and her sibling with a swollen eye from a flood affected village






















We got new toys from Birgunj.






















Malnourished child.































Wasted bum of the same child.

Now, I wouldn't pick a fight with this one.

Adios Amigo...... for now

It's been a long time since I blogged last and I decided now was as good a time as ever to do so. I am out of Obstetrics and Gynecology for now... have been for quite some time in fact.. about a month and a half to be exact. And the feeling is.... YEAH! Much like the way James Hetfield says it. Things were interesting in the beginning, but towards the end they became...well, scary. We had some women who would just bleed like crazy on the table after a c-section, with nobody willing to donate blood. And some deaths... really sick patients.

I am working in the department of Pediatrics now. And I seem to love it. At least you have patients who look at you and smile when you give them that clown face... and you can do a lot of things you cannot dream of doing with other patients... like holding them against your chest and listening to their heart, for instance. And that's not all. You don't have to listen to the constant drone of complaints that can sometimes get annoying, like the woman who said, " I still have that tingling on my little toe that I mentioned to you during my last visit.. And not one medicine you gave me seems to work.." ...not that softly, here in Raxaul, and at the end of seeing one hundred women that day you feel like saying, " I thought you were here to make sure that your baby in there was doing okay."
Of course I am overlooking the occasional child who screams on seeing you. Or the over anxious parents, occasional again, where the above mentioned drone sounds more like a twin engine.

My current work involves doing emergency calls and receiving sick babies born in the labor ward and OR... feels better to be on the other side of the operating room. There is so much to learn and it feels good.

Here are a couple of interesting things I came across in the last few weeks of my Obs and Gyne posting.


Another of those bad obstetric history charts.


This is hilarious!

One of my patients had already taken this wonder drug. Here's what the label says... since the photograph is more a strain to the eyes than anything else...
An easy way of birth Control
One capsule is sufficient to avoid conception for one year. 52 capsules are enough to prevent whole life conception without any side effects. A harmless medicine and no bad effects on health. Followed by directions and then,
Caution: After taking this capsule, sex in indulgence should be aboided atleast for one month.
I forget what she presented with, but it was nothing major. The whole thing is kind of scary because it probably torpedoes the ovaries. Sterile for life with no side effects. Found that really funny.

After the rain....

Finally it has stopped pouring... and the place is becoming sunny again.... Hasn't rained for two whole days.......That brings with it a lot of patients... a lot of them... But it is a relief not to have to wade through dirty water anymore.... Every house had carpets and rugs hung out in the sun today...

Couple of kids enjoying the sun after maybe... two weeks....

We have a school here in the hospital campus and it had to shut down for a while because of the rain..

Today was a busy day... But as I was not on call, I accompanied li'l Christine on a walk... And when she saw this lovely tractor she had to drive it ... This by the way is the vehicle that takes food and other relief material to the villages along with the disaster management team.....

It's amazing how the flora recovers from an insult so drastic... and that too so fast... It's just stopped raining and the grass is already growing above my ankles... and there are wild lilies all over the place... yellow and pink ones.... The whole place looks fresh and beautiful..

Wild pink lilies along the pathway... These are lovely flowers that greet me in the morning the next day after a rain.. if the sun is up... They line the whole pathway and make it look beautiful, together with the yellow ones...

All over the place new flowers are blooming and they look real fresh.... It is hard to imagine that just two days back all these plants were all under water....

It is green everywhere you look.. Put this snap in just to reproduce the wet and green feel......

And Dr. Shishir's flowerbed is full of blooms again... though still bearing signs of having been molested by the rain... ;-)

Even the sky looked so clear and bright today....

Not a single dark cloud in the sky...

The moon seemed to be happy to be up earlier than usual today... it looked quite big and I was lucky to get this really zoomed in shot....

The same day, the disaster management team had gone to Sigauli, a village about 20 miles from Raxaul. A lot of folks from all over India have come to Raxaul, as volunteers. I met a couple of dental interns... and this is what they had to say....

Jerry and Ashwin aka 'Zach' posing in front of the relief vehicle. Thanks Zach for letting me take your pictures and put them online.

A village built on higher ground converted into an island by the flood......
Found it difficult to believe that these pictures were taken the same day as the ones I did...

