Prized Gift from precious Patient

8/6/2019 Prized Gift from precious Patient

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PRIZED GIFT

FROM

PRECIOUSPATIENT

BY :

DR. SANAT TRIVEDI

AHMADABAD

INDIA


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My Precious Patient

I do not remember the precise date but this incidence happened somewhere in winter of 1962. The day was Sunday, and I was at my home

enjoying old filmy songs on radio.

I was working as medical officer of small rural health centre. In

those days government had started number of health centers in the

country, for the purpose of providing primary health care to rural

population. Main purpose of the government was to provide

curative and preventive health services to the population living in

small villages. In those days most of the medical graduates were not

willing to serve in the smaller villages. I had preferred to work in

the rural area, because it was the dream of my grand father, that after

becoming doctor I should serve poor, and needy patients.

I had read one epigram in Ayurvedic text. It was mentioned in the

book that as a doctor,

I do not wish to be king of the state, nor I wish to have place in

the paradise, nor I desire to have good re-birth, my only wish is to

help and heal the living beings who are miserable and sufferer.

I had also decided to follow the same path.

So immediately after completion of my medical education, I took thepost of medical officer at rural health centre. My salary was Rs. 45o

per month. I was provided with free residential quarter in the same

hospital campus. However I was happy and contented with the

amount I was getting as my salary, and I had decided that I will not

charge any fees from my patients.

There was nock on the door. I opened the door. Hospital servant had

come to call me for some emergency medical case.

I rushed to the centre clinic to examine the patient. There I saw a

patient lying on the examination table. The patient was small

woman, aged 18- 20 years. She was pregnant and was running 7th

month of pregnancy. She was very weak and was in great distress.

The patient was brought to the clinic by her husband for delivery.

On detail examination I found out that her skin was very pale, sign of

severe anemia. Further examination had revealed that she was

having edemas over both the legs. I took her blood pressure. Her

blood pressure was 190/ 100. [High blood pressure]. Fetal heart


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sounds were not perceptible; meaning the child in the womb was not

living. I asked nurse to test her urine for the presence of albumin and

sugar. Urine was tested in the laboratory. Laboratory report detectedhigh concentration of albumin in the urine.

It means the pregnant lady was suffering from pre-eclampsia. In

simple words, it is the toxemia of the pregnancy. Pre-eclampsia is

very serious disease. It is not possible to treat such case without

proper equipments and trained staff. The survival rate of the patient

is low. In most of the cases child dies in the womb.

The disease subsides after delivery.

My health centre was not equipped to treat such complicated cases.There were no trained nurses who can handle such cases. Even I had

no enough experience to treat such complicated case. The best

alternative is to refer the case to near by big hospital. Nearest big

hospital was in Ahmedabad, some 35 km away, from my centre.

I summoned her husband who was sitting out side the room. I

explained in detail the seriousness of the case, and advised him to

take the patient to bigger hospital in Ahmedabad. On hearing the

detail about the case he got puzzled. He could not decide what to do.He did not speak a word for the moment. Then he said, sir, it is not

possible for me to take my wife to Ahmedabad. I am very poor and I

can not afford the costly treatment of big hospital.

I assured him that he had not to spend anything for her treatment,

as the treatment in the government hospital was free.

He said, but sir, I do not have vehicle to take her to ahmedabad .

I told him I will arrange for the ambulance, and you have not to pay

for the ambulance charges.

He said, sir, what about her food?

I told him that food will be supplied to the patient from the hospital,

He said, sir, I do not know anybody in the Ahmedabad, I am beggar

and I can not afford to stay in Ahmedabad to look after my wife, and

I can not leave her alone in such big city

He added further, Sir, it is not possible for me to take her anywhere.

I have come to your centre with great hope. Please do not disappoint

me.

The patient was in distress. There was not much time for prolong

discussion. I had to take quick decision.


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On one side there was poor patient in distress, on other side I was not

having enough resources to treat her. As a doctor it was my duty to

save the life of the patient. But I was not fully equipped to treat suchcomplicated case. It was also question of my medical career. Death

of the patient in the beginning of the career means end of my

medical career. That was the beginning my medical career. If I fail,

then it will be end of my career as doctor.

I asked my nurse to convince the husband to take the patient to big

hospital but she could not convince him to take her to big hospital.

He loved his wife very much. He wished that she should get better

treatment at big hospital, but it was not possible for him to take her

to Ahmedabad, because of poverty.

I had no other alternative left. For safety, I asked the man to give in

writing, that he was advised to take the patient to big hospital, but

he was not willing to do so. So in the case of any complication or

death of the patient, the doctor will not be held responsible.

The husband gave it in writing.

For me now there was no alternative left except treating the patient

with available resources.

