Saturday, November 13, 2010

The Casualty

The Casualty in a Delhi hospital is what an Emergency Room (ER) is in a Glendale hospital. Patients walk into casualty if they are too sick to go to the OPD or if the OPD is closed. Doctors in Casualty treat some, refer some to OPD, and those who need to stay are sent to either Medical or Surgical Emergency. The patients are treated in Medical Emergency and then either sent home or more commonly transferred to the Medical Floor the next day.

If you want to see the widest variety of cases there is no better place then the Casualty of Irwin Hospital. But you need a strong stomach. I was in Casualty only for about three hours. A patient was brought in with tetanus. I do not remember ever having seen tetanus in my life. Her whole body was rigid like a wooden board. I could hardly bend her elbow or knee. She gave a history of a splinter in her hand. After about two weeks she developed difficulty in opening and closing her mouth (lockjaw). She came to the hospital about five days after  the start of tetanus. By now her body was stiff like a board. You could hold her leg and lift the whole body.

I had read about tetanus in books. The tetanus organism grows in untreated wounds. The bacteria releases a toxin that causes muscle spasm. Even if the bacterial infection is cured by antibiotics there is no way to remove the toxin which is already bound to cells. But in my heart I did not believe that a small splinter could cause that kind of wound for the bacteria to grow. Now I know better. In future I will treat splinters with respect. Even without a splinter I will get, and give to my patients, that tetanus booster every ten years!

Another young woman came in with wild movements of her head. She brought back memories of seeing other patients with conversion reactions (called hysteria in the past). You never see such gross/obvious conversion reactions in USA. There patients, under similar stress, develop Munchausen Syndrome or other disorder (Please do not quote me on this, I am not sure about the psychopathology of these disorders).

There were times when it made me very sad to see some of the deficiencies of simple equipment, like wheelchairs and stretchers.

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