The Rescue

An Andhra man, working in West Bengal, gets a 100% coronary block in Odisha while driving a train at 100 miles per hour.

( A rare moment in a railway doctor’s life)

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At 56, half of my life on this Earth has been spent as a railway doctor. Every thing that can happen in a Railway hospital has already happened to me in those 28 long years. There’s no more expectation, nothing new. The standard Tom, Dick, Harry and Harry, Dick, Tom things except that fateful day.

But then I had never expected a day like this in my wildest of imaginations, one of the most fulfilling day of my career. A very special day indeed.

I was in the casualty that day. A healthy winter has decreased the patient load. Every one was in picnic mode. At 9.30, I called the sister and said,

” I’m going to the first floor to look after my patients in the children ward. Ring me if you got anything serious.”

  Half of our cadre had gone on an year ending health check up camp. Another quarter were out of head quarter on year-end-leave and conference etc etc. I was on casualty duty in addition to my own.

   Halfway in the ward, my phone blinked. I knew the drill. Some old man down there needs the doctor for a routine BP check, though the sister is capable enough for such routine. Every staff in this hospital knows every patient in the colony more than their own sibling. It’s a close circuit. Their repeat list of medicines, their routine problems and even standard complaints are always the carbon copy of their previous visits.

…

I flicked my phone on with a wry smile. It was 10.30.

“Sir, the loco pilot of Utkal express is having chest pain. Doctors to attend.” 

” What is the position of the train ?”

“It has crossed the Mancheswar station. Will reach BBS in 10 minutes.” 

The hospital here is half an hour away from the station on an average traffic day.

“That’s too late.”

“But the message is flashed just now. Ambulance is ready. What emergency kit will you need?”

I imagined a loco pilot having a sudden heart attack inside his cabin while the express is running at 110 kms speed with 1500 people on board. What will I need ?

 Nothing short of a full intensive cardiac unit. And an emergency cardiac technician at the least.

9 out of 10 such calls come out to be false. Especially when the over- worked loco pilot needs some rest in a winter day.

…

The platform is in it’s usual chaotic state. The patient was in Platform 5 at one extreme end. A quarter kilometer walk plus up and down of a foot over-bridge. At least 100 people were climbing up the stairs of the foot over-bridge. Mail has just arrived. An equal number is jostling down for the departing Utkal. Somewhere among the hawkers, peddlers, passengers and on-Lookers there is a sick loco pilot.

 …

They have detrained him. He was sitting in a wheelchair on platform. I bent down over him and took his wrist. Pulse Volume was good. I imagined some missed beats. Then and there I positioned him near a bench on platform, and took the BP. In the midst of the jostling crowd, shrill whistles and noisy loudspeaker announcements, I guessed it was 140/90. Regular beats. I counted again. 72 beats in the minute and very regular.

” I had a severe pain here” he was pointing his finger at the center of his chest. “Just after the MCS outer. It was choking me. Now I feel a bit OK.”

” Ok, move him to an a/c room in the main platform. Let me check him one more time.” 

   I’m now pretty sure that this is going to be a false call. In the quite of the VIP room, the BP was again 140/90. Pulse was regular. Chest was crystal clear. No reflux. My suspicion confirmed. I relaxed.

“Have you had any history of Diabetes or Blood pressure earlier?”

“No sir.”

 He is not supposed to have. Mail express drivers are not supposed to have.

“I think, I have to move you to our hospital for an EKG and full cardiac check-up.”

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-2-

In the casualty, his BP was again 140/80. I went to the loo while the sister wired him for an EKG. 

“I must admit him.” I mused,” this driver belongs to KGP. I have detained an Express train and detrained the Driver. They had to arrange a relief driver at the shortest possible notice. That’s pretty bad. I got angry. This man has put two departments Medical and electrical in a wild goose chase. He will have to pay for this game. “

” Sister, put him on IV pantop.” I said as the sister handed me his cardiogram. I froze halfway. It was a short 4 channel record. Hardly 3 beats per lead and had runs of VT. Not a single normal QRS in view. 

My immediate impression was that these were artefacts. 

“Give the physician a ring.” I croaked and ran to Dr Sahu, our physician with the EKG. That must have been my season’s best 100 meter timing. There was a long queue and he was busy with a patient. I just flopped the strip over the prescription pad he was writing.

 “He is a loco pilot. I have picked him up from the Utkal express.”

“When?”

“Right now.”

“When did he have pain ?”

“Must be 10:30 around.”

“VTs. May need an angio. Have to move him to a Cath Lab before he flops.”

He talked to the cardiologist of Apollo as he looked at his wrist. 11.30.

  We don’t have a Cath Lab.

I ran back to the casualty. The ambulance engine was revving up for a colony call. I stopped the ambulance halfway and sat down for the  necessary paperwork, all the while praying to God. Let him live. You never know if and when an enquiry can be ordered. But if it is, then you will fail to count the number of holes they will  puncture into you.

While I was getting the paperwork ready, Dr Sahu looked at me. The second EKG was not having a single PVC*. His ‘Trop T’ was negative. ST, T changes are there though.

Again pulse was stable, BP steady at 140/80.

As I signalled the patient to be moved to the ambulance, I thought, “you cheat. I’m giving you the benefit of doubt. You’ve made me run the whole forenoon. The day you will come back from Apollo, don’t worry I will be waiting for you.”

…

 It was already  2.00 pm that day before I could be free to feel hungry and famished. I needed a coffee break. Dr Sahu our physician brews the best coffee in our campus. His trademark extra caffeine without sugar. 

He called me,” RK, will you join me for a cup of coffee.”

” I will be blessed. But with extra sugar-free. I’m starving.”

I’m a Diabetic on Insulin and was getting a bit hypoglycemic.

As he handed me a mug with extra caffeine and extra Sugar-free, he added, ” That loco pilot, we had sent, got a stent at Apollo. His LAD was 99 % blocked.”

Whoa ! I dropped my mug. He had a 99% block. And he was driving 1500 people at 100 miles per hour. Blissfully ignorant all the while.

“It happens. God seldom opens up all his cards to mortals.”

“Timing.” I queried.

” 12.30. “

I ran down the timings. 10.30 We got the call. 11.30 We received the patient in casualty. A diagnosis was made. 12.30 he gets a stent. Pain to Stent 2 hours.

“That may be one of our best primary PCI”  Quipped Dr Sahu. “Ahead of any European nations.”

In India it is possible only in Railways or Defence. One assistant professor staying inside the campus of AIIMS could not get access to their casualty and succumbed in a private hospital in the neighborhood. This is miracle of organised health services and team work. There may be many Ivory towers of excellent health care in our country But when it comes to prompt delivery of health care to the common man, IRHS had very few competition.

… …

An Andhra man, working in West Bengal, gets a 100% coronary block in Odisha while driving a train at 100 miles per hour.

In two hours, he gets a PCI stenting in one of the best set up which he could not have possibly selected on his own in his native state. But for that 3 beats of EKG record. That is Indian Railways Health Services in short.

That is Indian Railways Health Services in short.

As I breathed in the hot fresh aroma of coffee, I said, “All is not that bad with IRHS.”

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Glossary:

*VT– Ventricular Tachycardia, a life threatening ECG abnormality.

*PVC – Premature Ventricular Contraction, a serious condition

• Angiogram and Stenting– state of the art life saving procedure available only in equipped cardiac centers.

*PCI– Percutaneous Coronary Intervention.