Cost of gaining height

You may recall that few months ago I had posted about a man who looked like a boy.He was 23 years old but had the features only of 12 years of age.His height was 123 cms and his body feature were like a small boy.He was a case of Pituitary Dwarfism. Let me tell you what happened since.

The hormone tests proved that he is having a deficiency of Growth Hormone and Male sex hormone called Testosterone.Then I took a series of Radio graphs[Xray films] to see whether his growing ends of bones had fused.In normal males it will fuse anytime between 18 and 21 years.He is 23 now,so chances are it might have fused.But fortunately the radio graphs showed it had not fused.

That meant there is a chance that he may gain in height if given injections of Growth Hormone.That was good news,but the bad news was the injections are expensive. 15 day course of injections will cost around 8000 Rupees.He may have to take such injections for several months.

The family was very poor.The patient's father was a manual labourer and have to support a large family.My first thought was not to burden them by telling them about costly injections.As he was already 23 the chances of gaining much height is very less.The hormones injected may cause the growth plate of the bones to fuse thereby preventing further gain in height.

Bur not telling their options was unethical.So I gave a long explanation which his father listened with rapt attention. From the vacant look I could realise that he did not understand much.
He put everything on my head. Saru parayunathu pole cheyyam.[Will do whatever sir say]
Now I have the added responsibility of deciding for that family.

So I decided.Let us try the medicines for 2 months and see.You tell me when you have the money ready for 15 days medicines.I will order it and give it to you directly.We can save some money by doing that.He agreed.

After a week he called me and said the money for 15 days of injections is ready.I ordered the medicine and company couriered it in my address.I taught the father how to take the injections. The money had to be send to the Company office by cheque or draft.I asked him to do that.He confessed that he do not know anything about Banks and asked me to do it for him.I did not know what to do.He just gave me the cash and left.

After 15 days he came again with his kid.There was no increase in height[ as it may take few more weeks to get the effect].Cash was ready and I handed over the medicine.
After the end of next 15 day period he called and said there is a cash shortage.They were planning to sell a piece of land,but was not able to get a good price.I asked him to come to see me with his son.

I measured the height.There was an increase of 2 cm.All of us were happy to see the increase.

He asked me for few days time to get the cash ready. I told him that a gap in therapy was not good.

Should I volunteer to give him a loan? If he asked for a loan what should I do? I was wondering.
But he did not ask for a loan.He assured me he will get the money in few days.

I know that the father was struggling hard to get money for the injection for his son. Few more months of injections may further increase his height by few centimetres. But at what cost?

It seemed they all wanted her to die -Part 2

You may remember the post with above title few days ago.As a follow up I have both good and bad news.
Good news first.
The 'Positive' girl slowly improved. I took her out of ICU after 4 days and by 6th day she was insisting on going home. But she was very weak and taking very little food. I delayed for a day and then discharged her giving a prescription for 7 days. Before discharge I had a long talk with her mother and one her uncles.I told them that she is still not out of danger.I told them the plan of treatment.I told them if we do all we can for her she can be saved.I reassured that there is no threat of any one of the family members getting infected.They listened to me seriously asking me to clarify if they could not understand.Over all I thought they are coping well and have a genuine interest in the welfare of the girl.I told them to come to the hospital with her on the 8 th day of discharge.

Now the bad news.

Now it is the 15th day of her discharge. They have not brought her to me on the 8th day as per my advise. What might be the reason? Had they taken her to another doctor? If it is so, it is OK.Had they lost interest in her and is not continuing the treatment? That is unpardonable negligence.Or ......had she died?
I don't know what to do. Should I try to trace her?

Non medical reason for referring a patient-Part 2

You may recall my post few days ago on the above subject. Let me continue the story.
The patient a woman of 42 years was brought to my hospital next day morning. My physical examination and the blood results revealed that she is having Dengue fever with a decrease in Platelets, the cell that helps in clot formation when the blood vessel is injured. Apart from vomiting and mild fever she was doing well.
I reminded the relatives about what I told them the day before. I said to them that Dengue fever can be life threatening.
'Next few days are critical. Even if you take her elsewhere the management will be the same. Now you decide.If you like to stay I will try my best to make the patient all right'.
The decision was quick.'We have faith in you doctor'.
I was happy to see their faith in me.It is my experience that if you explain everything about the Patient's condition in simple terms looking in the eye the faith of the patient and the relatives increases.
With in 2 days of supportive therapy her Platelet count improved and she became asymptomatic. I discharged her from the hospital on the fourth day.The family was very happy and thankful.I saved them a lot of money and hardships.
Many patients are referred to a higher centre with out sufficient reasons.Nowadays doctors try to play it safe.
I took a calculated risk here.I admitted a patient to my small hospital with a probable life threatening illness who was referred to a big City Hospital by another Physician.The risk paid off and here we had a happy ending. That may not be the result in all cases.