Experience

This has happened in early eighties.  There is a village, 15KM from a second grade Indian town.  The town bus makes two trips, one in the morning and other in the evening.  The village did not have a qualified medical practitioner until Dr. Sujay had started his clinic.  Coming from a poor family, pressurized to earn Sujay opted to practice in the village so that he can serve and settle down in practice early.  He was welcomed by villagers who were until then were treated by RMP (quack). 

Sujay had to start his clinic in single room.  This is ‘L’ shaped room.  Those days disposable syringes were not known.  Glassvan (glass) syringes were used.  These syringes after use are washed and reused after sterilization by autoclaving (big hospitals) or simply boiling (clinics).  Dr. Sujay had kerosene stove on which he would boil the syringes and wash them with boiling water and reuse after boiling. The doctor has arranged his table and chair in front of entrance.  This would give him a chance of having view of the street and people walking could also see the doctor and inform villagers about his presence.  The doctor stayed for five hours – 9AM to 2PM.  This was extended when patients continued to come.  After 2PM, after the last patient, he simply put down the stove, takes his bag and buzz out to home in the town.

In the clinic there are two benches for patients to sit, if somebody is too weak, they can as well lie down and others would adjust on a single bench or sit down on the floor.  Sujay started his clinic immediately after internship.  He was young, friendly and considerate.  This had made him dear to the villagers.  Many would come tell their complaints and take tablets for relief.  For this they never paid.  In the village practice, doctor is paid only if an injection is given.  Examining the patient and writing down prescription means nothing.  It does not deserve any payment.  Even now this practice continues in villages.

On that eventful day, as usual, Sujay had come to his clinic, all the way greeting villagers, young and old.  People who are waiting told him “doctor I will come after half an hour or I will bring my ---- you will be there no”, and moved along.  By the time he reached his clinic the owner of the room cleaned it and made the patients sit.  She often sits there and watches doctor do his work, chit chats with patients and comforts them with soothing words. She is a widow, aged about 50 years and lives separately from her only son living in the immediate neighborhood. 

As the doctor came in, people started talking.

“What doctor, today you are late”

“I am waiting here for past one hour.  I am the first to come.  So see me first”

“My son has high fever; he did not go to school, please see him soon and send”

Hearing all this Sujay had lighted the stove.  Put the vessel with water on it.  Put few syringes in it to boil.  He adjusted things and medicines in various boxes on his table, took out his stethoscope and BP apparatus, hung the stethoscope around his neck.  As he was doing all this he was responding to patients talk.

“Now, now don’t worry, just two minutes.  I will see you all fast, write good medicines.  Let the water boil.  I can give injections.  Raju missed his school, I will give him injection he will attend school.  Now it’s over.  You said you have come first.  Come on sit here on this stool”.  The stool is just beside his chair.  Behind him is table with stove and syringes boiling.

He examined him gave him some tablets and told how to use.  He asked him to swallow one of the tablets (to observe any allergic reaction) and sit until syringes are boiled.  Then one after other he was examining patients, giving injection and some tablets; sometimes giving tablets to the accompanying person also who complained of symptoms and asked for tablets, refusing any examination to avoid fee, and take tablets one or two freely.

“Saar, I have body aches, give yellow injection.   It works well for me”, Rajaiah a labourer and alcoholic who frequently visits doctor came and dictated his treatment. 

“O Rajaiah, why don’t you stop drinking that arrack?  You need not come to me for these injections.  Instead you can eat eggs or mutton.”  Sujay said as he was examining another patient.

“Saar, I work whole day.  Without arrack I can’t sleep.  Give some tablets for numbness in my limbs”.

 “OK, sit.  Let me see these patients who have come already”.

“Arey Sheenu, what happened to you”, Rajaiah asked a youngster who was already sitting there.  He also sat on the other side of a bench where there was some place to sit.

“I am having fever for the past two days uncle.  RMP Chandranna gave two injections yesterday and day before.  No effect.  So I came to Sujay doctor”.

“Arey what Chandranna knows is nothing.  This Saar is really good.  He has healing touch.  You take one injection.  Next day you will run.”

Sheenu or Srinivas is young man who has studied till 5^th class and took up agriculture.  He generally visits village quack who is his friend.  When that treatment doesn’t work he will visit other doctors.  Now he was suffering from cough and fever. When it was his turn he went and sat on the stool by the side of the doctor.

“So your name is Sheenu, I think it is Srinivas, what is your age”

“22years sir.  I am having fever sir.  Cough is really troubling me.  Give me something that works fast.”

