Another day, another case.
This blog-post speaks of a man's "need"..... a need to get "diagnosed" first and then the need to get treated and the need to lead a normal healthy life..... Alas! That was not to be ! Read on.......
This patient's case is slightly peculiar because he presented with varying symptoms. I was supposed to present his case, but never got the chance to.....
This man was a poor construction-site worker from a remote village, and came to our hospital with complaints of swelling in the neck, fever, weakness, breathlessness, facial puffiness, abdominal complaints and various other non-specific complaints. He was admitted to our hospital 4 months ago to undergo a biopsy but backed out, for reasons best known to him.
Since I examined this patient in detail, I knew his clinical history..... he had multiple shotty lymph nodes all over his body (basically, a generalised lymphadenopathy). My provisional diagnosis for the case read: "Multiple enlarged lymph nodes due to ???Hodgkin's Lymphoma (possibly stage III B) with a severe degree of anemia and anasarca"
Now when I say, a severe degree of anemia.....his "Hemoglobin" levels were 3.2 gm/dl (normal level for an adult male as per Indian standards: between 12-16 gm/dl). Multiple transfusions later, he developed a cardiac overload, which he did recover from. Ideally concentrating on his primary disease, he should have undergone a "biopsy of his neck lymph nodes", but he was scared (?) of this procedure and even though I explained to him that it was a "harmless" procedure, he wasn't convinced. The patient's brother was basically running from pillar to post, just to get a "certain" diagnosis for this patient. My professors suspected a form of "Lymphoma", but a confirmatory test was required in the form of a biopsy, so that he could be referred to a centre offering "Specialised Cancer treatment" (since those facilities were unavailable at my teaching hospital). Since the patient was unwilling to get any form of procedure done on him (while his relatives were more than willing), he was asked to get "discharged". He actually did !!!
Around 2 months later, I was enjoying a "mini"-party with some close friends and just outside the venue..... this patient's brother spots me, and actually recognises me, and then addresses me as "Dr." (I was just a final year student then, but such "occasions" actually give you such a "HIGH"). I remember this patient well and I asked the relative how my patient was doing. I was in for a shock now.....
My patient had expired a week ago...... he developed a severe anaemia again and was admitted to the Rural Hospital in his village. But this time, no amount of transfusions or symptomatic treatment could help him...... his lymphoma, I guess, turned too aggressive......he died from a cardio-pulmonary arrest due to an extremely severe degree of anaemia ( I was told, his Hemoglobin was just 1.7 gm/dl !!! ).
So that party turned out to be exactly the opposite- a cause for celebration..... turned into a cause for mourning !!!
Patient deaths wouldn't affect me so often (more on that on another blog-post), but what happened here shouldn't have happened and in fact, shouldn't happen to anyone...... this man died for the lack of a diagnosis, a fear of the unknown and basically, according to me, his own foolishness (for lack of a better word).
But as my internship progressed and as my rural postings came to an end, I realised that this man's case was not an isolated instance. In fact, in the villages of India, thousands of such deaths go "undiagnosed" !
And we talk about "HEALTH FOR ALL" !!! Wow !
This blog-post speaks of a man's "need"..... a need to get "diagnosed" first and then the need to get treated and the need to lead a normal healthy life..... Alas! That was not to be ! Read on.......
This patient's case is slightly peculiar because he presented with varying symptoms. I was supposed to present his case, but never got the chance to.....
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Since I examined this patient in detail, I knew his clinical history..... he had multiple shotty lymph nodes all over his body (basically, a generalised lymphadenopathy). My provisional diagnosis for the case read: "Multiple enlarged lymph nodes due to ???Hodgkin's Lymphoma (possibly stage III B) with a severe degree of anemia and anasarca"
Now when I say, a severe degree of anemia.....his "Hemoglobin" levels were 3.2 gm/dl (normal level for an adult male as per Indian standards: between 12-16 gm/dl). Multiple transfusions later, he developed a cardiac overload, which he did recover from. Ideally concentrating on his primary disease, he should have undergone a "biopsy of his neck lymph nodes", but he was scared (?) of this procedure and even though I explained to him that it was a "harmless" procedure, he wasn't convinced. The patient's brother was basically running from pillar to post, just to get a "certain" diagnosis for this patient. My professors suspected a form of "Lymphoma", but a confirmatory test was required in the form of a biopsy, so that he could be referred to a centre offering "Specialised Cancer treatment" (since those facilities were unavailable at my teaching hospital). Since the patient was unwilling to get any form of procedure done on him (while his relatives were more than willing), he was asked to get "discharged". He actually did !!!
Around 2 months later, I was enjoying a "mini"-party with some close friends and just outside the venue..... this patient's brother spots me, and actually recognises me, and then addresses me as "Dr." (I was just a final year student then, but such "occasions" actually give you such a "HIGH"). I remember this patient well and I asked the relative how my patient was doing. I was in for a shock now.....
My patient had expired a week ago...... he developed a severe anaemia again and was admitted to the Rural Hospital in his village. But this time, no amount of transfusions or symptomatic treatment could help him...... his lymphoma, I guess, turned too aggressive......he died from a cardio-pulmonary arrest due to an extremely severe degree of anaemia ( I was told, his Hemoglobin was just 1.7 gm/dl !!! ).
So that party turned out to be exactly the opposite- a cause for celebration..... turned into a cause for mourning !!!
Patient deaths wouldn't affect me so often (more on that on another blog-post), but what happened here shouldn't have happened and in fact, shouldn't happen to anyone...... this man died for the lack of a diagnosis, a fear of the unknown and basically, according to me, his own foolishness (for lack of a better word).
But as my internship progressed and as my rural postings came to an end, I realised that this man's case was not an isolated instance. In fact, in the villages of India, thousands of such deaths go "undiagnosed" !
And we talk about "HEALTH FOR ALL" !!! Wow !
hey vinay.... have you thought of any solution for this... as we are a good group of young drs we can definitely work towards making it better for the rural people... specially ''awareness''.. lets think of a solution to this problem... what say ???
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