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. At least that’s what I was thinking when I reached the hospital.
At 9.30, I told the casualty sister,
” Sister, 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 a health check up camp. 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 a BP check and he must have insisted for the doctor. Railway is a close community. Our sisters know each person by face and their requirements. Often it’s a routine BP checkup and routine medicine. Our nurses are competent to handle them.
…
I flicked my phone on with a wry smile. It is 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 Mancheswar station. Will reach Bhubaneswar 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 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.
In 2 minutes, we left with an ambulance for the railway station.
…
The platform was 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 A100 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 was 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.”
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 Khargapur division. It is a different railway zone. 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.”
” 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.
( VT- Ventricular Tachycardia, a Lethal condition of heart, which can cause sudden death even in a young man.)
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. My 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 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 VT. ‘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 fore noon. You come back from Apollo. 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, you had sent, got a stent at Apollo. His LAD was 100 % blocked.”
“Timing.”
” 12.30. That may be one of our best PCI” ( Primary Coronary Intervention.)
A person gets an heart attack when the blood vessels supplying oxygen to the muscles of his heart are cut off. If this state persists for long, the heart muscles start dying. And dead muscles can’t be revived. The golden rule is to intervene ( Primary Cardiac Intervention) and restore the oxygen supply within 60 minutes. In advanced nations, such cases are attended by advanced cardiac ambulances and trained cardiac nurses. These nurses have been trained to recognise the earliest signs of muscle death and push appropriate antidotes right in the ambulance itself. These procedures are risky and can bleed the person to death on the way. But these cardiac ambulances are ICUs on wheels and are prepared to tackle such eventualities on the way to the hospital. They are also seamlessly connected to their cardiac units 24×7 for step by step management of such eventualities on the way.
In our cases, the loco pilot who got an acute heart attack while driving a train at 110 kms speed, was picked up from the station and got a stent in his left coronary within 2 hours of his first signs of heart attack. Seven days after, I was the happiest person on the earth to see him off walking out of our hospital with a note of his illness to his parent unit, Kharagpur. He had two school going girls at his residence waiting anxiously for his arrival.
… …
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 an ordinary situation. But for that 3 beats of EKG record.
As I breathed in the hot fresh aroma of coffee, I said, “All is not that bad with Indian Railway Health Services.”
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