 The patient was coughing without covering his mouth, droplets polluting entire room.  Sujay turned the patients head to a side and auscultated his chest.  He could understand the severity of infection.  He decided to give antibiotic injection.

In those days penicillin was regarded as panacea for all infections.  It was really a wonder drug.  The main draw back is the serious allergic reactions, sometimes killing the patient instantly.  Whenever penicillin is given, history is taken, whether patient had taken penicillin injection previously.  If they had taken it was given, otherwise when it was essential to give penicillin injection, a test dose is given to know allergy.  If the patient tolerated, it was given.  Sujay asked, “Sheenu did you take penicillin injection previously?”

“Yes sir.  I took it”.

“OK.  Then I will give you that”.

Sujay loaded penicillin in a syringe and gave it into arm. He withdrew the needle and was about to wash the syringe with boiling water.  Just then the boy slumped. 

Sujay left the syringe on the table and bent down to lift the boy. 

“Hey, what happened?  Please you all get up from this bench.  Help me let the boy lay on the table.  Allow some fresh air.  Just move away”.

Sujay understood that it was allergic reaction to penicillin.  He was thinking, talking and doing everything he can and should do.  Patients pulse was feeble and patient was unconscious. Sujay’s pulse was bounding, he could hear his heart beat, instead of lub dub it was just dub dub thumping.  He put a book under the legs of the patient.  With shaking hands he gave corticosteroid injection intravenously as another patient Rajaiah helped him.  He asked another accompanying person to open the IVset from its cover as he took out the saline bottle and fixed the set and connected to the needle already in the vein by giving injection.  He hung the bottle to a nail on the wall.  He watched the pulse again.  It was still feeble and patient appeared unconscious breathing laboriously.  He took the adrenaline vial took 1/2cc of it and diluted with distilled water and gave 1/2cc  subcutaneously.  Watched pulse again.  Patient’s breathing was slowly getting normalised.  He checked the BP.  It was very low.   He again repeated another dose of adrenaline.  Increasing the flow of saline flowing, Sujay wet with sweating once again looked for pulse, though it was fast it was feeling better, BP near recording normal, and Sheenu breathing normally. 

People on the road also came in and started talking,

“What happened?  Injection reaction?”

“Patient will live or die?  Don’t leave the doctor.”

“Doctors are commercial, they just want to give injection and take money, don’t have any service motto.”

“This doctor is good.  He gives injection only when required.  He treated so many serious conditions.”

People talked as they liked.  Rajaiah was trying to help the doctor as asked.  He was doing his best in helping the doctor. 

“Saar asked him whether he had taken injection and then only gave it.  It is not his fault.”

As all this was going Sheenu gained consciousness. 

“Eyy, Sheenu how are you feeling?”  Sujay asked on seeing Sheenu opening his eyes.  He once again checked the condition of patient and knew that the crisis was over.  He gained some confidence, and asked people surrounding to move away and allow fresh air.  He said the boy is fine to all and asked them to move out.  In another 15-20 minutes everything had become normal.  IV fluid was almost over.  Sheenu looked around. 

“Sheenu, you said you have taken penicillin previously.  You had such severe reaction!”

“Previously also I had the same problem after taking the injection sir”, Sheenu answered coolly.

“WHAAAT?  Why did you not tell me?  My god!  It was such a serious reaction.  You are saved.  Never ever take penicillin or any related medicine in future.” Sujay said in a raised voice.

 When Sheenu was about to get up and sit, Sujay asked him to lie down for some more time. Keeping an eye on him Sujay disposed other patients.  Rajaiah was given his yellow injection (B-Complex).  Some pain killers were also given.  He paid the doctor.

“Arey Sheenu, Go home carefully.  If I see your father I will send him.” Rajaiah said as he left the clinic.

After an hour of observation and after checking the general condition, Sheenu was asked to go home. He was given some tablets for fever and cough syrup. By then his father had come.  He was told that Sheenu had serious reaction to penicillin injection and he should never ever take it again in life.

Though Sujay sent the patient home and he returned to his home, he was worried about the patient as he was having abnormally increased pulse rate, the side effect of the anti-reaction injection.  In fact, the next day he was afraid to go the village alone.  So he took his friend along with him for support in case things turned worse.  Fortunately patient had become alright, his fever was less, and was feeling better.  Sujay wrote him some more medicines for further treatment.

Every doctor might face such critical situation many times in their life.  In such conditions if patient could not be saved, doctor feels so depressed as to give up practice for ever.  But once the stress is overcome doctor will again be ready to face challenge with added experience.

After this incident Sujay had made it a practice to ask if patient had any problem after taking any injection or tablet.