It was the challenge of saving the life of the patient. That was my

first medical challenge.

I shifted the patient in isolated single room. All the extra furniture

from the room was removed. The room was disinfected with

available disinfectants. The dirty clothes of the patient was removed

and clean hospital gown was put on the patient. The body of the

patient was very filthy, and there were all chances of getting

infection, so the nurse was asked to clean the patients body and

body parts with mild disinfectants.

I prescribed necessary treatment. I prescribed anti-hypertensive drug

for controlling high blood pressure. For prevention of future

convulsions some sedatives were given. The patient had not taken

the food since 24 hours, so some food and fruit juice was given to

the patient. However that was not helpful to maintain her strength

because she vomited after five minutes. She was also given

antibiotics for preventing infection.


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The patient was kept under constant observation. The nurse was

asked to remain present with the patient. She was also instructed to

report me immediately, in the case of complications.

I was not happy with the condition of the patient. I was worried

because serious complication like convulsions and eclampsia can

occur any time, and I was not equipped and prepared to face it.

I refer my medical books to ensure right treatment. I had strong

desire to consult some senior gynecologist to get his expert advice,

but there was no gynecologist in that small village. There were

number of senior doctors in Ahmedabad who can advise me for

right treatment in such case, but it was not possible for me to contactthem, as there was no telephone connection in that small village.

After two ours I again visited the patient. I examine her again. Her

general condition was same. There was hardly any perceptible

improvement.

10 pm at night the attending nurse informed me that within last two

hours the patient had two attacks of mild convulsions. I visited the

patient and given her second dose of sedative.

I was totally helpless. Whatever was possible with available

recourses was done. Now I realized that I have taken wrong decision.

As a doctor I should have known my limitations. And I should have

refused to admit such complicated case in my small health centre.

But then what could have happened? The husband of the pregnant

lady was unable to take her to big hospital. He would have taken her

to his small cottage, where she would not get any treatment, which

may lead to severe complication and death of that poor lady.

I could not sleep.

At 12 midnight there was knock on my door. I opened the door.

There was call from the attending nurse. I immediately went there.

Nurse informed me that the patient was complaining about pain in

abdomen. I examined the patient. There was pain in abdomen. The

area was tender. On further examination, I could feel mild

contractions of the uterus. There were mild labor pains. It means It

was beginning of the labor. [delivery] I instructed the nurse to shift

the patient in the labor room for natural delivery. The contractions of


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the uterus were very mild. So it was difficult for me to predict the

course of delivery.

Now there was small ray of hope of saving the patient, because in the

case of preeclampsia, the patient starts recovering from the disease if

she delivers the child.

I examined the patient in more detail. Her cervix was dilated a little.

[Size of two fingers] It means there was sure sign of starting of

natural labor. All the preparations for conducting delivery were

made. As the patient was very weak, she was unable to take strong

pains. In the absence of strong pains, normal delivery was not

possible.

It means she may require artificial interference for conducting labor.

In such case cesarean operation is performed for safe delivery. But

conducting any type of operation was not possible. We had no other

alternative except waiting for natural delivery. We all were anxiously

waiting. We all were worried. I preyed the God to help this poor

lady. The wall clock was showing 2 am of early morning. At 3 am,

her labor pain subsided. That was not good sign. It means process of

labor has stopped temporarily.

I again examined the patient. The cervix was fully dilated. There was

little descent of the child. I could feel the hair of the head of the

fetus. But there were no sign of strong labor pains.

At 4 am, the patient screamed due to strong pain. This time the pain

was severe and the contractions of the uterus were stronger. Nurse

was ready to conduct normal delivery.

Time was passing gradually. The progress of the labor was slow but

definite.

At 6 am she delivered the child. As expected the child was dead. It

was the case of still birth. Nature had helped that poor lady. We all

were very happy. Now there was no risk of any complications or

death of the patient. The nurse efficiently conducted the delivery.

There was mild hemorrhage. After ten minutes the placenta was out.

The nurse completed all the procedures of natural labor. She cleaned

patients organs, disinfected and covered the parts by pads. I

examined the patient. There was no sign of any complications. At the

end the patient was shifted to her room.


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It was great relief to me. I went home, had a cup of strong coffee,

and went to sleep.

Next morning at 9 am I went to hospital. I again examined the

patient. She was sleeping peacefully. Her heart rate and pulse rate

were normal. Her blood pressure has started coming down. When I

was taking her blood pressure, she slowly opened her eyes. She held

my hand for a moment. There was deep sense of gratitude in her

eyes. Small miserable girl was staring at me.

I told her, Laxmi, you are alright now. You will recover completely

within short time. The patients name was Laxmi.

