Shrink's Views

ramblings of an unknown psychiatrist

Shall I give up? I wont…

Posted by Dheeraj Kattula on April 26, 2009

She is a 55 year old lady who had come unconscious to our hospital last week.She had fever for the past one and a half month. Tribal belt in Orissa is a Malaria prone area.We admitted her to treat her cerebral malaria.It so turned out that she had Tuberculous Meningitis also.There were other problems too.Sepsis, shock, kidney failure with electrolyte imbalance of Hypokalemia,Hyponatremia and Hypocalcemia (low salts in the blood).

Her husband wanted treatment from us despite the presence of physicians in the same town. She was not well enough to be moved to the state capital either.We started her treatment in consultation with friends who are consultants in Christian Medical College, Vellore.

She beacme conscious in the first day of treatment itself.Her electrolytes improved.She was on a cocktail of antibiotics for sepsis,malaria and TB.She improved slowly over the week. Suddenly,last night she started bleeding from her gums and nose .Today morning we found her function of kidneys to be worsening.Her fever has come back and her blood pressure is falling.

Her husband had been having sleepless nights attending to her.Our nursing sisters too are tired taking care of her round the clock.It is tough for three nurses to take care of 10 inpatients round the clock, 40 outpatients during the day and also man the pharmacy.The family has already sold their goats to pay for the medicines.It is sad to see the patient struggling.I was begining to give up.As her BP fell, I was wondering if I should tell the husband that nothing can be done.

I decided NO.It is true that she is sick.She might not make it.It is also true her bills will not be paid.Her family is nearly burnt out.BUT she probably has a chance.If her set back were a temporary one,then it is worth trying.I started her on Dopamine drip.If her kidneys put out urine and her BP improves,that would be good.

Can we give up? When there is a chance and marginal costs are low…NEVER.

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