Dr. Christo Philip Chronicles
A Day in the Life at Duncan
People often ask us what a day at Duncan Hospital looks like. So I decided to write down all the events I could recall from one day at Duncan. Hopefully it will give readers a sense of the patients that come through the doors of Duncan each day and a glimpse into the lives of the staff that work at Duncan. Yesterday was a particularly challenging day, so the following is a glimpse from sunup to sundown...of course it does not include the 13 vaginal deliveries, the 5 c-sections, 1 breech delivery and 2 twins born courtesy of Dr. Dianna and Dr. Sharon. It also doesn't include the 352 patients seen in the outpatient clinics by Dr. Vinod, Dr. Jeni, Dr. Chandan, Dr. Sunil, Dr. RK, Dr. Mini, and Dr. Mahitha.
3:30 am - called to see patient in ICU with a perforated duodenal ulcer who is now breathless. Placed on respirator because his breathing is bad.
4:00 am - while waiting to place chest tube in the first patient who has a pleural effusion (fluid in chest cavity), a 4-year-old child with hepatic encephalopathy (liver-related swelling in brain) in another ICU bed starts having seizures. Patient begins constant seizures and because of the poor prognosis (bilirubin of 32 – normal is less than 10, INR high) due to total liver failure decide not to intubate. The child is given large amounts of midazolam and phenytoin to control seizures, and after 45 min the seizures stop. Also see another young boy (7) who has liver failure and ascites (fluid in abdomen). He also has hepatic encephalopathy (brain swelling due to liver problems). Question of whether he has a Kayser Fleischer ring suggestive of Wilson's disease.
4:30 am - start placement of chest tube in ICU with Dr. Divya for large pleural effusion in the first patient. Start the procedure but find out we don't have the right tools for a chest tube placement in the ICU. Nurses go to operating theater to find chest tube tray.
5:15 am - chest tube placed, 1.2 liters of fluid come out of the chest.
5:30 am - get morning report from ICU nurses on the adult patients in ICU.
6:00 am - spend some time reading through the Psalms because I feel so overwhelmed. Spend time in prayer for patients and pray that God would send others to help us at Duncan.
7:00 am - the first child with a bilirubin of 32 and seizures dies.
7:30 am - patient with likely eclampsia who is a 20 y/o (20 year-old) first-time mother who was found unconscious by her family is brought in. Her baby at 38 weeks is already dead. Her blood pressure is 150/110 (normal is 120/80) and she has 4+ albumin (should be 0) in her urine. She is transferred to ICU because she has pulmonary edema due to eclampsia.
8:00 am - finish a couple of emails to visiting students and friends.
8:20 am - read a couple of Vivek's (son) books with him along with a few poems for home schooling.
8:40 am - have breakfast with Melissa and the kids.
9:10 am - ICU rounds begin. A middle-aged woman with seizures who was admitted the previous night is transferred out of ICU. Family is elated by how much better she is. Patient with chest tube better but family very poor and unable to afford treatment - likely will need to give considerable charity. Pray with patient and family.
9:45 am - called to see 4 surgical patients that need to all be cleared for surgery later in the day. 2 patients have hernias that will be repaired, 1 patient is a 16-week pregnant woman that has appendicitis. I warn them they could lose the baby because of the infection. There is also an anal fistula that is cleared for surgery.
10:30 am - back to ICU. Speak with family of pregnant patient with the intrauterine death and eclampsia. She has poor urine output and likely has rhabdomyolysis (decomposition of muscle) and is developing renal (kidney) failure. Attempting to increase her diuresis (urine flow). We pray with the family for her healing.
11:15 am - see one of our staff in private ward who has diabetes and vertigo. Discharge another patient from private ward who has heart failure and aortic regurgitation.
11:45 am - go to casualty to see patients with Dr. Meena. There is an elderly man with shortness of breath who has a left lower lobe pneumonia. There is a 30 y/o woman with extreme tachypnea, breathing at close to 40 breaths per minute (normal is 15). Lungs are clear with normal saturation, so likely due to severe acidosis (level of acidity in blood). Arterial blood gasses sent off. See another staff member who has been vomiting all morning.