She could not speak any word. Couple of tears filled her eyes. One

can not decide, whether those tears were of pain, or gratitude, or ofrelief. She again went to sleep.

I was pleased and relieved of my worries. I thank God, for helping

that poor child.

As such it was Mother-Nature who saved her life. It is the natural

rule, that the living body does not keep any dead matter in the body.

So when the fetus in the womb died, the nature took her natural

course of action, and removed the dead child from the uterus.

All the post partum precautions were taken. Treatment was given for

preventing hemorrhage and infection. She was given antibiotics to

prevent infections. Drugs were given to prevent post- partum

hemorrhage. As she was very anemic and weak, I gave her some

iron tonics and multivitamins from my stock of drug samples. She

was recovering fast. Her blood pressure had come down to normal

within 6-8 days. Her edema over the legs had disappeared. She was

also looking better and her general conditions were normal.

But then there was another problem. Her husband had left the centre,

next day morning after admitting her. There was nobody to look after

her. She had no other relatives or friends who can look after her. She

did not have clothes as her all the dirty clothes were destroyed by the

nurse. [Fearing infection]. There was nobody to give her food. In that

small health centre there was no provision for providing food to the

patients. Most of the patients, who were admitted, were managing

their daily food through their relatives. However, for Laxmi, it was

not possible as she was having no friends or relatives.


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She was very innocent and child like. When I asked her about her

husbands where about, she informed me that it was very difficult tofind him, because they had no permanent residence. Their profession

was begging. So he might have gone to beg some money from

somewhere.

Therefore, we had to manage for our patient. I purchased pair of

cheap clothes from the market and gave it to her. Her breakfast,

lunch tea and dinner were arranged by our hospital staff. Most of our

staff was staying in the same hospital compound, so they willingly

volunteered to provide meals for Laxmi from their home.

Being child like, she was not all the time staying in her room. Sometime she used to go to other patients ward and chitchat with them.

Some time she used to enter in my consulting room and start playing

with some costly equipment. One day she went out from the hospital

for nearly two hours without informing anybody. We all were

worried. She returned after two hours. When I asked her where she

had gone, she told me that she had gone to see market. I scolded her,

and asked our staff to keep watch on her.

One day staff nurse informed me that Laxmis hair were highlyinfested with lice. In addition, it was likely that it might infect other

indoor patients. I called for the barber, and asked the barber to shave

her head. Laxmi was not willing. She thought she would look awful

without hair. It was very hard task to convince her for total shaving

of her head. She started crying like small child. Then our staff nurse

told her that Laxmi, if you will not agree to shave your head, our

doctor sir will be very angry, and will not talk with you.

With that fear in mind, she agreed to get her head shaved by barber.

After her head was shaved, her look was completely changed. She

was looking like nun. The nurse brought her to my room, I saw her

without her long hair, I could not stop laughing, and she again

started crying. I had to give her some sweets to bring her in her

original happy mood.

She was with us for nearly ten days. We all had forgotten that she

was our patient, and she had passed through very serious condition.


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She had become one with all hospital staff. As such she was living-

toy for all the staff members.

Her husband had gone somewhere on the next day of her admission

in the centre. He returned to the centre on 11th

day. We all were

worried about her. I was very angry with that man. I scolded him and

told him that he was very irresponsible man and he did not care for

his wife. He was very sorry for the same. But he had his own valid

reasons for his absence. He had gone back to his small village to

arrange for money, which might be required for her treatment, as

well as nutritious food required after delivery. If I analyze the

situation with his perspective he was right.

We decided to discharge the patient on next day. It was hard for the

staff to say good bye to Laxmi. During that short stay she had won

everybodys affection. As such she had become one of the

members of our hospital family.

On the day of discharge, she took bath. Put on some new clothes.

She was looking quite healthy and beautiful in her new clothes. She

was given rich breakfast, prepared by one of the staff nurse.

After saying good bye to all, she came to my room. She bow downand touch my feet. There was complete silence for short time.

Then she raised her head and stared at me. Her eyes were full of

tears. She wanted to say some words. But she could not speak.

Perhaps she wanted to say sir, I am very grateful to you as you have

saved my life. Perhaps she wanted to say sir, you are like my

father, and I will never forget you. She was willing to show her

gratitude by number of words, but she could not speak a single word.

I told her look Laxmi, now you are alright. Take care of your health

and take all the medicines regularly. Come down to see us whenever

you feel like coming.

She left my room without speaking single word. She was crying.

She was unable to speak anything. At last our precious patient Laxmi

left our hospital premises. She had gone. We all were sad. It was

difficult for us to imagine hospital campus without Laxmi and her

mischievous behavior Such is the way of life. We doctors could not

afford to create intimate emotional attachment with the patient.


