Vanakkam, hello and welcome to another few snippets of life here on the Indian subcontinent. March is almost at an end and that marks two months of my time here already over. I am being sent beautiful photos of the British springtime which I am missing out on and the air here in my little corner of the Nilgiri Hills is getting warmer by the day. The seasons are on the change! With all the movement of people this week has gone by in a flurry. Also today is exam day for our nurses who are getting their formal qualifications. It’s all go!
The most memorable case in the last week as far as I am concerned is a patient who I saw last Thursday. With my rather ropey Tamil I ascertained that she had been suffering from abdominal pain for the past 3 days, no diarrhoea, vomiting or pain on urination associated with it, and that she was currently having her period which was heavier than usual. Knowing the high pain threshold of my tribal patients and not wanting to miss anything I asked one of the Indian doctors to check my version of events with the patient, could this just be very bad period pain? It seemed unlikely that this woman would have travelled to the hospital just for that. My Indian colleague managed to gain an extra few pieces of info. This patient had previously had a sterilisation procedure (tube tie) and before her current period she had missed one month. The question was there; could this be an ectopic pregnancy? Although our hospital doesn’t have enough money to stock urine dip pregnancy tests we do have an ultrasound scanner. The doctor who spoke to our patient has had training in obstetric ultrasound so she had a look. There it was, right next to the left ovary what looked like it could be an ectopic. Although interestingly the majority of her pain and tenderness was on the right side and we couldn’t exclude appendicitis. The senior staff decided we had no choice but to take her to the operating theatre as an emergency. Under a spinal anaesthetic it was possible to do an open operation to see what was going on. The senior obstetrician/gynaecologist and her husband the senior surgeon both scrubbed for the procedure. The woman was extremely slim so finding the relevant anatomy was not difficult but on closer inspection the fluid filled sack attached to the left ovary was nothing more alarming than a small cyst with a little blood in it. This is known as a haemorrhagic cyst, not usually anything to worry about. We still needed to find the culprit when it came to diagnosing her pain. After a brief rummage with the intestines we found it, a rather angry looking appendix! So there you have it, not an ectopic after all but appendicitis.
What really struck me about the proceedings was the way the patient dealt with everything. These women are so brave, having lived their whole lives in the tribal villages to make the journey to the hospital and put their faith in the care of the doctors here when it is so different from their previous sphere of experience. Before the operation you could read in her face how scared she must have been. After the spinal anaesthetic, although she was fully awake she could feel no pain from the operation and she started to relax a little. I was not needed to scrub in for the operation so I busied myself preparing things and trying to be useful, I had time to regularly check on how she was getting on. Manually checking her blood pressure and changing the warmed bottles of intravenous fluid. This gave me the opportunity to hold her hand and say some reassuring words in my broken Tamil. Every time I went to check up on her she would give me this huge grin, I couldn’t believe that there she was in this amazingly stressful situation smiling at me.
Post operatively when I went to check up on her again and on the ward rounds before her discharge yesterday she gave me the same wonderfully warm smile. I feel like as well as learning Tamil I am also learning another language, one which I have always known but now need to rely on so much more, a method of non-verbal communication. I use it much more consciously now than I ever did in the UK where I could just say what I was thinking.
Another place where non-verbal communication has become vital to me is the delivery room. While the nurses are sitting their exams this has jokingly referred to as my department. On Monday and Tuesday we had 5 difficult and complicated obstetric cases and I was sitting in the labour ward all day and well into the night monitoring them. I am very proud to say that I delivered four of them, the fifth needed a caesarean section. Developing a relationship with your patient when you cannot make small talk is a very different experience. I find that I am constantly learning to pick up cues as to when the women need their hand held, their brow mopped or their back rubbed and when they need time to themselves to rest.
You can probably tell that I have been busy in the hospital this week as my writing is more clinically orientated. The Knowles family clan are arriving in two days and I will be taking a break from my hospital duty so I have been feeling even more inclined to make the most of my experience before the holiday starts. We will be travelling to the North of India which is both exciting and a little scary for me, a journey into the unknown! Anyway I will try and keep up with my blog and let you know about the travels etc.
In the meantime lots of love and hopefully hear from you soon.
A x
P.S. I thought this would be very boring without any pictures so here is one of the very cute and super destructive toddler who lives in the hospital, (its a long story).
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