12:00 pm - see patients in OPD with Dr. Divya. A patient with constant migraines needs a consultation. Another patient with diabetes needs her medications adjusted.
12:15 pm - run home for a quick snack.
12:40 pm - called to casualty to see one of our dentists who is sick. There are multiple sick patients in casualty that also need to be seen. 65 y/o man comes in gasping. His saturation is barely at 30% and the lungs sound horrible. Even not improving on oxygen. History of TB for several months. Family told there is nothing we can do except palliative care; diazepam given to ease his respiratory distress. Family decides to admit for comfort care. A few minutes later another 70 y/o woman comes in with cough she’s had for one week and severe breathlessness - some relative was prescribing her medications. Her saturation is about 40% and her lungs sound awful. X-ray shows bilateral TB involving the entire lungs. Told there is very little chance that the patient will survive but family wants everything done. Admitted to ICU on antibiotics but decision made to not intubate if she gets worse. Meanwhile Test on arterial blood gasses on 30 y/o woman comes back. pH is 7.04 and bicarbonate is so low it is unrecordable, creatinine comes back at 10. Outside ultrasound shows severe bilateral hydronephrosis (swelling in kidneys) of unknown cause. Family asked to take patient to Patna (7 hours away) for dialysis - they take time to decide. Given bicarbonate to help her with her acidosis. Also a 3-month-old comes in severely dehydrated. Given IV fluids and admitted to the pediatric ward.
1:50 pm - home for lunch.
2:40 pm - have Luke (son) read me a book for homeschooling.
2:50 pm - go back to casualty. Dr. Meena is getting ready to intubate a 24 y/o man who came in with florid secretions and likely organophosphate (pesticide) ingestion. We can't get his heart rate up. Total of 12 mg of atropine given. Patient intubated, friends manually ventilate the patient until family can arrive. Craziness breaks loose in casualty. There are patients coming in left and right. 11 y/o comes in with vomiting and likely carpal spasm due to hyperventilation. First young man admitted to ICU on ventilator and started on atropine infusion – heart rate still continues to intermittently drop. 10-day-old baby comes in with neonatal sepsis due to pneumonia - admitted to nursery. As soon as first man with OP poisoning is transferred to ICU, another man comes in with severe hypertension and dizziness - given blood pressure medications and asked to come to outpatient clinic. 20 y/o man comes in with 8 days of abdominal swelling - his abdomen has significant ascites - differential diagnosis is liver failure vs TB abdomen. Another 55 y/o woman is brought in from six hours away in Nepal with left thigh swelling and unable to walk for 5 days. She has been in bed for the past five days because of the pain. Her leg is externally rotated and shortened - she has a left hip fracture.
4:30 pm - a 20 y/o G4P2 patient comes in - she is now 16 weeks pregnant and had come to our antenatal clinic the day before when Dr. Rama Krishna had picked up a loud murmur. ECHO was done by Dr. Joanna which showed an Ebstein anomaly (she was born with the tricuspid valve in the wrong location) along with rheumatic heart disease of her mitral valve. She comes to see me for a final consultation. Her husband is in Kashmir so I explain to her mother-in-law that the woman is very sick and will get sicker in her pregnancy and she needs to see a cardiologist and a high risk OB-GYN in Patna. Referral letter written for Patna, start her on penicillin injections to prevent further damage to her heart valve, and on lasix to control her heart failure. The family of the patient who was admitted for palliative care due to tuberculosis has a change of heart and asks for discharge so that he can die at home. Dr. Meena works on filling out the discharge summary so that they can take him home.
5:00 pm - Dr. Divya brings in two more patients from the outpatient department for me to see. The first is a 34 y/o man with continued cough even after 6 months of TB medications. His repeat chest xray shows continued active lesions. He likely has multi-drug resistant TB and is referred to Muzzafarpur for further testing. The second is a poor patient that likely has trench foot. His toes are all being eaten away by a fungal infection. His toes have been macerated and oozing pus for the past few months. He doesn’t have money for his medications so we write for charity to help him.
