Musings

A bloody night to remember

It was the winter of 1995. I had just wrapped up work for the day and stepped out of the Surgery ward where I was posted.  “Doctor!” I heard a voice behind me. I turned around to see a young man smiling at me. He thrust a small pink polythene bag in my hand saying “I had gone to Vaishnao Devi. I got this prasad for you.” He seemed familiar, but I could not recollect where I had seen him before. “I am Vineeta’s husband,” he said, ” I had gone to the other ward. They told me that you are no longer posted there. The nurse there told me you might be here. I waited until you finished your work.” It took me a few more moments before I could place him. I smiled and spent some time asking him about Vineeta’s health. Thanking him for the prasad, I left for my hostel.

Vineeta. How could I forget her? You never forget your first patient who shakes up your understanding of what it means to be a doctor.

Early in 1995, I joined my post graduation in Pathology. But the clinical branches were facing a resident crunch then. And the Dean sent out a decree saying that all residents from non-clinical branches would have to do six-month house jobs in clinical branches. Due to some technical glitches, I got my admission a month late in this college, and all the plum postings had already been allotted. I didn’t have any say in the matter, and my Dean said I had to do a Surgery house job ‘to lose some weight’.  Since he was a wise man who I really respected, and had always treated me fairly in the past, I didn’t argue. I joined the surgical team immediately.

On the second day of my posting, my Unit was on emergency duty,  and I was told to manage the female surgical ward on the first floor. Apparently, work here was relatively light compared to the male ward, which often received critical cases of stab injuries, road traffic accidents and head injuries, keeping doctors on their toes all night.  I was new, naive and nervous, and had to depend on following instructions from my senior colleagues and nurses.

At around eight in the evening, the Unit’s medical officer called me from the casualty. “I’m sending you a patient who is vomiting blood.” He gave me detailed list of instructions of how I was to manage the patient and ended the call warning me, “Trust me, this one patient is enough to keep you awake tonight.” I didn’t realize then what he meant.

A few minutes later, a stretcher was wheeled into the ward. On the stretcher was Vineeta. She was a thin lady, hardly 20 years old, and the front of her saree was completely soaked with blood.  Running beside the stretcher was her worried husband. He held an infant in one arm and a small shopping bag stuffed with clothes in the other. My registrar Sandeep accompanied the patient. I had hardly spoken to Sandeep since I had just joined the previous day, but he seemed to be a very quiet, calm and efficient man. He was not at all flamboyant, like surgeons usually are.

Sandeep quickly settled the patient on the first bed, where we could keep an eye on her throughout. He started intravenous fluids and gave quick instructions on drugs to push in. Vineeta kept vomiting voluminous quantities of blood. It is one thing to study about portal hypertension and hematemesis in a surgery textbook, but quite unnerving to see someone vomit litres of blood in front of you.  One of the several problems in portal hypertension is that the veins at the end of the esophagus are distended and lead to life-threatening bleeding. These days, with endoscopy, the management of portal hypertension has altered considerably. But back then, inserting a balloon into the stomach and inflating it, was the standard emergency measure to reduce bleeding.

As Sandeep quickly prepared to insert a Sengstaken-Blackmore tube into her stomach, I was sent to the blood bank with her blood samples. I got two bags of blood matched and issued. I also warned the staff there about this critical patient who would require more blood and requested them to help us out with more as the night progressed. I asked Vineeta’s husband if he could arrange for blood donors. But it turned out that he was alone in this new city.

Sandeep told him that we would require lots of ice to try and stop the bleeding and also handed him a list of medicines which were needed.  He handed over his baby to one of the nurses and went out to bring the ice and medicines.  By the time I returned with the blood bags, Sandeep had managed to put the tube in its correct place and inflate its balloon. He had started pushing in ice water.  He told me how to proceed next and told me to call him immediately in case I needed help. There were more patients who had come in to Emergency and his services were needed in the operation theatre.

I sat on a small stool next to the patient, with a bowl of ice and cold water beside to me. I pushed in ice cold water through the tube into her stomach. As I aspirated the fluid back, I got bright red blood in my syringe. As instructed, I continued to push in cold water trying the control the bleeding. Vineeta’s husband had even managed to find an ice factory and had got a whole block of ice transported to the ward. Simultaneously we kept the blood transfusions going.

After over two hours of doing the same thing mechanically, my hands felt frozen with the ice. But all I remember even today, is how the warmth of her blood would flood my numb hands each time I aspirated the fluid back from the tube.  The entire exercise seemed futile,  as her bleeding didn’t seem to be stopping.

Vineeta herself was stoic, never complaining, not saying much.  Between her bouts of bleeding, she would hold her baby to her breast and feed it. It was a sight I can never forget. Her wordless struggle and her courage broke my heart. Her husband was equally logical- never once questioning my expertise and just trusting us all along. Somewhere, in the middle of the night, he was sent to buy some Pitressin to constrict her vessels. He came back with Pitocin which some pharmacist in the market had carelessly issued. The error detected, he had to go back another time. It felt really bad to make him run around when there was a baby to take care of, but we had no other choice.

The nurses rallied around me, gently helping me and guiding me. My senior colleagues would periodically peep in to see how I was managing.  At midnight,  another resident offered to give me a short break so I could have a quick dinner at the hostel and return. I walked to my room where the canteen boy had helpfully left a plate of food covered with a thali on my table. As  I tried to eat, my tears just gushed out. I didn’t think Vineeta would make it. The thought of the baby made something sink inside me.  How was I going to convey this news to her husband? Did I need to? He was at her bedside all through watching her condition deteriorate.

I soon rushed back and took over charge from my friend. My multiple visits to the blood bank continued. After the fifth bag was issued, the blood bank staff knew what was going on and didn’t ask any more questions. I would simply call and send an attendant, and they kept the blood bags coming. The feel of numbness of the ice cold water and the warmth of blood continued till the wee hours of dawn.

Somewhere after sunrise, the bleeding ceased. Through the night we had transfused a total of 22 blood units. Vineeta finally looked stable. I went back to my room at the hostel, exhausted, had a quick bath and returned for my rounds which were scheduled at 8 a.m. At the rounds, the Unit incharge listened in carefully, and gave some quick instructions. While leaving the ward, he wordlessly gave me a pat on the back.

Vineeta stayed with us for the next two weeks and made good recovery. When I think back,  I realize how special a patient she is to me. When I gave up all hope, she showed me how to fight back. I think of the team of colleagues and nurses who trained me and taught me to believe in life. I remember Vineeta’s husband who trusted me completely despite my lack of expertise. I have never been to Vaishnao Devi, but the prasad that he got me that day is perhaps the most cherished blessing I have received in my life.

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