The Gangrene
It started with just a simple boil on the bum ("pilo" in nepali). Slightly uncomfortable but my uncle was ok. After a week, on Saturday he went to a local clinic to get the pus drained. Everything went ok.
The next day, the boil appeared different. The skin around the boil turned blue and started to smell really bad. My aunt and uncle went to the clinic again and asked the physician if it was normal. He prescribed few more antibiotics and said it happens sometimes.
Monday morning, effect grew more. His groin area turned blue. The skin at the lower right back and front body also started to turn red. My uncle and aunt got worried. They and few other relatives went to local hospital of Chhetrapati. He wasn't in pain, he could sit and walk like a normal person. The hospital staff told them to wait for the skin specialist who would come only in the evening. They gave him some antibiotic and painkiller for the mean time.
Around 5 in the evening, the doctor appeared. Just at a glance, he diagnosed it and referred to Teaching hospital for immediate surgery. I joined them in Teaching Hospital around 7 PM.
In the Hospital, they first took my uncle to emergency unit. They needed to do some test before operating. There, I saw the infection in my uncle's body. His lower left abdomen had gotten red as if some poisonous snake had bitten him. It was smelling like rotten food. He was sweating too. He had temperature of only 94.6 F which was bit unusual. He had higher temperature few days before.
The surgeon was busy with other operations. Meanwhile, my uncle was being attended by other doctors. X-ray, video x-ray, blood cross matches and many more test. They had to make sure, anaesthetic could be used on him. I was told to make two units of "whole blood" ready for the operation but they didn't have B+ whole blood in the Hospital's blood bank. Luckily, they had B+ packed cells. The doctor said packed cells will do too. I paid for it and got it reserved. After around 3 hours, at around 11PM, we were told to take him to Operating Theatre. We also bought things needed for operation like syringes, vials, bandages.... Finally, the surgery would be carried out.
Though my uncle could walk, I pushed him in a wheelchair from emergency unit to Operating Theatre. I helped him change his clothes then made him lie in a trolley in the ward outside OT. He said to me, "wow, it's cool here. Looks like they have an AC running". The room had several vents in the ceiling for air circulation. Then, I checked the diagnosis report there. It was "Fournier's Gangrene". I checked wiki and read about the particular infection. This bacterial infection had mortality rate of 40%. But I was hopeful that my uncle would make it. He hadn't complained about any pain. Thought all of his organs are safe. I and my relatives left the OT area and waited downstairs.
At around 1 AM, the doctors called us again. We were all surprised to see my uncle in the same trolley. They hadn't even started the surgery. The doc said his blood test showed very low platelets (only 15000 and they need minimum 50000 to operate, I don't remember the unit), so we have to manage 4 units of Platelets Rich Plasma (PRP) and also 4 units of FFP (Fresh Frozen Plasma). They also told that infection spreads very quickly in this case. We had to manage the blood quickly.
I already had trouble finding blood earlier, I knew that it wouldn't be easy. There was only 2 pints of FFP in Teaching Hospital Blood Bank. I phoned Gangalal Hospital, Exhibition Road Blood Bank and Bhaktapur Blood Bank. None gave us positive reply. My uncle's son said their answer may change if we go there in person. With two motorbikes, I and my three cousins went to Gangalal Hospital in the rain in the middle of the night only to hear no. Then we went to Exhibition Road. Only when we told them that we need blood for immediate operation, we got one PRP and one FFP. We still needed more platelets. We phoned our relatives who had the same blood group. They arrived in teaching around 2-3 AM but there were no staff in blood bank in teaching to carry out the donation process. They would come only in the morning at 10 AM. Then I phoned Bhaktapur blood bank again. They had staffs there. My relatives went to Bhaktapur and came back with 4 PRP and 1 FFP at around 5:30 AM. Even then, the operation couldn't start. The docs told us first they would give 2 packs of blood to the patient, then wait for 2 hours and check the levels, then another two packs and so on. They could operate only after the levels come to the lower limit.
9 AM and more relatives had also arrived there. They came to support my aunt and her sons. All of us who stayed up the night were tired by that time. So we went home to get some sleep.