5:30 pm – 8-month-old girl is brought in for an upper respiratory infection, while getting history another 30 y/o man comes in with unclear history. His has wet lungs, his saturation is 70% and heart rate is in the 140s; he is gasping. We intubate him and give him atropine with which he improves somewhat. Family says he went out of the home last night and came in that morning altered. Unsure of cause but as soon as we put in the NG tube the characteristic smell of organophosphate comes out. As we are intubating him an 8 y/o boy who is hit by a motorcycle comes in with a large laceration of the face - father is freaking out - we tell him he has to wait until the intubation is done. The 30 y/o woman with the renal failure is taken home. Family cannot take her for dialysis tonight so they will take her home first and try in the morning - we tell them she will likely die in the next few days if she doesn’t get dialyzed. Dr. RK, Dr. Chandan and Dr. Vinod come to help us in casualty after they are done with their outpatient clinic patients. They see the remaining patients in casualty to help Dr. Meena.
6:30 pm - I go back to ICU to check on the first patient we intubated earlier. He looks bad. His pH is 6.83, bicarbonate is unmeasurable. BP is 240/140 and he has a slow heart rate again. Increase the atropine, start on nitroglycerin drip-- he has very little response on the ventilator so I talk to the family and explain he likely has a head bleed. Unusual to see such high BP with organophosphate poisoning but it happens occasionally. No ventilator available for the second intubated OP patient. Nurses work frantically to wash out and dry a ventilator circuit so that we can get him on the 3rd adult ventilator. We try the circuit but it is not working. Thankfully Dr. Vinod is able to take a baby with sepsis and apnea off the ventilator and thus we connect the new patient to that ventilator. Dr. Vinod and I discuss another patient intubated earlier in the day by him - a 7 y/o boy with pneumonia, pulmonary edema, and hypertension. Unsure as to the cause. Dr. RK fixes up the laceration on the 8 y/o boy’s face. Dr. Sunil has another surgical case - acute appendicitis in a young man. I go to the surgical ward to do a pre-anesthetic evaluation to clear him for surgery which will happen an hour later.
7:15 pm - I get home but ICU calls again because the young man with OP poisoning is very sick. His heart rate is in the 40s and now his BP is very low. We stop the nitroglycerin infusion and increase the atropine. Poor prognosis again explained to the family.
7:40 pm - I go back up to casualty with Dr. Emily to sign some prescriptions and see another patient that has had a reaction to a medication he received from an outside pharmacy.
7:50 pm - go to one of the nursing school staff’s home for their 13th wedding anniversary. Have dinner but am extremely tired so we leave early.
8:50 pm - a couple more calls from ICU and surgical ward about new patients. Another patient with necrotizing fascitis (dying tissue) has come in that needs to be cleared for surgery. Collapse into bed.
Please pray for endurance for all of us and that God would be glorified here...special thanks to our wonderful casualty and ICU nurses who work tirelessly and without complaint. Without their hard work and dedication it would be impossible to care for so many sick and needy patients. With Pranoti, Nand Kishore, Suresh, Roseleen, Zing, Suman, Divan, Justina, and Sangmu.
At Duncan Hospital...
"The God I Never Knew"
|Ramesh and his medical team at Duncan
Sometimes it takes a tragedy or two for God to get our attention. Ramesh's life of sorrow began when he was a child. His mother contracted tetanus, and despite the fact that his father sold their family home and property to pay for her treatment, she still died. His father moved them to a rental house in the city to look for work. Tragically, a few years later, Ramesh's father died as well.
This left Ramesh taking on the responsibility of providing for his two younger brothers when he himself was just a teenager. He found work in a chemical factory and labored faithfully for many years, but one day, one of the chemical vats exploded and the left side of Ramesh's face, chest, and arms were badly burned by the acid. He was disfigured beyond recognition on over half of his body. The acid also ate away his left eye, causing him to lose vision in that eye.
He spent over eleven months in a government hospital, slowly healing. While he was recuperating, Ramesh's family went deeper and deeper into debt, selling most of what they owned to survive. Somehow Ramesh recovered and found work as a peanut seller. Most of his day was spent with people gawking at his scars. Ramesh's wife, three small children, and his two younger brothers all lived together in a small, rented house. The middle brother sold coconut water from a cart and the youngest brother worked in a nearby factory.
