Jaundiced stories!

This is a photo of the campus of Kasturba hospital...in the centre of Mumbai city besides Arthur road jail....It is a hospital for infectious diseases ...all kinds...from H1N1 to hepatitis and chickenpox....The buldings are very old with sloping roofs and british style architecture with lot of greenery in the campus which takes you back in time....I had quite a nice learning experience while working here.

                      Coming back from the 2nd Nirman camp (refer to the blog "Who is John Galt?")I was full of energy ,ready for all kinds of problems in the big bad world and to follow my dreams.So with such vigour ,alighting from the train from Nagpur at CST station I directly went to report for duty.I was posted in the hepatitis ward of Kasturba hospital.My senior had briefed me about my duties in the ward and what was expected from me.I had no idea about management of hepatitis patients.But I was ready to learn-करके देखो !! was the motto in my head!So I signed in the muster and entered my ward where I was supposed to work for the next 35 days without any holidays.Damn excited I was....I was getting the M.D Medicine feel.

                     The campus is a very pleasant place...complete contrast to the outside Mumbai city.Everyday felt like a vacation for me ...so no scope for Monday blues.I entered my designated ward quite content and happy where I got a warm welcome from the sisters.But then immediately the continuation sheets and requisition letters were thrust in my hand and I was asked to take my rounds.So I made up my mind that this is how it is going to be.

                     As it was my first day I was taking my rounds slowing trying to learn about the treatment.Everything was new to me..I observed itching was quite a common symptom in hepatitis because of raised bilirubin levels.The recovery period of hepatitis is very long ....can take upto 2 months.As my senior Dr Komal had told me I had to check their bilirubin levels every 7th day.The drop in bilirubin was different for each patient and for different types of hepatitis.

                   There are 5 types of hepatitis - A,B,C,D,E.Hepatitis A and E are quite common and are transmitted by faeco-oral route ...i.e by contaminated food items.Maximum patients in the ward had hepatitis A and E.Hepatitis B and C are transmitted by blood and could be sexually transmitted ....We had 4 patients of Hepatitis B while I was there in the ward.Hepatitis D is a very rare form and it requires the virus B for its survival.

                  It was quite interesting to listen to the conversations of these patients.They used to discuss their bilirubin levels since they knew that when bilirubin levels fall they can get discharge from the hospital.'अरे मेरा bilirubin आज कम आया " "तेरा कितना आया "

                  Some patients were there in the hospital only because of their high bilirubin levels but they did not have any symptoms ...one such patient was Sagar...But he was so patient....During rounds he was the one who used to ask me how I was instead of me asking him...He also used to remind me when I should send his blood to check for bilirubin.Another patient was there who was so bored of the hospital but I couldn't discharge him so he went DAMA (discharge against medical advice )

                 In hepatitis ward there were no emergencies but I got 2-3 patients who were quite serious.1 patient Akash who was severely jaundiced (bilirubin level 30) and had high liver enzymes.When we checked his viral markers all were negative and so following protocol I asked him to get his sonography done.He got his appointment 2 days later.Till then he was continuously having high grade fever and he had severe pain in the right upper quadrant of his abdomen where the liver is present.I gave symptomatic treatment and waited for the sonography report.Finally we got the report which said that there was a huge 10*11 cm abscess in his liver.I immediately informed m senior who asked me start him on antibiotics and transfer him to Nair hospital which I did.But the patient wasn't ready for the treatment. I begged him to stay and complete the treatment but he was quite adamant.So we had to give him DAMA.God only knows what happened to him later.In such cases now whose fault it will be that the patient did not get proper treatment?

                    Another toxic patient was there whose bilirubin level was 55....He had leptospirosis.My first leptospirosis patient.I not only learnt the medical treatment of various diseases but I also learnt how to deal with different kind of people.You cannot give the same treatment to everyone.

                  During rounds I used get a lot of questions from patients but I had to finish my rounds in time.So I decided to give a common health talk to all the patients in ward.I gathered them in the centre of the ward and had a nice conversation with them.I told them about different types of hepatitis and how they are transmitted.Some were alcoholic so I told them about the hazards of alcohol intake.Then I told them about their diet low protein and high carbohydrate diet they needed.

                  I still miss Kasturba...the campus ,the friendly sisters and their snacks,the gratefulness of the patients,learning to handle  serious patients from seniors.....How I worked on the day of floods and stayed overnight in the hospital itself!!I even remember a patient touching my feet when I gave him discharge which only told me how little I had done for that patient!

               I am glad this was a part of being a community health doctor.I don't know how much difference I made but it made a lot of difference in me.This Kasturba hospital experience will stay in my heart forever!!