With their farmland inundated by the rain... people are resorting to fishing to feed themselves...
As soon as the water rises there are fish everywhere.... at least in the campus... from one ward it was rumored that they caught about a kilo of fish... ;-)




A house wrecked by the rain....
Looks like it is still inhabited...

Snakes are in plenty here and they take the lives of many people as it takes more time to travel through the flood water.... This one here is not poisonous though....










The road ended there and the rest of the trip was on a boat....




















Another partially destroyed house..... And i was worried about getting my carpets wet.....













Part of the relief team......












Part of the village under water with the huts barely spared.....








People would just rush toward the boat as it arrived, for the food packets.... They had a tough time convincing the people that there were enough packets for everyone....






That's how deep it gets at some places.....

The guy was actually their boatman... who was so drunk that he jumped off the boat.. ;-)




It is really difficult to believe that the water is so deep just about a half hour away from the hospital.... And this probably is just the beginning... the real killers are probably going to be the diseases that would spread like wildfire because of such an environment.... The medical team that went to the villages saw a lot of bizarre cases today... so we might be in for something major soon.....

Rains in Raxaul

I would be doing great injustice if I do not write something about this issue..... Thats probably the least I could do....

Thought I would start with a good picture.... the whole place was flooded so bad a week back we had water reaching halfway up our knees almost everywhere in the campus.... including wards and residences...
This beetle found a safe place to rest... on top of a floating leaf.. not for long though... That's the plight of people right now in the surrounding villages..


I didn't actually walk around with my camera in the rain.... guess i should have... but i have quite a few pictures on my phone camera... and that is where most of the ones you see here are from... Again I don't have pictures of the real flood situation... I took these today, as a matter of fact, a day after the rains have stopped pouring and the water is receding....


I took this snap after a two minute walk from the hospital... The water had already receded quite a bit.... The two blokes may look like they are having a lot of fun.... but truth is people have to wade through water reaching up till their chests to go about their daily activities.....


The floods have taken their toll on the sick too.... Last month we probably had the highest number of deaths and complications in the ObGyn department since a long time.... People have to brave more than just water to bring the patients to the hospital... Snakes and all kinds of other insects are out scurrying for higher ground... and since most of the water is muddy... you wont even know what bit you...




A bridge I came across when I went for a walk this evening... A wise man's... a rich man's rather attempt at keeping his house accessible to civilization... just minutes away from the campus... In the villages around the hospital.. people have lost their homes..... not much of a house anyway... wooden structures washed away by the rain...Weird stories of bodies floating around in the water are doing their rounds....


About ten minutes walk away from the hospital is a leper colony..... it is surrounded by water that at some places reaches your neck I am told.... And people have died by merely slipping and falling into the water... There is a river near the colony which is overflowing...


A demolished house I came across this evening...


It rained non-stop for almost ten days about a week back... and we had floods.... then it stopped raining and it was hot and humid for maybe three days.... and it started raining again... This time the rivers were already brimming and this downpour probably caused the rivers to overflow.... my theory... It stopped raining a day back and the water which usually recedes hours after the rain stops is still pooling outside my residence...


That's as far as I could go walking today... The brick pathway, my favorite route for my morning walk... just ends abruptly as you can see because of the water flooding it... people are seen wading through the water... I saw leeches in the water on my way back to the hospital.... And Rimi tells me that if these leeches stick to your skin, they don't let go till you cut the skin around the suckers..... I don't want to prove her right or wrong...


The worst thing is working when there is water everywhere... The hospital has provided rubber boots for all the staff... But still it grosses me out to see blood clots on the water in the labor room... Or worse.. the other day I was on my way to attend an emergency call and the security guy asked me to take a different route... looking ahead I found the whole pool of water turning red from the blood soaked gowns and pads of the labor room..... :-0
David Darg from Operation Blessing was here the other day. And he did an awesome job making this video and putting it on you tube... Good work Dave... It's a pity I couldn't meet with you while you were here...






It has stopped raining for the past two days and just when we thought it was all over... dark clouds hover over the countryside...





Looks like we are in for another bout of heavy rainfall......





Okay..... Will make another post soon.... if I or worse, my laptop, is not washed away.. Cheers!