Then disaster struck again. His youngest brother ran off with the factory's owner's daughter, causing the angry owner to hire thugs to threaten Ramesh's life and torture him to force his brother to leave the young woman. In his moment of greatest despair, Ramesh felt he had nothing left to live for, and he drank down a bottle of pesticide.
He arrived at Duncan Hospital gasping for air with his wife and middle brother by his side. He was quickly intubated, started on an atropine infusion, and transferred to the ICU for ventilator support. He improved fairly quickly, and by the next day, they had removed his endotracheal tube. The staff watched him carefully for another day, prayed for him with his family, and by the third day he looked well enough to come out of ICU.
Later that afternoon, Dr. Philip felt an urge to go see Ramesh, even though he was about to teach a class. He found a concerned nurse checking Ramesh, who was slipping into unconsciousness and suffering from all the symptoms of organophosphate poisoning again. The staff broke the news to his wife and brother and rushed him into the ICU to intubate him again. Dr. Philip explained to Ramesh's family that with the second intubation he was likely to develop intermediate syndrome, a condition where the muscles become paralyzed.
His family stayed close by to support Ramesh, keeping vigil in the ICU waiting room. It was obvious how much they loved him. Again Ramesh improved, and on the sixth day he was extubated. Dr. Philip tried talking with him, but he was sullen and withdrawn. His younger brother never once came to see him in the hospital, and had called to say he didn't care if Ramesh lived or died.
A day later, another doctor checked on Ramesh and found him struggling to breathe. He was transferred back to ICU and re-intubated once again. Now Dr. Philip had to explain to the family that the chance of a quick recovery was next to nil. They were looking at another one to two weeks in ICU. The family was struggling to pay the bills because both wage earners in the family were at the hospital. The community medicine doctor did an analysis of their financial situation and determined a reasonable amount to ask them to pay, with the remainder given as charity care.
The staff continued to pray for Ramesh and he came off the ventilator two days later. They talked with him and his family a number of times about God's love for them. One of the ICU nurses gave Ramesh a copy of the Bible in Hindi, and with his one good eye he faithfully read through it, starting with the book of John. A few days later, Dr. Philip spent a long time talking with Ramesh about his life and how the Lord must have a plan for him because three times he had almost died and three times God sent someone in the nick of time to save him.
Ramesh then said something unexpected, "I knew I was going to die when I came to Duncan Hospital. I had been treated at a government hospital for the poisoning before they transferred me here. I don't remember much about when I came to this hospital, but the one thing I do remember is that I saw a vision of God when I came to Duncan. I saw Him before I went unconscious. When I survived, I kept wondering who it was that I saw, but now that I have read the Bible I know that the God I read about in this book is the One I saw when I came here." Dr. Philip was flabbergasted. He had heard of God revealing Himself to people through visions and dreams, but this was the first time one of his patients had experienced it.
The doctors and nurses prayed together with Ramesh and explained to him the wonderful news of God's love for him - that He sent His Son, Jesus, to die for Ramesh's sins and that by accepting this gift of God, Ramesh could have new life. He understood and accepted this Good News.
Ramesh was still quite weak, so he spent another two and a half weeks in the hospital. When he was discharged, a large portion of his bill was given as charity so that the family wouldn't go into more debt. The hospital staff threw a party for Ramesh before he left. He shared with them at the party, "My whole life I never knew this God. But because of what happened to me, I met Him for the first time here in a vision. After being here, I know who it is I saw in my vision. Now that I know about Him, I will tell all of my friends and family about what this God has done in my life!" His smile radiated as he shared with them. It was still the same crooked smile due to the scars on his face, yet his countenance was transformed. Though the physical scars remained, Ramesh was made whole because of God's incredible love for him. In God's redeeming work, Ramesh went home a sinner forgiven, a heart transformed with the assurance of knowing a Friend who will never abandon him.
Through Dedicated Doctors and Nurses...
Finding Relief From Seizures
Pintu was a 14-year-old boy who came to Duncan with a history of uncontrollable seizures over a seven-year span. His family had spent almost all their money going from hospital to hospital trying to find a cure. No one was able to get his seizures under control, even at the major medical institutions in Delhi.
