PERSEVERENCE

                                    PERSEVERENCE

It was two months since I had joined Asha Kiran hospital- a small resort like place in picturesque Orissa.  After intense training, my seniors left me in the ward to take first calls. 50 year old Sukhdev had come with acute renal failure, shopping in various hospitals on the way without any respite. I had seen his serum creatinine report which was 22 mg/dl which meant that his kidneys were long lost in dysfunctional slumber. The very look at the report triggered a sense of hopelessness and the first thing that came into my mind was referral. The skinny man who was disoriented on presentation had a wife and two sons who were visibly exhausted in their shuttle to find a panacea. The elder son replied that they had gone to enough places already and they could not go anywhere else. I gave a fluid challenge, wishing that the sleeping kidneys would limp back to life encountering a fresh bolus of saline, without any success. Giving more fluid to a patient with non-functional kidneys is like pumping in more water into a pressurised tank without an outlet. Conceding my limited experience in these matters, I had to call my medical superintendent who was a physician.

Dr. Vinod is a thin, humble man with an aura of nonchalance about himself. Tackling the hospital with various constrains and patients who are too ignorant to understand his benevolence did not deter him from doing what he was called to do. This day was no different. In plain formals and leather chappals, that reflected both his sobriety and simplicity, he arrived in the scene and described the best possible option for the disease- haemodialysis. The relatives did not deter from their stand of staying on come what may. Then he offered them the next therapeutic discourse- peritoneal dialysis where the body fluids are filtered by the layer of abdomen called the peritoneum. Three plastic tubes are pierced through the abdominal skin to infuse a fluid into the abdominal cavity and simultaneously collected out through an efferent tube bringing along all the wastes of body’s metabolism.

The process had started at 8: 30 pm which is midnight to the early sleeping community of Lamtaput. After the repeat assessment of creatinine- an ideal parameter for assessment of kidney function, Dr. Vinod called up the pharmacy to fetch a dozen pints of PD fluid that were lying useless for long in the dusty corner of the store room. The patient was shifted to the ICU, a 2 bedded room with cardiac monitors and oxygenators- the only semblance of any intensive care equipment. The power was gone and the invertor illuminated the small incandescent bulb lighting up the dark environment. I had sat beside him as he opened the book on dialysis and went through it briskly. In ten minutes he looked at me and said, “Let’s begin”. He had successfully put in the catheters with absolute sterility during the procedure to preclude any infection.

 Now the most difficult part of the procedure was to pump in fluid and ensure the infused fluid comes out. He had given one litre of PD fluid and had seen for any response from the outlet. There was none. He had tried it the second time and a meagre 20 ml had come out. I was convinced that the procedure was a failure and abandoning was inevitable. Dr. Vinod visibly exhausted looked at me and said “let’s try again”. I was wondering why he should bother about a 50 year old man who any way will die soon that too with a procedure that did not have such a good success rate. He had tried it 7 times in the next 4 hours before the procedure was actually showing effect. It was 12:30 am when he had said it is finished. The process continued for the next three days and the repeat serum tests showed that the kidneys were picking up. Sukhdev’s urine output had increased and his orientation was good. Dr. Vinod had to go on leave before which the patient’s vitals and renal function were back to normal.

Death is cruel, not just because it takes away life but also because it comes at the most unexpected times. After fifteen days of nonstop struggle and hard work Sukhdev, for the first times had eaten rice- the staple diet of this part of the world. Everyone was packing their bags to be discharged. That calamitous day I was on call. I had just visited him in the evening rounds. He said he was not feeling well. But he did not know what was happening to him, nor did the vitals chart showed any abnormality. I assured him that his body is doing much better than before and he could soon go home. I moved to the next patient when the wife of the patient came running to me seeking help. The scene that followed will always remain in my memory till the end of my life. He was vomiting blood. Copious in amount- he vomited 2 litres of blood and had immediately succumbed. It all happened in seconds. My last visit to him was only 10 minutes ago when I had dispelled all his fears. I was shocked and troubled- at my inefficiency, the ephemerality of life, the trauma to the family. I declared Sukhdev dead, the most probable cause being-“ bleeding from the gastro duodenal artery due to ulcers in the stomach secondary to acute renal failure.” I handed the body to the relatives and walked back to the room.

Few days later Dr. Vinod returned to the hospital and looked at the empty bed where Sukhdev stayed. I had to break the bad news that he was no more. He took some seconds to gain composure and enquired about the whole ordeal. A torrent of questions raced through my mind. Why does God give hope and then take it away? Why should Sukhdev have to improve before breathing last? Why should the wife and children be assured that the worst has passed? Why should we work so hard for a patient who would succumb to death anyway? Why should we admit people whose problems are beyond our infrastructural capacity? Dr. Vinod replied-“each patient teaches us something. And we teach every patient something. It is not that only when we medically succeed that the family will appreciate our efforts. Sometimes death, more than anything else, will teach faith to the family, perseverance to the staff, endurance to our minds and above all relationship and bonding between the staff and community around. Each man is made in the image of God. And there is an intrinsic worth of being a human being. It is that life we are striving to protect and uphold. Death is not an indicator of defeat. It is the symbol of tenacity and perseverance.

One year down the line, there were many, who came with fatal diseases. Some survived, while some are no more. Even now, a 16 year old girl is in the ICU just having been operated for the second time.  She has tubes in the stomach, lungs, liver, urinary bladder, veins and nose. She was operated for removing the stones in the gall bladder and now a tube directly into the trachea for better air entry. She is paralysed by anaesthetic drugs and artificial respiration is being given. Staffs are working extra hours, non-stop bagging to give oxygen has been happening for the past three days. To top it up, the relatives do not trust us, and think all this is being bought by money which they are reluctant to pay. Whether she will survive this massive medical emergency can be anybody’s guess. But we have learnt the same lesson which the Late Sukhdev taught us- perseverance.