CONQUEST OF DEATH 21

(FOOD POISONING?)

I was recovering from a life threatening illness. I was not fit to restart my practice. I was taking treatment from a doctor friend of mine. One day as we were discussing about the drugs for managing my problem another friend of ours entered the consulting room.

He said

“My daughter is not well. She still gets pain in the stomach. It is incessant. She is constipated and has no appetite -------“

The doctor interrupted and said

“I have not examined her; I gave medicines on hearing from you over the telephone; bring her here. I shall examine her and give medicines accordingly” 

“Ummmm---- She is in agonizing pain and prefers to lie in bed, does not move about even in the house------“

Sensing the emergency I said

“Well well! If you have no objection I shall go for a visit to his home, examine her and report to you”

“That would be excellent” Both of them agreed.

While we were on the way to his house I told my friend

“Tell me her history”

“My daughter is back from the US. To celebrate her return; yesterday we brought sweets from the shop, mainly dairy products. She ate more sweets than she usually did. Within hours she started getting severe pain in her stomach. She was uncomfortable. We tried some household remedies. She found no relief. So I phoned the doctor. He gave some medicines. But her pain is not relieved.”

“Does she vomit?” I asked.

“No”

“Does she get loose motions?”

“No. She is constipated to day”

“Sorry, you have already told me that”

“Does she have fever?” I enquired.

“NO”

We reached his house. His daughter was in bed. She was groaning because of unbearable pain. Her thighs and legs were flexed on the abdomen. She was lying in the left lateral position. She turned her face towards the wall away from the light.

“This is my friend” He started introducing me to his daughter.

As he started introducing me she turned from left lateral position to right lateral position. Her decubitus however remained the same.

“Raisondetre (the reason) he is here is to examine you and give medicines for your stomach pain.” He told her.

“Please tell me your history” I said to take her in confidence.

She narrated the same story as her father did.

“Please lie on your back. Keep your thighs and legs flexed. Take a deep breath and relax” I said.

She had high fever, 104 degrees F. Her pulse was rapid. I was not equipped to examine a patient so I could not measure her B.P. Her breathing was shallow, thoracic in nature. Even after taking deep breath her abdomen would not move. Her abdomen was distended a little. As I examined her abdomen she was guarding her abdomen. I could not localize any specific region of maximum tenderness or guarding of the abdomen. She had signs of peritonitis but no localizing signs.

I sent her blood and urine for pathological examination.

As the clinical picture was nebulous and pathological reports would have been available only in the evening I prescribed antibiotics. 

To bring her fever down I personally started tepid sponging. After about half an hour of sponging; her fever came down by 2.5 degrees F. Her pulse slowed down.

She was exhausted after sponging. So I stopped sponging; started antibiotics.

“Monitor her temperature and pulse rate every hour and report to me every hour” I instructed my friend.

“Is this food poisoning?”

“NO. It is peritonitis. (Infection of the sac covering the intestines). But I am unable to find the exact cause of it”

I reported the case to the doctor friend and came back to my home.

My friend reported me every hour. Hour after hour she was improving.

In the evening her pathological reports were ready. They were suggestive of infection. With my antibiotic therapy her temperature became normal. Her pulse rate became normal. So advised them to continue the same treatment.

The next day I went to their house for ‘follow up examination’.

She had high fever. Her abdomen was softer a bit but there were signs of   fulminating infection of the appendix. That was ominous.

“She has developed an appendicular abscess (Pus in the region of the appendix) or may be even gangrene of the appendix. (Infection in the dead appendix) She requires an urgent operation. Unfortunately I am not physically fit to perform the operation.”

We contacted a senior surgeon in the suburbs. I explained the case to him. On examining her he agreed with my diagnosis.

“But to be safe let us get the plain x-ray of her abdomen and accordingly we shall proceed.” He said.

“That should be fine” I responded.

“In an hour’s time your operation would be over and your will be relieved of agony” I told her.

With a smile on her face she acknowledged my remark.

“I am tired and very hungry too. I am not fit enough to stay till the operation is completed. Please relieve me. Let me go home and relax.” I requested everybody. They all agreed.

Exhausted, tired I came home. Every one at home chided me for overwork even in ill health. I did not altercate.

About an hour later the surgeon telephoned me and said

“There is a ‘funny shadow’ in the region of the appendix. It is not a urinary stone. But I am unable to comment on it. So I am continuing the conservative treatment”

I did not discuss because I did not see the x-ray. I was not fit to go there again and advice. I was worried and restless. I was sure she was deteriorating.

Late in the night the surgeon phoned me and said

“She is deteriorating. I have decided to operate on her. I shall be glad if you can come to assist me”

“Doctor I am not in the pink of health. I am sorry for not being able to come. You please proceed” I replied.

“OK” He said.

He phoned me early in the morning next day and said

“Doctor you were absolutely right. She had gangrenous appendix, there was an appendicular abscess, and there was a faecolith (A stone of the faecal matter) at the base of the appendix with impending perforation of the base of the appendix”

“Thank you sir for the commendation! SO? That ‘funny shadow’ in the x-ray in the region of the appendix was a faecolith then?” I said.

“O yeah! I could guess neither then nor even now! Well even now you excel!” He said.

“NO--- no--- no-- sir! Say it not! I am glad that the patient is safe now!”

“Yeah! She is settling”

“Thank you sir”

As expected she had wound infection. I dressed her wound regularly till the wound healed properly. She recovered completely.

To complete some formalities my friend came to my home. He lauded me in front of my wife for my help.

My proud wife said

“His diagnosis is accurate. Right in the beginning of his practice he had operated and managed an identical case as that of your daughter before. He is not keeping good health now; otherwise he would have operated on your daughter much earlier and the delay in her recovery would have been avoided”

To vindicate my action of overstress at that time in spite of my ill health I said

“Had I not overworked at that time, they would have had her ‘death certificate’ in their hand!!”

A TRUE STORY IN REAL LIFE!

 A DRAMA IN MY LIFE!!

DR. HEMANT VINZE