He came to Duncan's emergency department and received a thorough exam. His labs showed that the "seizures" he was having were muscular contractions caused by abnormal calcium metabolism. It was determined that Pintu had diminished parathyroid hormone secretions, so once he received medication to treat that condition along with calcium supplementation, this boy who had seized up to eight times a day was finally cured.
|Pintu and Dr. Christo Philip
With tears in his eyes, his father told the hospital staff how bright his son was, but that due to his seizures, Pintu hadn't been allowed to go to school. Everyone thought his family was cursed because of his son's condition. He said, "I have gone to every part of this country for a cure, and if only I had brought him to Duncan years ago, how much better my son would have been!"
Pintu returns to Duncan regularly for checkups and continues to do well. He is getting private tutoring to catch up in his studies. This young man's life was drastically changed thanks to the thorough medical care he received at this EHA hospital.
Miracles Are Happening...
Brought Back to Life -- Three Times
| Ragini (in pink) with hospital staff and family
The odds were stacked against her. Ragini, a 19-year-old young woman, found out her husband had lost his job and responded by attempting suicide. Upon arrival at Duncan Hospital, she was struggling to breathe, so staff intubated her immediately and placed on the ventilator in the ICU. In her first two days in the hospital, she had three separate instances of cardiac arrest lasting at least five minutes and requiring CPR. Each time, the medical team faithfully got her heart going again.
She then developed intermediate syndrome, which paralyzed her for almost three weeks. After almost a month in the hospital, this
woman whom hospital staff did not think would survive, much less speak or eat again on her own, was able to do all that and more. Ragini walked home on her own two feet. Her family was so grateful for the care provided to her at Duncan -- especially the nurses who lovingly cared for her for over a month and kept her from getting bedsores.
Ragini came back for a visit three months later, a completely transformed young woman with no residual neurological deficit. Everyone thanked the Lord for her miraculous healing.
Through the Mother and Child Health Clinic...
Duncan Hospital Educates Women
Rabita Devi is a woman from Guleria village in Bihar. Married at 16, Rabita suffered the grief of delivering two stillborn children over the course of the next seven years.
Rabita Devi and her baby
In 2012 she conceived for the third time. Understandably, she was anxious about losing this child too. She couldn't stop thinking that her baby could die.
One morning as she peeped from her window she saw a horse and cart near her home with a mother stepping out, holding her newborn baby. She went to this neighbor to ask where her baby had been born.
This neighbor proceeded to explain to her the importance of getting antenatal checkups and choosing to deliver in a hospital. She told her about the Mother and Child Health Clinic in Barwa village where antenatal care was provided at minimal cost. This clinic also referred women to Duncan Hospital for their deliveries.
Rabita went home with her hope renewed. She told her husband, Jitendra, all she had learned. Soon Rabita visited Barwa Clinic and was referred to Duncan for an abnormal presentation. On January 30, 2013, Rabita delivered a heathy baby boy via C-section. Duncan staff were able to provide her a 75 percent discount based on her ability to pay.
Today Rabita is a happy mother who makes a point to tell other young women about the importance of antenatal care and hospital deliveries. Duncan staff are succeeding in re-educating women about mother and child health, one woman at a time.
In a Duncan Dental Chair...
Man Finds Eternal Relief
His pain was more than physical. Nilay wept openly, and the dentist was quick to find out what was wrong. Because of a severe toothache, he had been unable to attend an important religious event. This particular festival draws millions of people, and the attendees' belief is that their sins will be washed away and they will attain moksha (salvation). Naturally, Nilay was upset that he could not attend. The EHA dentist who heard this story felt led to share the way of true salvation and the finished work of the cross with Nilay. Tears streaming down his face, Nilay accepted this salvation plan right in the dental chair. That day both his physical and his spiritual pain were healed.
From a Disability Screening Camp...
Feet Made Whole
Little Ashish was born with a clubfoot condition in both feet.
Ashish and his mother
Naturally, his parents were concerned, so after hearing about the disability screening camps held by Duncan's Community Based Rehabilitation Department, they brought him in when he was six months old. They had been told by the doctor at the government hospital where he was born that his treatment would involve surgery and could not begin until he was a year old.
