My Memorable patient

MY MOST MEMORABLE PATIENT


That was the first posting after my post graduation in medicine. The place was in a remote head quarters hospital of Karanjia, a godforsaken hill township the eastern part of India. A few kilometers away, there were the dense forests in the foothills of Similipal, famous for royal Bengal tigers and elephants. I had left behind my family in hometown, Baripada, former capital of the Maharaja of Mayaurbhanj. Most of my patients were local tribesmen, who came to hospital only when black magic, traditional “medicines” and quackery failed.
It was the month of May when the first monsoon rains had hit that part of the country. There was a knock at my door around 4am. I came out of the mosquito net, groping in the dark, and with much difficulty I found my way to the door. When I saw Dhanu, the hospital ward boy, I immediately realized that I had to go to the hospital. Dhanu told me that a young man had come from a remote village with pain abdomen and the junior doctor wanted my help.
The patient was a 20 years old healthy boy, rolling with pain. When I asked about the history, his brother told me that there was some function at there village and the boy had taken some local alcohol and mutton at night and slept on the floor. Suddenly he got up around midnight and complained of pain in the abdomen, and vomited. Assuming that all this was due to alcohol, people went back to sleep. But the boy made their life miserable. The local black magician was summoned, who told them that the boy was a victim of an evil spirit which had entered his body. Only the sacrifice of a goat or a rooster could satiate the spirit. Needless to say, all this had failed. It was only then that they brought the boy to the hospital.
A careful examination of abdomen did not reveal any abnormal finding except vague tenderness all over the abdomen. In spite of pain the child was having a shallow respiration which made me suspicious. The villagers who had accompanied the patient said “Due to the black magic quite a few people die every year during this time.”
Examination of the eye revealed the diagnosis -it was a case of krait bite with bilateral ptosis (drooping of eye lids). The anti-snake venom which was lying in the store had expired a few months back But there was no other way I could save this young boy. Polyvalent ASV 20ml was administered directly, and another 30 ml in drip, plus a dose of hydrocortisone (200mg) was given intravenously.
I told the brother of the victim about the possibility of snake bite, to which they said, “Doctor, are you mad? This is nothing but black magic.” I asked Dhanu to make 3 cups of strong tea. A cup of tea was given to the patient through the Ryel’s tube. I asked the people to look for the snake where the patient was sleeping.
I told my junior to check the patient’s blood pressure, respiration and give him neostigmin hourly if the respiration became shallow. At about 5:30 am, I went home to freshen up.

When I returned at around 8:30 am, I saw a big crowd. I was sure the boy had died. But the father of the patient fell at my feet and said, “Doctor, you are our God, what you told is right.” He opened a gunny bag, and lo behold, there was that speckled band the most deadly krait snake of India. The young boy survived and I became famous overnight. As a result of this incident my transfer was delayed by 4 years.
On the day I left Karanjia the young man, whose name I still remember, even after 24 years, Ignesh Majhi (not the real name) was waiting for me with his two children and wife to say good bye.
Ignesh was the most memorable patient of my life.


Dr. Sanjoy Kumar Satpathy.SENIOR CONSULTANT(MEDICINE)
AYUSH HOSPITAL
BHUBANESWAR