It was around seven in the morning. The duty doctor was called in telling a six year old with vomiting and abdominal pain had come. He was a frail looking kid with obvious dehydration. IV fluids were started and blood investigations were sent.On suspicion of an acute appendicitis, he was sent for an ultrasound. After nearly 20 minutes ( exactly when the consultant arrived) he was brought back to the ward with the report saying the cliché, “NORMAL STUDY”. But now there was something different about his breathing. The consultant picked it up and without a second thought asked for a GRBS to be done. 3, 2 and 1…the glucometer gave it’s verdict- HIGH. Diabetic keto acidosis…the sirens were now blaring in everyone’s head. “Please get an ABG,”the duty doctor gave her orders as the consultant did a quick history taking and explained the situation to the anxious parents. Meanwhile, the nurses had wheeled the boy into the PICU. Monitors were connected. Additional IV access was established. A frantic call from the lab informed that the ABG machine was under repair. So much for perfect timing! The junior doctor looked at the consultant in disbelief. Send for serum Bicarb, Dr.Jeyanthi ordered in an unperturbed manner and continued giving orders for fluid correction and supportive management. The difference that comes from experience! The lab reports flooded in with one bad news after the other. Severe DKA. And Probable sepsis.
I listened to this narration from my friend who was the duty doctor in the picture so far. It was by evening that I got a chance to go by the PICU from the OPD. And that’s when I first saw him. A bag of skin and bones, his chest was heaving as if all the air inside wanted to escape at the same time. If you have seen Kussmaul’s breathing once, you will never miss it again. But this was something extreme. He was on supportive ventilation and had IV lines all over. His BP was failing and he was on 2 supports. One line faithfully delivered IVF and another insulin. His electrolytes seemed to be following a choreography of their own. We would have to wait and see how all this would have affected his little brain- if he ever makes it out of this. The consultant who came for the evening rounds shook her head in disbelief. “I have seen many DKAs but this is simply complicated. Some miracle has to happen!” The parents were not willing to take him to a higher center. Bottom line was that hope was sparse. Little Lingeshwaran was waging a losing battle.
Being off duty, I had a perfect sleep, woke to a beautiful sunday morning and was getting ready for church. But the head nurse called up asking for some help in the ward. The previous night was very eventful.Lingeshwaran’s condition had worsened even further. Higher center option was stressed on and parents had finally accepted. So all arrangements were made and the child was shifted into the ambulance. Within minutes, he had a seizure. And hence he was shifted back to the PICU. We will continue here. Whatever treatment you can do, that’s enough. If we lose him, we will think of it as fate. His family declared.
Before we started the morning rounds, we stood by him and prayed. She meant it cent percent when Dr.Rincy prayed that we knew not what we were doing and only a heavenly healing touch could heal this boy. His mother sobbed as we prayed. His parents had waited for years before this precious child was born. seizures continued to make occasional reappearances. His endotracheal tube was blocked and had to be changed. But soon the new tube decided to wriggle free from his throat. And hence a third Intubation. The blood gas values were still terrible. He had high grade fever spikes and antibiotics were upgraded.And like it was the only thing left to happen, his heart decided to arrest and scare us! With resuscitation, his little heart was taught to beat again. So much had happened by that Sunday noon. As I passed his relatives waiting outside, I wondered how they would accept his death. I was so sure he would not make it! So much for my faith!
He had another cardiac arrest the next day. This time CPR and adrenaline seemed to have no effect. The monitor continued to show the dreaded flat line as his once heaving chest lay motionless. Let’s try one last time, Dr.Rincy declared. There seemed no hope, but it’s every doctor’s dilemma corner- how do you simply stop trying to save a six year old?! You want to make another effort. Just anything as you slowly deal with the fact that some things are beyond your medical science. The CPR was continued and more adrenaline pumped in. And then that much needed miracle happened. The flat line started to dance as his heart started to get back in action. We would have lost him if this doctor had decided to give up. She knew well it was beyond her control but she simply had great faith in her heavenly Father and continued despite all the limitations. The extensive CPR had caused his ET tube to come out and hence he had to be Intubated again.His blood gas, sugars and electrolytes were still on a will of their own. I would visit him daily, when on duty and otherwise, to know of his progress and go through his chart which now looked like a small book. And I would sometimes sit at the corner of the PICU and stare at him. So much had happened. If only he would come out of this. A happy ending is always something we all look forward to. I prayed for one here.
“Lingesh has opened his eyes!”, Josy came to me with the good news a few days later. And slowly he improved. His sensorium was better. He was off the ventilator but still needed oxygen( He had a bad lung infection too). He also had mild laryngeal edema and hence could not speak properly. It took more than 2 weeks for his voice to return. His blood sugars were still a tricky situation. It would either be too high or he would hit asymptotic hypoglycemia. On one of my duties, the sister franctically showed me the glucometer value- 20!!! I ran to the boy and saw him sitting upright on his bed staring at me as if I was hypoglycemic! The necessary correction was done and I sat down again. Only to see the next crazy GRBS value of 400! His tricky blood sugars were now exclusively controlled by Dr.Jeyanthi alone due to its fluctuations. His family had stayed strong through all this. They were closely knit,with his maternal aunts and his favourite uncle always being around to help his parents. One day as I watched his mother flip through the Tamil Bible, I prayed that God would use this opportunity to reveal Christ’s love to these beautiful people.
3 weeks later, it was one of my duty days. Since it was not very busy, I decided to pay Lingesh a visit. He gave me a sly smile as I approached him, took his play gun and aimed it straight at me. I feigned a scared face and tried to tickle him. He smiled more and ran out of the bed. It was pure joy to see him out of his bed and smiling. It had taken lot of effort to ambulate him and his voice took its own sweet time to return. His sugars were now under reign, his mom had learned to give him insulin injections and he was ready to go home.
I thought of the boy on the PICU bed fighting for his life. And here he was, playing like any other normal six year old. He was talking, eating by himself and all set to get back to his normal life. This was indeed a miracle. It’s miracles like this that make you love your profession. I had once asked Jeyanthi ma’am why she had chosen pediatrics after working as a junior doctor in medicine for years. It’s simply a joy to see children get well and go home happy. Even more than adults, it’s quite a good feeling to see a sick child being able to play again. I realised what she had meant as one of Lingesh’s toy bullets hit me point blank.