Even we can save 2 LIVES

While having small talk at dinner in a messy mess with one of my male colleagues during my Post MBBS Government service, I asked him as to which subject he's interested in doing his PG [1] in? He said "OBG"! [2] And I was like, "Why?" with an expression on my face saying 'what's wrong with you?' Because all that I have,  is PTSD [3] from OBG. It's not the subject itself, as I liked to read it.(Thanks to a very good teacher we had in our UG college & Marrow's Dr. Sakshi Arora [4]). Nor was it the hectic duties during internship (as we had some good PGs who were good to work with). But it was the labor ward which was in and of itself a war zone!!! 

Lots of women shouting for lots of things!!! Pregnant ladies shouting out of pain, nursing staff shouting at the pregnant ladies and the consultants and PGs shouting at nursing staff and at each other!!  Kind of like a food chain or rather a 'Shout chain'! Everyone's busy, frustrated, tired... And they are removing their frustration upon the one's below their professional hierarchy.

Anyways what was interesting was my colleague's response to my question as to why he wants to sacrifice his neck to OBG. He said: " Because you can save two lives. Both mum and the baby." He was right! But still I wouldn't dare to enter OBG.

Fast forward three years later, out of the blue and out of the OBG ward , a pregnant lady ends up in Psychiatry ward. O my despair! That too Telugu speaking. (Telugu was a foreign language back then for me) This patient was severely agitated, refusing to eat any food and vomiting like those dragons in GOT[5] . It was self induced vomitimg secondary to her depression. The only complaint that she was having was "Nappi" (Pain in Telugu - she had psychogenic chest pain). They had gone to multiple hospitals before ending up in our hospital. OBG which generally has high tolerance to screaming ladies also couldn't tolerate her screaming and referred her to Psychiatry. She was agitated that bad, you know! The family thought the cause of her suffering was that thing growing up in her belly. They wanted to get it aborted. Well! I and a senior resident did multiple attempts to make them understand, that abortion ain't a solution and aborting might worsen her symptoms. But we weren't successful in convincing them because of language barrier. Finally one of our Telugu speaking consultant managed to convince them and started her on medication and ECT. [6]

After 3 ECTs, the lady wanted to have mutton Biryani!! She started complaining to me like an Indian wife how her husband drinks alcohol. I mean to say she was all NORMAL. Anyways, we gave her totally 5 ECTs and the lady was good to get discharged from the hospital. The family was happy.. but wait, the story doesn't end here!

The medication she was on, made her heart go TUGDUK TUGDUK TUGDUK... racing like a horse (She had Tachycardia as a side effect). We had to change her medicine, after which the same old 'NAPPI' story repeated. Again we gave her ECT and got that 'NAPPI' out of her. She delivered prematurely (Probably due to ECT or medication), and the baby of course needed some special care. However the mother and baby were healthy at the end of the day.

Of all the cases that I had to handle in my Psychiatry life so far (well it's technically not far, as it has just started walking - Pun intended!!) , this was the most satisfying one. As I had to put a lot of time and effort for this case , because she was at a very vulnerable part of her life and her agitation & food refusal could put her and her fetus at risk and there were some medical issues that this patient was having along with some family drama that I had to handle as well.It was a tough case to handle, but at the end of the day we saved 2 lives. It was a worthwhile effort!

This case piqued my interest in mental illness during pregnancy. As much as 1 in 5 women during their perinatal period [7] have symptoms of common mental illness (like depression anxiety etc) which mostly remains untreated even in developed countries, let alone the developing and underdeveloped ones. Which in turn adversely affects not just the mother, but also the fetus and also impacts the physical and mental health of the child/adolescent/adult to be in future. This is because, an untreated mental illness in a mother leads to inadequate care towards herself as well as the baby. So for a healthier mother & baby...nay a family ..nay a nation...nay the world, a mentally healthy mother is quintessential. And that's why alike the OBGian gladiators, we the Psychiatrists, we can save 2 lives as well!!!

Footnotes 

[1] PG = Postgraduation

[2] OBG = Obstetrics and Gynecology

[3] PTSD = Post traumatic stress disorder;  Used figuatatively in the blog.

[4]Dr. Sakshi Arora is a faculty in marrow - an online teaching format for medical students

[5] GOT = Game of thrones - A web series

[6] ECT = Electroconvulsive therapy

[7] Perinatal period= The time period during pregnancy and after child birth.