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Laxmi had gone. I was again busy with my routine work. Morning I

was attending O.P.D. In the evening I use to visit small villages, forthe work of mass vaccination, family planning and prevention of

malaria. After one month there was epidemic of gastro-enteritis, in

few villages. I had to rush there with the team of para-medicals for

the control of epidemic. In the month of august I was sent to Nagpur,

for short term training of leprosy control.

The image of Laxmi has gradually disappeared from my mental

screen.

In the month of October, there was Divali festival. Divali festival isvery important festival in that area. People used to prepare sweets

and distribute it to their friends and relatives during that festival. It is

just like Xmas in the western country. There are four days of Divali

festival. People usually go to temples, and their friends house to

meet them. Children put on new clothes. House wives decorate their

houses with different colored designs [ Rangoli]. There used to be

colored lightening in the city at some important places. Last day of

Divali festival is celebrated as New Year day in this part of India. On

that day people wish happy New Year to each other. They usually goto their friends and relatives home to wish them happy New Year.

[Sal Mubarak]

We had four days vacation in the health centre. I was also busy

enjoying and celebrating the festival with my friends. In the morning

of New Year day, we had small get together party at village town

hall. Most of the Government officials and some leading persons of

the village were present over there to greet good wishes to each

other. After attending that party, I went home. As prevailing

tradition, people used to go to each other places to wish them happy

New Year. It was customary to offer sweets to each visitor. Number

of friends and relatives had come to wish me happy New Year.

The visits of friends and relatives lasted until 12 noon.

I was relaxing in my room. The flow of visitors was over. I was also

planning to take my lunch. At that time there was nock on the door. I

thought of some new visitor. I opened the door. I saw one couple


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was waiting out side near the door. I could not recognize them. I

could not fix their identity in my mind.

Both of them were in very ordinary clothes. The lady was looking

young and beautiful. She had covered her head with peace of cloth.

Any how I welcome them. The lady bow down and touch my feet.

Minute passed. I could feel soft touch of two water drops on my feet.

The lady raised her head. Her eyes were wet with tears. My feet were

wet with her tears. Some thing stirred in depth of my heart.

Suddenly clear image of Laxmi appeared on my mental screen. I

could see same innocent face and same eyes filled with tears. Laxmi

had come again to wish me on New Year day. I was very glad to seemy dear patient again. I welcome them both in the house and offered

them sweets. Laxmi and her husband enjoyed the sweet. I also gave

them box of sweets as Divali gift.

Then Laxmi said sir, I have brought some gift for you. Now it was

my turn to be surprised. I could not imagine Divali gift from that

poor couple. She brought out small plant of pipal tree from her

cotton bag. She gave that to me as Divali gift. I was surprised to see

that pipal plant. I always like pipal tree. Nobody in the staff wasaware of my choice. Then how did that small lady know my choice?

She said sir, every day number of patients visit this centre for

treatment. Most of them have to wait outside in the compound. There

is no shelter for them. There is no place for them to rest and relax. So

I thought to plant pipal tree in the compound, so that sick people and

their relative can rest under the shadow of that tree.

I was pleased and moved inside by the idea of Laxmi.

I took Laxmi and her husband to the health centre campus. I asked

her husband to plant that tree near the gate. They both dig small hole

in the ground, and planted that small plant. I watered that plant.

Laxmi was very much pleased. Now she was ready to part. She again

bowed down and touch my feet, and moment later she raised her

head. This time she was not crying. Her eyes were clear, full of joy,

Joy of giving present to her doctor sir.


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They left, leaving behind sweet memory of my precious patient.

I know they were staying far away from my centre. And they could

not afford any transportation. Therefore, they might have walked thedistance of 10-12 km to wish me happy New Year and to present me

New Year gift.

Again I was busy with my routine health work. After three months, I

left that centre. I was selected by the authority for further study in

the field of public health. I did my post- graduation. I was promoted

to the higher post. I was posted as chief health officer of some

region. Years have passed. Life was flowing smoothly. After five

years I had chance to visit my old area. I decided to visit my old

health centre. After some three hours of drive I reached to that smallvillage. The village was same. There was hardly any change in that

village. My car reached to the gate of that old health centre. As usual

the compound was full of patients and their relatives.

And I saw big pipal tree near the main gate of that centre. Number of

patients and small children were resting under the shade of that big

tree. The pipal plant planted by Laxmi, had grown to big tree.

Again Image of Laxmi surfaced from my memory. I remember her

words.Sir, this pipal tree will give shelter to many sick and weak patients.

I was affectionately looking at pipal tree, a prized gift from my

precious patient.

Writer :

Dr. Sanat Trivedi

Ahmedabad

India

Prized Gift from precious Patient

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