A Snake Bite to remember
I met Mr P at a function organized by a society of my community, to honor me in my home district. They claimed, I was one of the few from my community, who returned to work in India after working in Melbourne. Also my uncle was standing for elections in the society that year, so he actively went about organizing the function to subtly convey to the voting members, that he supports young achievers in the community.
A certain Mr P was invited to be the MC (master of ceremony) in that function. He later told me he was felicitated by the same group earlier. Mr P has great command over English and his mastery has to be heard to be believed. He is an expert in languages. His PhD thesis was about a dialect in Naga language. Government of India approaches him for work related to North eastern languages. To top it all, he was a student of Prof U R Ananthamoorthy. Yes, the same alleged rationalist who had claimed that he urinated on (his) village deity at night when no one was looking. I was in my early thirties at that time and he was in late forties. When we spoke to each other we came to know that we stay in the same neighbourhood in the city. So we decided to keep in touch.
Our meetings were feared by Mrs P, let me call her Babhi. We used to be loud and argumentative. I never believed a word he said and used to make fun of Nehru, Gandhi and Socialism. He being a true follower of Ananthamoorthy used to give me back in kind. We still fondly remember the day Babhi came with a chapatti roller in hand and threatened us to stop arguing loudly. She said that she was scared that the kids will think we were actually fighting (although I believe she was scared herself). We turned out to be great friends and still are. To my satisfaction, Mr P today has turned capitalist and agrees that “woke” phase of life should not last beyond adolescence.
This weekend article is about his younger daughter S and her husband. S was a 16 yr old when I first met her. She was a bright student and went on to become an engineer in computer science. Like all CS engineers of early 2000, she moved to Amrika and started working in the Silicon Valley. It was here she met her John Doe. Mr P, the liberal that he was, did not oppose to their marriage. I used to occasionally rake up about S to tease him; by repeating his old dialogues about communism being a product of capitalist oppression blah blah…
Newly-wed S and her husband Mr John Doe visited India and stayed in Mr P’s home. Me and my wife invited them home, had lunch together, discussed about life in US and harped about non availability of domestic help in the US that is taken for granted here. Mr P and a friend of his had arranged for a tour of Madikeri and surrounding areas for the newly-weds. So, they were off to Madikeri next day.
By 3 PM next day, my wife called me (I pick only her calls on my cell inside hospital) and told me to talk to Mr P. Mr. P was calling me continuously and I had not replied his calls. I knew something was wrong, so I called Mr P immediately. He was almost crying and it took me awhile to understand that John had been bit by a snake and was not responding after first aid in Madikeri Govt Hospital. I knew Dr Ravi, an old student and now a colleague who was working in Madikeri Govt hospital and called him immediately. He apprised me of the situation and told me the snakebite was on right elbow and John was responding to painful stimulus. Dr Ravi had done all the necessary first aid. I requested Dr Ravi to accompany John and S to the hospital where I was working at that time.
It was 11 PM when they reached our casualty. I was waiting there after hand-holding Dr Ravi in managing the patient through the transit. John was awake but intubated and Dr Ravi was giving him artificial breaths using an ambu bag. He was able to manage a weak thumbs up sign when he saw me otherwise his muscle power was very poor. He was shifted immediately to the ICU. Snakebite protocol started and he was put on ventilator for artificial respiration. He appeared to have stabilised for the night. I explained to Mr P & S that their presence will not help John and made them leave to their home.
Next day, it appeared as if John had gone into a coma. His heart rate seemed to be fixed in a window of 50 to 60. He was not responding. His GCS was 3/15 with absolutely no response for even deep painful stimuli. His pupils were not reacting to light and not a muscle moved in his body. I was deeply worried, had no idea how to face S or Mr P but I had to do it. When I met them in the counselling room; S was crying hard and Mr P had tears in his eyes. I explained them everything dispassionately (years of ICU practice has converted my heart into stone: says my wife) and gave them no guarantee about John’s recovery. Hope and prayer was the last resort, so I told them to pray.
John’s condition did not improve the next day too; my staff and junior doctors had already started susurrating behind me. I could perceive them make eye signs to each other. “Sir, patient’s pupils are not reacting to light”; they informed me three times in the day as if I had not heard it the first time. I had my doubts too; I rummaged through all available data on snakebites and found one similar report by a doctor called Rallis. I emailed him and asked for his phone number. Dr Rallis being a nice man called me back. I explained John’s condition to him. He asked me to stay put and continue the supports as long as John’s heart holds and, if necessary, support aggressively and last but not least: don’t worry about non reacting pupils.
After 3 agonizing days I got a call from ICU at around 2 AM. I thought John may have kicked the bucket; but to my merry, I was informed that John’s pupils had started reacting to light. I got ready and drove to hospital to check and was wonder-struck to see him, showing signs of life. It was pure ecstasy nay jouissance. Very few understand how a doctor feels when his almost dead patient comes back to life.
Next day I allowed my next in-charge to explain the good news to S and Mr P while I observed his performance carefully. It had become my habit by then, to allow juniors give the good news while I personally discuss bad news with the patient relatives.
In the next 2 days John improved very fast and was off artificial respiration. S and John send me a card now every year for my birthday.
Doctors like myself carry the burden of a graveyard in our minds of all the patients we lost. Amidst the graveyard, we do remember these beautiful memories like a lost person in desert who comes across an oasis.
Dr Jagadish J Hiremut is a superspecialist medical doctor based out of Bangalore, a medical author, blogger, medical technology expert and is a proponent of Value Based Ethical Medical practice. He is Director for clinical services and Advanced Medical Technology in the home grown multinational medical equipment company Skanray Technologies Pvt Ltd. He is also CEO of ACE Embedded Intensive Care Units Pvt Ltd a company which runs outsourced Intensive Care Units for hospitals. You can follow him on twitter @Kaalateetham or mail to firstname.lastname@example.org