When I went back to hospital at around 5:30 PM, there was a different scene. They had operated around 11 AM and my uncle was still unconscious. The docs had told my relatives that he would need a medication that would cost Rs 800,000. They also told that the medication cannot guarantee his life though. And my relatives were discussing "how we can afford such expensive medication, he was ok when we took him to OT. He didn't look like he had suffered any internal damage. The docs are just trying to increase our expenses." Different opinions started to flow. I wanted to know about the situation from the doctors but visitors were not allowed to ICU at that time.
My relatives had been there for the whole day. They were tired so they requested me to stay that night too. My younger cousin would join me later. After my relatives had gone, I went to the ICU. The observations showed my uncle's heartbeat and cholesterol was ok. Platelets count was ok too. But his blood pressure was only 90 over something. The resident doctor told me that most of the reports are ok. He also said Intravenous immunoglobulin(IVIG) is generally given to patients in such cases. A daily dose can cost Rs 80,000 and it should at least be given for 5 days. I asked the doc when can they start using IV if I bring them the vial. He said only the specialist/surgeon can start that medication, the soonest would only be the next day. I phoned my elder cousin, nephew of my unconscious uncle, and told about the vial and the price. We decided that we would start the medication the next day. I was hopeful because his pulse and platelets were ok.
It was around 10 AM, when the ICU called for the relatives of the patient at bed no 7 again. Leaving my younger cousin at the ground floor, I went to ICU but they didn't let me in. The resident doctor were applying CPR (Cardiopulmonary resuscitation) on my uncle. I couldn't believe what was coming. I started praying with tears in my eyes. I wished there were my other relatives in the hospital to pray with me, maybe then, the god would listen. Maybe, the prayer would be stronger. I prayed to save him at least for that night. Tomorrow we would start IV.
The docs came out after a while. They said his heart had stopped beating but they managed to revive. "How is that possible? He had a normal pulse rate just an hour ago. How can he have the arrest?" They said when the blood is infected, the bacteria turns the blood acidic and it can stop the heart from functioning. It's called sepsis attack in medical term. And such attacks can come again. "He is only 48, his kids are still young. He is the breadwinner in the family. Please save my uncle", I pleaded. The docs couldn't promise anything. They gave me a list of few other drugs to get for the night. They told me there is no hurry after they saw that I was scattered.
When I was buying the items in the drug store, my elder cousin from Bhaktapur called me. I broke down during the phone conversation and requested my cousin to come to hospital as soon as possible. It was around 11 PM. When I went back to ICU to hand the drugs, the docs were again trying CPR on my uncle. A nurse took the drugs and told me to wait outside. This time, I had to wait for a longer time. I just kept praying. My younger cousin was there too. After a while when the docs came out, they told us that they couldn't get the heart beat back. He told me that "he might be gone". My cousin started crying. But I didn't, I was still trying to understand the situation. I asked more questions to the doctors. After a while I asked, "what do you mean by 'he might be no more'? Are you going to observe him for more while?". Then he said,"No, He is dead". Only then I realised that our favourite uncle is gone. Just a day ago, he was smiling. He was joking that his balls had turned red and if we wanted to see. And now he is gone.
It's been a year now and I often think to myself if only the surgery could have been carried out before he had contracted sepsis, may be, we could have saved him. If only we had taken him directly to Teaching Hospital when the skin started to rot. If only we could get blood support in time, he would still be among us. I am not a doctor but I feel guilty that I didn't go to see him or suggest him to go to Hospital when there was time. Everything went so wrong that time.
I wish such tragedy never happen to anyone else. If you see such signs (skin starting to rot, turning red or blue, and starting to smell anywhere in the body) please take the patient immediately to a reputed hospital. Children are prone to sepsis more. When the blood is infected, germs get transferred to other organs quickly. The temperature of the patient starts to drop drastically when one contracts sepsis. May be, my uncle had already got sepsis when we got him to emergency of Teaching hospital. Also, if you hear anyone looking for blood, please donate. Nepal Blood Banks don't have proper reserves, so they can't provide blood at times. It's very painful to lose someone for the reasons which could have been avoided.
