A hospital just out of Colombo. The paediatric ward. A ward round one Saturday morning. Students trailing their teacher. A couple of house officers and nurses. A mother with her baby. Looking nervous and tired. Listening.
The consultant ended her lengthy advice. The mother looked relieved. Her baby was about to be discharged after two long weeks. The paediatrician looked relieved too but there was a hint of concern in her face. She said after a pause "do you have any questions before you go?"
At this moment the teary mother stepped forward and said in her almost breaking voice "I don't have any questions but I just want to thank you for saving my baby" and she prostrated and touched the feet of the consultant who blurted out "no, no I was just doing my job..." and stepped aside.
It was true. She was just doing her job. Some days ago she was doing her ward round and this baby was being blasted with blue light for his jaundice when upon examination the consultant was shocked to realise that the baby needed resuscitation. The mother had earlier said he was crying all night but the doctors didn't believe it. (a crying baby inside the hospital is a good sign). The baby was immediately taken, oxygen was given to it and some fluids and some medicine. It took almost 30 mins for the baby to start crying again and open his eyes. The infection has spread badly to his blood even with the antibiotics and his blood pressure had dropped badly. His breathing was rapid and pulse weak. He was then transferred to the Paediatric HDU to be consistently monitored for some days.
I shivered to think about what would have happened if the consultant had been satisfied with the baby when initially he was presented to the clinic with pustular rash. She hadn't been satisfied at all and ordered him to be admitted to the ward for further management and care. Crucial decision.
Now the mother was tearing up in gratitude. In my mind I was thanking God, medical science and the free universal healthcare we have here which works indeed. Her baby was saved without she having needed to spend a single cent for his healthcare. The doctors were just doing their jobs according to what they've been taught. No super power or luck involved. They needn't be thanked. For now there were other patients in the ward that needed saving. We had to move on.
We were discussing the case at class that morning. The madam (aka the consultant paediatrician) was re-emphasizing the fact that all she expects from us for this first paediatric appointment is to master history taking, clinical examinations and the elicitment of physical signs. The theory could wait. Good clinical judgement could save a lot of lives is what she said. When the clock struck twelve and the class was done she mentioned there being a good patient that was just admitted for a UTI (by "good" what she meant was good for learning) and she pointed at a friend and asked him to do the history taking and examination properly and to present it on Monday.
It was Saturday so we had no further lectures or classes so we all decided to stay back and observe the ward. I accompanied my friend to go see this new patient and take their history. He was a 3 year old small boy, slightly obesed, fair-skinned, good looking. He was lying on the bed staring and his mother was seated next to him reading something. My friend greeted her and asked if he could speak to her. I satisfied myself with growing through his bed head ticket and other clinical notes/books. What I found was disturbing me to the core though. I understood why the boy was staring blankedly. Why he wasn't responding to any of my talking.
He was born with a congenital heart condition called tetralogy of Fallot. His father and sister too had been born with heart defects. This condition is surgically correctable. Until he was two he had lived an almost normal life. His growth and development was normal. He loved playing with his friends and only occasionally suffered from episodes of cyanosis associated with his condition.
Then when he was two they had decided to do the corrective surgery at the Lady Ridgeway Hospital. The defects were corrected and his heart was repaired. The miracle of medical science again? This time things had gone horribly wrong. So horribly wrong that he was permanently disabled for life and would live the rest of his life in a persistent vegetative state.
What had gone wrong? His problem list now was depressing. He was quadriplegic - paralysed in all four limbs as a result of cerebral palsy. His bladder was out of voluntary control and now he suffers from a recurrent UTI. He also suffers from recurrent RTIs because his cough reflex and ciliary action doesn't work properly. He suffers from chronic constipation too because his bowel movements doesn't occur properly. He also has an uncontrolled seizure disorder and is on multiple medications for that. In addition to all of this he needs continuous physiotherapy, eye therapy and constant care and attention.
What had gone wrong? What had caused his cerebral palsy with global developmental delay affecting his speech, sight and hearing too? It was definitely a complication of the open heart surgery but what exactly had happened? Did he suffer from a severe arrhythmia that had led to a cardiac arrest causing hypoxia and ischaemia to his brain? Did he suffer from a septic shock after surgery leading to severe global cerebral hypoxia and atrophy? I don't know but his cerebral hemispheres were basically busted.
My friend took a long time to take the history. Then we examined his systems one by one. I understood why he seems to be a good patient to practice our examinations on. He had a slight ejection click/murmur. Crepitations were heard at his basal lungs. His limbs showed all the classic signs of an upper motor lesion. Hypertonic, spastic paralysis, hypereflexic and a positive babinski reflex.
When we were done we decided to observe how the mother would feed her boy. She took him to her laps and fed him spoon by spoon of some semi-solid mixture. She had earlier said he did respond to taste. Tastier food were swallowed faster than bland stuff. In between the spoonfuls, she kissed him on his forehead.
I realised how medical science was not one constant miracle in the life of us humans. It could fall epically and ruin the lives of children even. We debated the reasons as to why children have to suffer such horrible fates. My friend was talking about karma and sins of a past life - which frankly disgusted me. I was saying how life was a test in all aspects and that the mother is being tested through her child. That the child would not be tested and that she would be rewarded for all the care and attention she gives her child.
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