How GOD saved me in a Medico-Legal case?

God saved me number of times (more than thirty times) till date. Now I am giving the real account about one very extraordinary event that occurred recently.

Details are as follows: I retired from the state government service, working in the medical and health department, as medical officer. By the grace of God, I was again given posting to work as medical officer, on contract basis, in a primary health (Medicare) centre, in a remote area. (Previously this type of system was not there). Doing Tubectomy (Female sterilization) surgeries is one of my duties as per the job chart and I did a number of tubectomies.

1. August 20, 2004: I did four tubectomies on that day and all the cases were all right and were discharged in the evening of the same day and they left for their respective native places. There is one female health nurse to give follow up, post operatively for seven days, to every Tubectomy case.

Now I am giving details of one case of the four Tubectomy cases. She is about 26 year old and having three children, at the time of surgery. Her native village is 20 km away from my headquarters (PHC). The patient was without any complications for the next two days, i.e.; on 21st and22nd August.

2. August 23, 2004: The patient developed spotting (slight blood discharge) at 2 pm. But the female health nurse did not visit the case for these three days (negligence on her part). There are other health personnel (supervisory category) also, who also not visited that operated case. The parents of the woman patient approached a rural practitioner (a quack) and brought 3-4 tablets to arrest the bleeding and gave them to the case. But the little discharge of bleeding was still continuing, even on August 24.

3. August 25, 2004: The patient suddenly developed heavy bleeding discharge and went into unconsciousness. The parents and the relatives of the patient were in panicky condition. As it is a remote area, there was no immediate transport facility to shift the patient. Somebody went to a nearby a big village and brought a rented vehicle and the patient was taken to Kanigiri (a medium sized town), which is more than 35km away from the patient’s native village. All the way (in the journey), she was having the bleeding discharge.

4. At Kanigiri: She as admitted in a private nursing home and her Hb (Hemoglobin or blood) blood count was done which is 35% (normal 70-80%in this area) only. The private practioner secured 2 bottles of blood (belonging to her blood group) and started transfusing the blood intravenously to the patient. The bleeding is not stopped and she is in semiconscious state and the Hb is 35% and there is no improvement in her condition.

Mean while, a health worker (a relative to the patient), happened to be there and he phoned to the deputy district medical officer(stationed at a place which is more than 40 km away from Kanigiri) and on his advice, at 6.30pm, the patient was referred to Ongole town (district H.Q hospital), which is more than 85-90km away from Kanigiri. Blood transfusion and artificial oxygen (given through nose from O2 cylinder) were provided, as the patient was unable to take breathing, due to less Hb%. The patient reached Ongole at about 8pm.

5. about me and my paramedical staff members:

At that time I was in my native place (to attend personal work), which is far away from Kanigiri and knowing the situation through phone only. At Kanigiri, the relatives of the patient began to pass adverse comments against me and my operation procedure.

The most horrible thing is, the medical staff (stationed at PHC –H.Q, which is just 22 km away from Kanigiri) were requested by the doctor (who was treating the patient at Kanigiri), to come over to Kanigiri, to follow the case. But no body from the staff, including the ANM (happened to be the relative of the patient) also did not go there (even though vehicle is readily available for transport purpose), to see the patient, thinking that the relatives might manhandle them. They showed such negligence of duty on their part, and left me to my fate.

The higher authorities informed me by phone to go to Ongole and I reached Ongole at 9pm and talked to the patient.

6. At Ongole: The gynecologist examined the patient. There is no improvement in the condition of the patient.

There were only two options:

1. If the hysterectomy (removal of uterus) operation is not done, the patient would certainly die, as there is continuous bleeding from the uterus.

2. If they do operation, the survival chances of the patient are 50% only. So what to do? Doctor is in dilemma.

After consultations with the parents of the patient, it was decided to do operation at 11.30 pm. already four bottles of blood were given to the patient. The Hb is still 35% only.

At 11.30 pm the gynecologist developed second thoughts whether to do surgery or not. After the requests made by us, she decided to do operation. After the consent, obtained from the patient, she was taken into the theatre at about midnight. After 15 minutes (around 0.30am), the staff of the theatre came out and asked the parents to sign again on another set of papers , then they started weeping operative period, thinking that, the patient died in the theatre, and after persuasion signed on the papers (consent was already given ).

Just imagine about my position, as I was alone among them.

In the theatre, while doing operation, a sudden gush of blood came out while removing the uterus and Bp was low, pulse was not palpable, patient was in unconscious condition. So they thought the patient was no more.

Anyhow after some time, as a last resort, the anesthetist made small incision on the skin of the leg and able to secure the vein to give I.V fluids and blood. The operation was over and she was kept in the side by room for post operative care. The surgeon informed us that after 48 hours only that she could tell about the recovery of the patient, until that time anything might happen during post operative period. Again we were in dilemma what would happen to the patient.
Totally nine bottles blood were given and administering of oxygen was stopped on the third day. Now she was alright and she was discharged on 12th day and came to her village. She developed Typhoid fever after a week and it was treated.

Another trouble was, she developed deep bed sore on her right buttock region and the bone was exposed and it took more than two months to get itself healed. Any how the patient was completely cured by 5th January 2005.

The total time taken for the complete recovery of the patient:

Date of operation= 23-08-2004.
Healing of bed sore= 05-01-2005 (4 months and 12 days).

She escaped from death:

1. at her native place,
2. During the transportation,
3. During the operation
4. During the healing stage of bed sore (post operatively).
You can very well imagine my position during this entire period and the trouble I faced.
God saved me a lot.

Injection in rural health care

This incident was happened in 1987 in a tribal area (Rajavommangi) in Andhra Pradesh, where I worked as a medical officer.
A female patient about 26 years old was brought to the hospital by her husband at about 2 PM.
Complaint: Severe pain in the abdomen.

The time is an odd hour as hospital was remain closed from 12-30 PM to 4-00 PM.
Only one staff member was with me at that time. I gave her anti spasmodic drug in the IV (intra venous) form in anticipation for quick relief.

The injection was bought by the patient relative from a near by drug store as the hospital store was closed. Immediately, the lady developed sweating and pulse became weak.
I immediately gave her required treatment for the reaction in the form of Dexamethasone injection.

She recovered within 10 minutes. But, I LEARNT A BIG LESSON.

Lesson: Never give injection in Intravenous route when you are working in rural areas unless it is necessary or it is the only possible route for that drug.

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