The next day, the boil appeared different. The skin around the boil turned blue and started to smell really bad. My aunt and uncle went to the clinic again and asked the physician if it was normal. He prescribed few more antibiotics and said it happens sometimes.
Monday morning, effect grew more. His groin area turned blue. The skin at the lower right back and front body also started to turn red. My uncle and aunt got worried. They and few other relatives went to local hospital of Chhetrapati. He wasn't in pain, he could sit and walk like a normal person. The hospital staff told them to wait for the skin specialist who would come only in the evening. They gave him some antibiotic and painkiller for the mean time.
Around 5 in the evening, the doctor appeared. Just at a glance, he diagnosed it and referred to Teaching hospital for immediate surgery. I joined them in Teaching Hospital around 7 PM.
In the Hospital, they first took my uncle to emergency unit. They needed to do some test before operating. There, I saw the infection in my uncle's body. His lower left abdomen had gotten red as if some poisonous snake had bitten him. It was smelling like rotten food. He was sweating too. He had temperature of only 94.6 F which was bit unusual. He had higher temperature few days before.
The surgeon was busy with other operations. Meanwhile, my uncle was being attended by other doctors. X-ray, video x-ray, blood cross matches and many more test. They had to make sure, anaesthetic could be used on him. I was told to make two units of "whole blood" ready for the operation but they didn't have B+ whole blood in the Hospital's blood bank. Luckily, they had B+ packed cells. The doctor said packed cells will do too. I paid for it and got it reserved. After around 3 hours, at around 11PM, we were told to take him to Operating Theatre. We also bought things needed for operation like syringes, vials, bandages.... Finally, the surgery would be carried out.
Though my uncle could walk, I pushed him in a wheelchair from emergency unit to Operating Theatre. I helped him change his clothes then made him lie in a trolley in the ward outside OT. He said to me, "wow, it's cool here. Looks like they have an AC running". The room had several vents in the ceiling for air circulation. Then, I checked the diagnosis report there. It was "Fournier's Gangrene". I checked wiki and read about the particular infection. This bacterial infection had mortality rate of 40%. But I was hopeful that my uncle would make it. He hadn't complained about any pain. Thought all of his organs are safe. I and my relatives left the OT area and waited downstairs.
At around 1 AM, the doctors called us again. We were all surprised to see my uncle in the same trolley. They hadn't even started the surgery. The doc said his blood test showed very low platelets (only 15000 and they need minimum 50000 to operate, I don't remember the unit), so we have to manage 4 units of Platelets Rich Plasma (PRP) and also 4 units of FFP (Fresh Frozen Plasma). They also told that infection spreads very quickly in this case. We had to manage the blood quickly.
I already had trouble finding blood earlier, I knew that it wouldn't be easy. There was only 2 pints of FFP in Teaching Hospital Blood Bank. I phoned Gangalal Hospital, Exhibition Road Blood Bank and Bhaktapur Blood Bank. None gave us positive reply. My uncle's son said their answer may change if we go there in person. With two motorbikes, I and my three cousins went to Gangalal Hospital in the rain in the middle of the night only to hear no. Then we went to Exhibition Road. Only when we told them that we need blood for immediate operation, we got one PRP and one FFP. We still needed more platelets. We phoned our relatives who had the same blood group. They arrived in teaching around 2-3 AM but there were no staff in blood bank in teaching to carry out the donation process. They would come only in the morning at 10 AM. Then I phoned Bhaktapur blood bank again. They had staffs there. My relatives went to Bhaktapur and came back with 4 PRP and 1 FFP at around 5:30 AM. Even then, the operation couldn't start. The docs told us first they would give 2 packs of blood to the patient, then wait for 2 hours and check the levels, then another two packs and so on. They could operate only after the levels come to the lower limit.
9 AM and more relatives had also arrived there. They came to support my aunt and her sons. All of us who stayed up the night were tired by that time. So we went home to get some sleep.
