Conquest of Death 23

CONQUEST OF DEATH 23

(A SHORT CASE)

The out-patient department of our hospital was crowded. I was late in starting my work. In my cabin I was busy examining the patients. Anon entered my house surgeon and said

“Sir has told you to examine this patient and present to him as a short case. From the point of view of examination though this is a long case convert it into a short case. You are allotted fifteen minutes. After fifteen minutes sir will examine you.”

“OK” I said

I finished the interrogation and examination of the patient in time. Then I went to sir’s cabin and said

“Sir I am ready”

“Narrate the important points in the history, positive findings, important negative points and the diagnosis” He instructed.

I nodded and started the presentation-----

“A middle aged lady complains of:

Dull backache

Burning micturition

Increased frequency of micturition. Day to night ratio 10-12 to 4-6. Passes adequate quantity per act of voiding.

The urine is amber coloured and clear, not turbid

No straining while passing urine.

No thinning of the stream of urine.

No haematuria (passing blood in the urine)

No history of perceptible fever but does get night sweats off and on even in the cold season------“

“Really?” Sir interrupted and asked

“Yes sir-----“

“Hun------I did not ask this point. Good. Go ahead” He said

“All these symptoms are for more than 8 to 10 months”

“She is thin lean, under weight, under nourished, anaemic. Her pulse rate is 90 per minute. Her B.P. normal----“

“How much?” He asked

“140/90 mm. of Hg.” (That was the time when age plus 100 systolic and proportionate diastolic i.e. 90 was considered to be normal. To day the recommended normal reading for B.P. is: 120/80 mm. of Hg. With the kidney disease today this patient’s B.P. 140/90 will be treated aggressively to maintain it at 120/80 or even at 110/70 level)

“O.K.”

“She has lumps in both the flanks; they have regular, smooth surfaces and are mildly tender”

“Your diagnosis” He asked

“Bilateral hydronephrosis (enlargement of the kidney)”

“What would you like to do?”

“Investigations to prove the diagnosis and other supportive investigations to plan the management”

“First the X-ray KUB (Kidney-Ureter-Bladder)”

“Here it is”

“The x-ray shows soft tissue shadows in both the flanks”

“Next?”

“If blood urea and creatinine are normal then IVP.” (Intravenous pyelography. Now this investigation is known as IVU i.e. Intravenous urography. In this investigation a radio opaque dye is injected intravenously. By using the contrast medium x-ray pictures of the urinary tract are taken. The sonography was not even introduced in the realm of medicine.)

“Here are the pictures” While mounting the plates on the viewing box he said “Your analysis------“

“Non functioning Right Kidney, markedly enlarged and distorted Left Kidney, ‘beaded ureter’. The bladder capacity seems normal. My diagnosis: tuberculosis of the urinary tract.”

“How would you manage?”

“If the supportive investigations show that she is fit for operation then start anti tubercular treatment and advise ‘Right Nephrectomy.’ (Removal of the kidney)”

“I have already investigated her. I have already started anti tubercular treatment. Post her for the operation on the next operation day”

“Yes sir.”

I explained the plan of management to her and to her relatives.

They agreed to follow the plan religiously.

“She will be posted for operation on the next operation day” I said.

“Will be fine” They all said

I admitted her in the hospital.

I assisted my sir. The operation was successful. Her post operative recovery was uneventful. I continued anti tubercular treatment.

To attend a medical conference sir went out of the town. On the tenth postoperative day I removed the stitches.

Because of some family problems she requested me to give her discharge from the hospital.

“Let sir return, I shall ask him and then you go home” I said

“I have some genuine difficulty in the family. Please let me go. I shall attend the OPD regularly.” She earnestly requested.

I honoured her request.

Four days later sir returned to the town. Not finding her in the ward he was annoyed.

“You should have not discharged her” He said

“Sir she had some genuine difficulty. She promised me to attend the OPD regularly for follow up. She will attend the OPD day after tomorrow.”

“I am worried. Now she has one kidney. It is also badly damaged. We have to protect it. To protect such a badly damaged ureter and kidney the urologists now suggest wrapping of the omentum (the curtain of fat in the abdomen) round the ureter. I think we should advise her to under go this operation”

“O.K.” I said

As promised she attended the OPD.

Sir explained the situation to her and advised her to under go this operation. She agreed.

We performed the operation. She had very rapid recovery. She attended the OPD regularly. She recovered from a life threatening illness completely.

She used to greet me many a times.

Later because I was busy in establishing my practice I could not meet her.

Almost twenty years lapsed. One day my receptionist knocked the door of my consulting room and said

“Doctor, phone for you”

“Who is it?” I asked

“Your doctor friend”

“Do you remember this case? She says you have performed two operations on her” asked my friend as I replied his call

“Certainly yes” I said

“She complains of urinary infection. What should I do?”

“Get urine culture and antibiotic sensitivity done and report to me”

Neither she nor did her family doctor friend of mine reported to me about the problem.

Though I still possess her x-ray reports as documentary evidence, I have lost a valuable, living or live clinical evidence of “CONQUEST OF DEATH”

A TRUE STORY IN REAL LIFE!

A DRAMA IN MY LIFE!!

DR. HEMANT VINZE