Friday, February 3, 2012


    It was more then 30 years ago, but I still remember it like it was yesterday.I was in my  1st year of residency in India, in medicine.We had this 14 years old patient named Ramila. She had intestinal tuberculosis. This occurs in countries where milk is not routinely pasteurised . So when one has milk contaminated with TB bacteria it settees in intestine rather than in lungs as commonly occurs in most of the patients. It causes nausea , vomiting and gastrointestinal symptoms.  She was 14 and weighed may 65lbs.She could not eat much and we used to force her to eat and drink milk, which was provided by the hospital. In those days the treatment for TB was to give intramuscular injection of streptomycin and pills of two other drugs. One of the medicine --pas was so high that even normal person would get nausea. She had no 'meat' to give injection in 'butt' After being in the hospital for almost 2 months we decided to to discharge her home . She came from a village near by. Her father was not very happy taking her home for several reasons . She was still not eating well , not gained weight, and she could not do anything to help him at home. But I had to.
       We did not hear from her for next 2 weeks . We had set up follow up with TB clinic. I was sitting in out patient clinic .Our clinic is usually very busy , we did not have any time do anything other than going from one patient to other . We had quota system for x-ray , and we could not order x-ray freely. So we used to do  lot of   fluroscopy.  We used to 'collect 8 or 10 patients to do it and one of us would go and do it . It was 11 am and our outpatient ended at 12 noon .And I saw Ramila   with her father . H e came to my table and said , ' I Will not take her home , you have to take care of her , she is  all yours, treat her as your sister. . I am not going to take her home today .' Ramila was still not eating was unable to keep much down . I did not know what to do . He also wanted to me to do fluroscopy . This was very common , all general public wanted it . So I decided to honor his request. I thought it may help him to understand that there was not much that I could change .
        In next 20  mins. we had our last group of patients to do the screening. When I did  the screening  of Ramila I was shocked. She had what we call air-fluid levels , suggesting that her intestines were blocked, intestinal obstruction . I called the surgical resident and she was admitted to surgery ward. I  explained  to the father that she may need surgery to relieve the obstruction. The day was too busy , so I did not have much time to check on her . But next day in the afternoon when I had time to think I decided to go to the surgical ward. I was expecting Ramila to be operated , but instead I was told that the father refused the surgery. I could not believe it . I told the ward boy es to look for him  around the the hospital so I could talk to him and convince him to agree for the surgery  I could not find him Next day he came to the daughter and the surgical resident called me . I had extended discussion with him and finally he agreed for the surgery . Ramila was not in the best shape for the surgery , and did not make it , she died shortly  after  the surgery .

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