Weekends with Dr Jagadish: A beautiful child called Poovi

Dear friends, I will be writing to you every weekend on issues which are nice or important or maybe something which caught my eye or taught me a lesson.

In this episode, I shall write from one of my first experiences as a doctor in an ICU taking care of a child.

Eighteen summers ago as a freshly minted Doctor out of a university hospital, I joined a hospital to work in ICU. The concept of paediatric ICU was not so well developed in India then, whilst NICUs were ubiquitous. The children were invariably kept with adults in the ICU if they needed extra support beyond the ability of ward staff/facilities.

A child was brought to the ICU where I had just joined as ICU in-charge. The baby was little more than a year old and was suffering from severe breathlessness; the attending Paediatrician had diagnosed it as community acquired pneumonia and treating the baby as such. On admission we had put a small tube into the stomach of the baby and did a wash. The lavage screening later confirmed an organism called streptococcus pneumococci as the cause of pneumonia.

We used to allow an attendant to be with the baby in ICU if the baby/child was less than 4 year old, as we could not afford our nurses to babysit. Invariably with all babies we were accustomed to see the mother/grandmother of the child babysit in ICU. In this unusual case, it was not the mother but sister of child who took to the job of babysitting.

It was here I saw this beautiful little girl; she barely looked like a 10 year old. My first reaction on seeing the child was; why is this child inside ICU?  I was concerned about her contracting resistant nosocomial infection. I called for the nurse in charge, requested her to send the child outside and bring mother or someone else the baby is familiar to accompany him. At that moment, the girl spoke to me directly (the voice was sweet as any small kid’s voice would be) and said “Doctor uncle: please allow me to be with my brother, there is no one other than me here, amma is back in village, she has work to do”. I ignored her sweet voice, with the faux authority of a man in-charge and asked the nursing in-charge present there, to check for her dad or anyone else to be brought in, instead of her.

The nursing in-charge was a smart lady, she had already done it and told me that the girl was right and she was the only one available to baby sit the kid. I asked the nurse attending the child “can you manage the baby without her?” To this too, the nursing in-charge replied that the baby cries incessantly, if Poovi goes out. That was the first time I heard the child’s name. At that point, I went to attend to other patients, the ICU was full, I was new and had to impress the staff and the boss who paid my salary.

In the next eight days, I was greeted by the radiant smile of little Poovi whenever I entered ICU and I got used to it. She grew on me, my rounds in the ICU started with her smile and ended with a small chat to her. She became the raison d’etre for me spending extra time in ICU. In her own innocent way she told me about her alcoholic father, her hard working mother and how she (little Poovi) used to take care of her brother.

On ninth day myself and the paediatrician decided that the baby was better and can be shifted to ward, so little Poovi and her brother were sent to paediatric ward. The paediatric ward was in the far corner of the hospital which I seldom visited it as I did not like to be amongst crying babies; except that on this instance little smiling Poovi lured us (me and 2 other nursing staff) to visit her. I spent twenty rupees and got her a dairy milk chocolate, boy was she happy!  I remember telling the nursing staff on many occasions, that I had never seen such a beautiful child and mera nazar na lag jaye usko.

In the next four days the baby was discharged, an uncle of Poovi along with her mother took the children back to their village in Coorg, called as the Scotland of Karnataka. A month or so elapsed and our memory of the baby and Poovi were almost evanescing.

One morning at 5 AM, I was woken up by the nonstop ringing of my phone (landlines were the life savers of that time). I was asked to come and see a child immediately. Staying in the quarters given by the hospital, it was just a 3 minute walk to the casualty. I was shocked to see Poovi brought unconscious to casualty and her inconsolable mother. She was admitted to the same ICU where she used to welcome me with her beautiful smile. In the next 3 days her condition worsened and we lost the most courageous, caring and beautiful child to the dreaded pneumococcal meningitis.

I can never forget her smile or her love to her brother or her ability to adapt to the needs of her family; she has always made me wonder “are all girls born mothers”. It always brings me tears to even think that I was somehow responsible for the death of this beautiful child and I curse myself for allowing her to be with her brother in the ICU. Lesson learnt at a great irredeemable cost.

PS: This series "Weekend with Dr Jagadish" will be published in @indsamachar and as usual all my articles will appear on my personal blog.

Dr Jagadish J Hiremut is a superspecialist medical doctor based out of Bangalore, a medical author, blogger, medical technology expert and is a proponent of Value Based Ethical Medical practice. He is Director for clinical services and Advanced Medical Technology in the home grown multinational medical equipment company Skanray Technologies Pvt Ltd. He is also CEO of ACE Embedded Intensive Care Units Pvt Ltd a company which runs outsourced Intensive Care Units for hospitals. You can follow him on twitter @Kaalateetham or mail to drjagadish10@gmail.com