The doctors at Duncan Hospital asked the parents to bring Ashish in weekly for serial plaster applications. After seven casts, his feet no longer had any deformity. He will continue to wear splints and hopefully will lead a normal life. Ironically, a child brought in to a disability screening camp now is no longer disabled.
Expanded Capacity Addresses Growth...
Mother and Child Health
Duncan Hospital has taken a giant step forward in their care for expectant mothers. Patients are now seen in the Mother and Child Health building, which opened in August 2011. During the first month of this facility's use, 661 babies were born. This building is enabling doctors and nurses to provide better, safer care for mothers and their children.
Many Indian women who do not live near an EHA hospital give birth at home, where the consequences of complications can endanger the lives of both the mother and baby. The compassionate care patients receive from doctors and nurses at Duncan often is their only exposure to the love of Christ.
The hospital serves approximately two million people from an area in the north Indian state of Bihar as well as parts of neighboring Nepal. If it were not for Duncan, these people would have nowhere to go for safe, sanitary medical care. The original building was constructed in the 1950s and had deteriorated significantly. Every year, during the monsoon season, parts of the hospital would flood. The new facility is cleaner, more spacious, and has more natural light and ventilation. The nurses' stations are within the wards so nurses are better able to monitor and care for patients. Currently, all inpatient services have been moved to this new facility until funds are raised to build separate medical and surgical wards as well as a complex for radiology, x-ray, ultrasound, and laboratory services. Your gift today will help Duncan Hospital move toward the reality of having this expanded facility to serve others with love.
Preparing to Serve...
School of Nursing and Medical Laboratory Techology
India has a critical need for primary health care training. An extension of Duncan Hospital's efforts to serve the poor is its School of Nursing. The students take the three-year General Nurse Midwife program, and must pass both written theory tests as well as practical exams. Once these students graduate, they can move on to become staff nurses and help the many patients they encounter.
Students often come from lower-middle-class or middle-class backgrounds from many different Indian states and also from Nepal. Some desire to upgrade from their status as Auxiliary Nurse Midwives, which is a two-year degree. The Duncan School of Nursing began in the 1950s and the General Nurse Midwife program started in the 1970s. To date, 586 nurses have graduated from the GNM program and gone on to serve at Duncan or other EHA hospitals. The School of Nursing expects to receive approval from the Indian Nursing Council as a College of Nursing so that they can offer Bachelor of Science training as well. Duncan's School of Medical Laboratory Technology also offers a course at the Bachelor of Science level to train students to become laboratory technologists. These students support the medical treatment of the doctors by collecting samples of body fluids such as blood in order to conduct tests, document results, and send this information to the doctors.
About Duncan Hospital
Located in Raxaul, Duncan Hospital serves 11 million people in North Bihar and Southern Nepal. It was founded by Dr. H. Cecil Duncan in 1930 and shaped by Dr. Trevor Strong and his wife, Patricia. The Regions Beyond Missionary Union managed the hospital until 1974, when it was handed over to EHA. Duncan’s service priorities now include obstetrics and gynecology, medicine, surgery, pediatrics, ophthalmology, radiology, and dentistry. They also provide nursing services and education.
Duncan’s current goals include striving to establish and maintain principles as they look beyond their hospital walls to impact the town and surrounding communities. Working toward social and physical transformation, they desire to impact the community’s holistic health, facilitate groups for worship, and develop trust with the local community.
In 2011, Duncan Hospital opened its new Mother and Child Health Block, a brand new facility that houses up-to-date medical equipment and patient care areas. This building has 235 patient beds as well as operating rooms, labor rooms, an ICU, and wards for pediatric patients, obstetric and gynecological patients, and newborns.
The hospital runs community health and development programs focused on six areas: urban community development; rural community development; community based rehabilitation for children with disabilities; HIV and AIDS care; community eye services; and community dental services.
They seek to work with the community to meet the needs of the poorest people, wanting to make sure that no one goes without medical care because of a lack of funds. Offering prenatal care, they help women prepare for safe childbirth and make wise decisions regarding medical care for themselves and their children. They seek to raise awareness about AIDS and HIV within the community. They also offer a literacy program, trying to help everyone who desires to learn to read.