A month later:
The head of unit made a quiet exit as soon as the out-patients queue receded. The residents were entertaining some medical representatives from the pharmaceutical industry, a task that they had to endure, no matter how much they disliked it.
Patients and their relatives were being herded out of the out-patient department like cattle in a farm. Thats how patients were treated in government hospitals, unfortunately. They were literally the ‘cattle class’, a term colloquially used for travelers in the economy class of airlines. Whereas the airline travelers had the means to pay for an airline ticket, the class of people in the government hospitals were truly penurious.
Whilst the commotion occurred outside, we sat within our chambers, entertaining information about drugs from these representatives. In the midst of it entered a frail girl, looking middle aged, with a hunched back and a solemn look. She walked in alone with a hand over her belly and a natural fish-face, owing to the loss of her buccal fat (fat over the cheeks). Her hair was shaggy and her eyes sunken in. She took a seat in the chamber and waited. Puzzled, Dr. P and I immediately left our seats to tend to her.
Just a few minutes later, her mother and brother entered our chamber. It was Jeenal. A month had passed by, and Jeenal hadn’t followed up. We presumed she was feeding well and wouldn’t need the follow ups. However, that was clearly not the case.
Unrecognizable from her past form, Jeenal had stopped feeding from the jejunostomy tube. On prodding her, we realized that the tube had been blocked since a week and she hadn’t bothered to come in. Jeenal had been starving for an entire week and ignored it.
Without giving it a second thought, we immediately admitted her to the ward. Unblocking the tube was an easy task, but making up for the malnourishment due stoppage of feeds was the biggest challenge. Overload her with nutrients and she wouldn’t tolerate it, underload her, and we risked causing further malnutrition.
To control her nutrient intake, we started Jeenal on parenteral nutritional supplementation (injection of nutrients through the veins, directly into the vascular system). The feeds through the jejunostomy tube were started simultaneously.
Our worry lines increased, and all of us in the unit put in extra hours to ensure Jeenal’s nutritional status would improve.
Two weeks later, Jeenal had gained sufficient weight to allay all our fears. Her jejunostomy tube was functioning well and the parenteral nutrition had ceased. It was time to discharge Jeenal again. However, this discharge came with a promise to follow up weekly.
Jeenal followed up diligently over the course of the next four months. A month before Jeenal was to undergo a definitive procedure, I moved to another unit in the same ward.
I saw Jeenal in the ward, on the day before she was to undergo a definitive surgery. Her esophageal (food pipe) scars had healed, leaving behind a scarring of the outlet pathway of the stomach. She would be subjected to a commonly performed procedure, gastro-jejunostomy, wherein a part of her small intestine would be connected to her stomach, to bypass the narrowing at the outlet of the stomach due to scar formation.
Jeenal seemed happy and calm. There was a palpable excitement in her voice, when I mentioned that she would finally be able to eat through her mouth.
Jeenal’s mother had gone to the Gurudwara (temple) to pray for her well being. Her brother was alongside her, holding a polythene bag housing all the surgical materials (that wasn’t available at the hospital), required for the forthcoming procedure. Dr. P, who by now had been relieved of all his duties, to prepare for the forthcoming exams, strolled in at the same time.
“Jeenal!” he exclaimed. “Everything’s going to be alright. Boss is an excellent surgeon and he’s planned everything in detail.”
Jeenal smiled. Her brother clutched her hand, whilst holding on to the same polythene bag.
Dr. P politely enquired about the contents of the polythene bag, glanced at the prescription for the surgery and winced.
“How could anyone prescribe all this material worth thousands of rupees to this family? Haven’t they spent enough on her treatment already,” Dr. P mumbled to me in an tone that was inaudible to Jeenal and her brother.
Dr. P promptly called the chief resident to make arrangements for the surgical material. Jeenals brother was instructed to return all the material and retrieve the money that had been spent.
Jeenal was moved to tears. She’d repeatedly mentioned to us of the financial burden facing her family, due to her illness. Dr. P had the maturity to understand the sacrifice of her family and waive off the charge of surgical materials.
“I hope the both of you will be in the operating room while I’m being operated upon. I trust you two the most!” Jeenal pleaded.
Unfortunately, neither of us could be in the operating room while she was being operated. However, we did step into the ward to wish her luck, just prior to her being taken into the OT for surgery.
Jeenal had become a part of Dr. P’s and my residency. The three of them were our family in that hospital, a place where every doctor is treated in a ruthless and relentless manner. Jeenal and her family understood our travails and helped us out at every step along the way, while she was in the hospital. Be it carrying our instruments around while we rounded patients, or packing some food for us, when we were on emergency duty, with a seemingly never ending ingress of patients.
Jeenal was operated upon, laparoscopically (minimally invasive), as she was concerned about the scars that it would leave behind on her abdomen.
A fugacious stay in the Surgical Intensive Care Unit (SICU), was followed by a transfer to the general ward.
The clishmaclaver of the ward patients, a point of annoyance in the past, suddenly felt like music to her ears.
Two days after surgery, all the invasive tubes had been removed and Jeenal was walking around the ward and even sipped on water. The eudemonic pleasure of taking something (read:anything) orally was unparalleled.
Jeenal insisted on a discharge before her birthday, which happened to fall on the sixth post-operative day. However, on the fifth day post-surgery, Jeenal developed a fever, albeit a mild one. One that disappeared after its first appearance, flattering to deceive.
Inspite of the fever she had developed, Jeenal insisted on going home the next day, to celebrate her birthday. The crest of her tantrums forced everyone in the unit to bow down to her demands, and Jeenal was discharged on the sixth day post-surgery, without a hint of fever, albeit reluctantly. She was strictly instructed to follow up 2 days after discharge, in the ward, with the unit head.
The morning of her discharge, Jeenal had dressed up and ordered cake. She cut the cake in the presence of the nurses, her mother, Dr. P and myself. Her brother had planned an elaborate birthday party for her at home.
Jeenal’s gambol knew no bounds. This was her happiest moment since that fatal day seven months ago, when she’d ingested the corrosive poison.
She waved at us as she left the ward. But, something told me that this wasn’t the last time we’d see her as a patient!
(to be continued…)