CONQUEST OF DEATH 22
(SAVE MY SON FROM ‘HEART ATTACK’)

That was an ominous Sunday. The ward work was light. Soon I finished. I was then enjoying my breakfast in a relaxed mood. From the window of the canteen I saw crowd outside the casualty office. I decided to help the casualty officer. Quickly I finished my breakfast and entered the casualty office.
I started attending the surgical patients. After some time, ignoring the queue a middle aged lady entered the casualty. Howling frantically she was saying
“Save my son from ‘Heart attack’------ save my son from ‘Heart attack’-----“

Since that was a ‘medical’ case I did not heed it.
Seeing my indifference she started requesting earnestly
“Doctor p-l-e-a-se---save my son. He is a teen-ager. This is not the age to die of ‘Heart attack’ p-l-e-a-s-e-----“ 
Her fear was irrelevant and incorrect for a teen-ager boy does not get a ‘Heart attack’. Hence I said
“Mom please come in queue----“
“My son got ‘Heart attack’ how can I -----“she was arguing with me in a North Indian dialect.
“Relax mom relax!  Teen-agers do not get a ‘Heart attack’ relax---“ I assured her and tried to pacify her.

Ignoring my assurance she started narrating
“The boys were playing a cricket match on the play ground. The opposition was losing the match. Then there was a quarrel and then broke fighting. Some boys kicked my son on the stomach, on the back----- he fainted, collapsed then and there---- the boys ran away-----his friends brought him home---- he was conscious----he got pain in the stomach---- I gave oil massage--- the pain became less-----he took tea and slept---- but no use----now he got pain in the left shoulder----- this is ‘Heart attack’ so we rushed here----- how can I come in queue? I am afraid-----“
Stunning! That was absolutely stunning!!

A North Indian lady having no formal education told me ‘pain in the left shoulder’ is a sing of ‘Heart attack’!! I was dumbfounded.
Her son was entering the casualty office. He walked slowly and cautiously, stooped forward, supported his left flank with his palms, his face anxious, winced. He was moaning. His breathing was shallow, rapid and thoracic. There was no movement of the abdominal wall at all-----
I helped him lie on the examination couch.
His pulse was rapid. His B.P. was normal. His abdomen was not distended. He had marked guarding in the left flank.

The x-ray machine in the hospital was not working. So I viewed his abdomen on the fluoroscopic screen. There were no radiological signs of intestinal perforation but the shadow of the gas in the stomach was distorted and displaced. That was ominous. The composite picture was suggestive of injury to the spleen. 
“Let us admit him in the hospital” I said.
“Anything serious?” asked his father.
“His spleen is injured. He may be required to undergo an emergency operation-----” As I was explaining to them,
Anxiously intervened his mother and said

“---b-u-t the patients of ‘Heart attack’ get pain in the left shoulder and the left arm---- so he got ‘Heart attack’ also ---- will the operation be safe-----  “
“You are not a ‘doctor’, please listen to what doctor says” Chided her husband.
“You are obsessed with the idea of ‘Heart attack’. Of many causes of pain in the left shoulder and the left arm one can be a ‘Heart attack’! This is not a ‘Heart attack’-----“I assured her.
She breathed a sigh of relief and said
“Thank God! Now I am relieved”

After preliminary investigations I started blood transfusion. His general condition improved. Soon he became stable, but the pain continued. The splenic injuries are treacherous. They can challenge the clinical acumen of the physicians and test the dexterity of the surgeons.  I was aware of it.
I explained the situation to his relatives. I gave the required instructions to the sisters on duty and told them to keep a close watch on the patient.
Two days later like a bolt from the blue his abdominal pain aggravated. He became restless. He developed pallor. His pulse became rapid. His B.P. was normal.

“He is deteriorating. Probably he has fresh bleeding in the abdomen. He requires an urgent operation.” I explained the situation to the relatives. They consented.
I started the operation.
As expected, his spleen was damaged. I removed the spleen and sent it for pathological examination.
I continued the blood transfusion. Soon his condition became stable.

The next day he developed high fever. The surgeons are neither worried for the fever on the next day of the operation nor do they investigate the fever. As per the surgeon’s wont I gave him symptomatic treatment for the fever. He did not respond. The high fever continued. On the third day he became delirious and restless. The deathly pallor of the face, the lips, the nails were worrisome.
I sent his blood for ‘urgent pathological examination’.  Within an hour I received the blood report. It was positive for malaria. I referred the case to the physician for the treatment of malaria. Within two days of starting the treatment his fever abated. He became weak and anaemic. He took about three weeks to recover.

Because of the unexpected fever a questionnaire surged in my mind:
Was his spleen already infested with malarial parasites?
If yes then such a spleen is vulnerable for rupture with a trivial trauma or even without a trauma.
-----but the report of the examination of the spleen from the pathologist was against it.
How did he contract malaria then?
Through the blood transfusions!!
Yes! This is a well known complication of blood transfusion.
A simple blood test proved life saving then!!
Yes! It did!!

Had I not sent his blood for an urgent pathological examination he would have died of ‘fulminant’ malaria.
Then not only the medical fraternity but even a common man would have ridiculed me saying
“Operation ‘successful’ but the patient died!!”   
   
     
A TRUE STORY IN REAL LIFE!

A DRAMMA IN MY LIFE!!

DR. HEMANT VINZE