When I went back to hospital at around 5:30 PM, there was a different scene. They had operated around 11 AM and my uncle was still unconscious. The docs had told my relatives that he would need a medication that would cost Rs 800,000. They also told that the medication cannot guarantee his life though. And my relatives were discussing "how we can afford such expensive medication, he was ok when we took him to OT. He didn't look like he had suffered any internal damage. The docs are just trying to increase our expenses." Different opinions started to flow. I wanted to know about the situation from the doctors but visitors were not allowed to ICU at that time.
My relatives had been there for the whole day. They were tired so they requested me to stay that night too. My younger cousin would join me later. After my relatives had gone, I went to the ICU. The observations showed my uncle's heartbeat and cholesterol was ok. Platelets count was ok too. But his blood pressure was only 90 over something. The resident doctor told me that most of the reports are ok. He also said Intravenous immunoglobulin(IVIG) is generally given to patients in such cases. A daily dose can cost Rs 80,000 and it should at least be given for 5 days. I asked the doc when can they start using IV if I bring them the vial. He said only the specialist/surgeon can start that medication, the soonest would only be the next day. I phoned my elder cousin, nephew of my unconscious uncle, and told about the vial and the price. We decided that we would start the medication the next day. I was hopeful because his pulse and platelets were ok.
It was around 10 AM, when the ICU called for the relatives of the patient at bed no 7 again. Leaving my younger cousin at the ground floor, I went to ICU but they didn't let me in. The resident doctor were applying CPR (Cardiopulmonary resuscitation) on my uncle. I couldn't believe what was coming. I started praying with tears in my eyes. I wished there were my other relatives in the hospital to pray with me, maybe then, the god would listen. Maybe, the prayer would be stronger. I prayed to save him at least for that night. Tomorrow we would start IV.
The docs came out after a while. They said his heart had stopped beating but they managed to revive. "How is that possible? He had a normal pulse rate just an hour ago. How can he have the arrest?" They said when the blood is infected, the bacteria turns the blood acidic and it can stop the heart from functioning. It's called sepsis attack in medical term. And such attacks can come again. "He is only 48, his kids are still young. He is the breadwinner in the family. Please save my uncle", I pleaded. The docs couldn't promise anything. They gave me a list of few other drugs to get for the night. They told me there is no hurry after they saw that I was scattered.
When I was buying the items in the drug store, my elder cousin from Bhaktapur called me. I broke down during the phone conversation and requested my cousin to come to hospital as soon as possible. It was around 11 PM. When I went back to ICU to hand the drugs, the docs were again trying CPR on my uncle. A nurse took the drugs and told me to wait outside. This time, I had to wait for a longer time. I just kept praying. My younger cousin was there too. After a while when the docs came out, they told us that they couldn't get the heart beat back. He told me that "he might be gone". My cousin started crying. But I didn't, I was still trying to understand the situation. I asked more questions to the doctors. After a while I asked, "what do you mean by 'he might be no more'? Are you going to observe him for more while?". Then he said,"No, He is dead". Only then I realised that our favourite uncle is gone. Just a day ago, he was smiling. He was joking that his balls had turned red and if we wanted to see. And now he is gone.
It's been a year now and I often think to myself if only the surgery could have been carried out before he had contracted sepsis, may be, we could have saved him. If only we had taken him directly to Teaching Hospital when the skin started to rot. If only we could get blood support in time, he would still be among us. I am not a doctor but I feel guilty that I didn't go to see him or suggest him to go to Hospital when there was time. Everything went so wrong that time.
I wish such tragedy never happen to anyone else. If you see such signs (skin starting to rot, turning red or blue, and starting to smell anywhere in the body) please take the patient immediately to a reputed hospital. Children are prone to sepsis more. When the blood is infected, germs get transferred to other organs quickly. The temperature of the patient starts to drop drastically when one contracts sepsis. May be, my uncle had already got sepsis when we got him to emergency of Teaching hospital. Also, if you hear anyone looking for blood, please donate. Nepal Blood Banks don't have proper reserves, so they can't provide blood at times. It's very painful to lose someone for the reasons which could have been avoided.