It seemed they all wanted her to die.Part 3

Yes, they all wanted her to die,may be even myself.And she died.
The girl I mentioned in 2 of my earlier posts [November,December]died few days ago. Not seeing her come for review for last 2 months, I called the cell number I had obtained from Hospital records again.The person who answered immediately gave it to the girl's mother.
Why you are not bringing her to me?How is she? I asked in an accusing tone.
She is no more,died few days ago', was the matter of fact reply.
I was shocked.
' Did you take her to any doctor?'
'No, She was better with your medicines'.
'Did she die in a hospital or home?'
'She died at home'.
I held the line for a few seconds not knowing what to do.Then I disconnected.
Sense of depression engulfed me.And guilt.May be I should have been more pro-active.Should have telephoned that number more regularly and threatened them of action if they did not bring the girl to me.Or I should have asked one of my acquaintance in the District Positive network[an NGO of Positive ppl] to go and find out where she lived and try to interact with the family.
I hid an important fact in my first posting about that girl.The fact was her father died few years ago due to HIV/AIDS and she might have been a victim of incestuous relationship[.Her mother was negative.]This was one of the most important factor that made her family want her to die.For them her death means an end to their humiliating secret.
She was severely ill,with her CD 4 count 20[indicating very advanced AIDS] at the time of diagnosis.Still with proper care there was a 40/60 or on the pessimistic side 20/80 chance that she will recover.
But they never wanted her to recover.Should I blame them? For them she was a dirty stain on the family,someone they wanted to forget fast.
May be I should have been able to ask some NGOs to take her under their wings.Take her out of the house where she is not wanted.If she was an orphan I might have done that before discharge from the hospital.But she was not an Orphan.She had a mother,sister and brother, and Uncles.
I wish she was an Orphan.Then she might have survived.

A Study in Contrast

The other day two of my patients were boys who presented so differently.Their stories were a study in contrast.
The first boy came along with his anxious parents.Both of them were school teachers. The boy was around 14 years and appeared healthy.
' What brings you here?' I asked.
' His urine is frothy'.The mother said.Is he having a kidney problem? They were very anxious as a classmate of their son had Kidney disease.
I examined him in detail and could not find anything wrong.Then I asked for a series of tests of urine and Blood and that too were normal.
I reassured the parents and send them off.


The other' boy' came with his father.They were from a village 30kms away. They came with a reference letter from a Local doctor.The ' boy' looked as if he is about 12 years old. When I looked down at the patient file in front of me I was shocked to see the age written as 23.Was it a clerical mistake?I asked the father about the boy's age.Yes it is 23. I read the reference letter.Yes he was referred to me to find a reason for his short stature.
I examined him. His height was 123cm and weight 24 Kilograms. He did not show any features of puberty. He had no hair growth over face, chest, armpits or genitalia.
His penis was small and testicles rudimentary. His voice was like that of a 10 year old child. It seemed as if his body got stuck at 10 years for the last 13 years.
'When did you notice that there is something wrong in your son?' I asked the father.
He told me that once a doctor told him the boy had problems and need many tests to find out the cause,but nothing was done.
Why those tests were not done?
Money was the major problem he said apologetically. 'Also I was sick for several years.So there was nobody to take him to distant City to do the tests.' He added.
He is probably a case of ' Pituitary Dwarfism'. It is an abnormality rarely seen in children.They stop growing early or growth is very much delayed. This is caused by deficiency of Growth hormone . Such children may have deficiency of other hormones also.This may result in lack of sexual maturity as seen in this boy.
Early diagnosis in the childhood is important. Treatment with Growth Hormone Injections usually makes a big difference.But it have to be given before adulthood.By 18 to 20 years the bone plates fuses and further growth is not possible.
Treatment with sex hormones may help this 'boy' to mature.But he will never gain height. He could have gained height if treatment was started when he was around 15 or earlier.
Such contrasting tales I see in my practise regularly. India is full of such contrasts. Over anxious literate and well off parents who know many things and is afraid of all known and unknown diseases attacking their children on the one hand,and the illiterate poor rural folk who accepts everything that is given to them as destiny on the other hand.
India is a land of
Luxury,opulence and high education on one side
and
poverty,illiteracy and ignorance on the other side.

When will this huge divide go away?

Is it AIDS doctor?

A 48 year old man came to my clinic with his brother. The man is working in one of the Persian Gulf Countries. He was in Persian Gulf for the last few years but was not regularly employed.He was staying with and was dependent on his friends and relatives most of the time. 5 months ago he was fortunate enough to get a good job. Finally he started sending money to his family in India.

His illness also started 5 months ago.He began getting loose stools. Some times there was blood in the stools.He lost all his appetite and became thin.His friends asked him to see a doctor. He did not had a health insurance or other benefits.He knew that seeing a doctor there means lot of money.He applied for leave to come to India for treatment,but it was rejected. He continued to suffer and lost around 20 kilograms in weight. Sensing something wrong his boss gave him leave.Thus he presented before me.

He was extremely ill looking, thin and emaciated. He said he is having frequent tummy pain along with loose stools.Some times it is mixed with blood, which he attributed to Piles. He was pale and his blood pressure was on the lower side.I asked him to lie down. I examined his abdomen. He had a fairly large and hard palpable Liver.He also had pain on pressing his lower abdomen on the left side.For me the diagnosis was obvious.

I asked him to do some blood tests and an Ultra sonogram of his abdomen and come back to me with the reports in 2 hours.
Both of them went out but the patient's brother returned immediately, came close to me and asked
'Is it AIDS doctor?
I wish it was AIDS. I replied.
His face showed his confusion.I explained. Probably it is advanced Colonic cancer which had spread to Liver. If in operable the chances of survival are very slim.
If it is AIDS I can offer a lot and he will live healthy for long.But......
The Ultrasound scan suggested my impression was correct.He was referred to higher centre. Subsequent CT Scan and a colonoscopic biopsy confirmed the diagnosis.

Yesterday was his day of surgery.It was planned to remove the colonic tumour and to give chemotherapy later for the Liver lesion. His brother called me in the afternoon.He was crying when he said that the colon tumour was in operable as there was adherence to Urinary bladder. They just did a diversion of bowel to abdominal wall so that he wont have obstruction to bowel movements. His days are numbered.

Colonic cancers especially on the left side are slow growing and are diagnosed early because of alteration in bowel habits and bloody stools. When diagnosed early it is a curable cancer.
This patient because of his circumstances delayed seeking medical help which now proved was suicidal.