Fragrance, Fluids, Fits, Frets – heightened encounters in normalcy

By Dr. Geeta Sundar

I’m surrounded by smells. Whiffs. All kinds. From the moment I step into the hospital, my nose is an overworking machine. And as I walk into the corridors that bridge the entrance to my wards, I’m precipitated with stench of ammonia, the smell of breakfast, coffee, blood, phenol, hospital alcohol, smoke, toothpaste and sweaty odors and stools of bed ridden patients. It’s overly sensitive. It’s overly disgusting and it’s all at once. It’s a solid minute before I can filter out the worst and focus on my own breath as I re-adjust my mask.

#suchislife

Thanks to COVID and the bygone era of 2022, I’m more comfortable with a mask than without it. Our odors are made up of what we eat – the alkaline and acidic content, our genetics and our working jobs. And as Indians, with our diets and masalas, our smells are an all-time high. It’s what it is, we hone our noses to adjust to all kinds of smells as doctors, albeit often the smells are not for the faint hearted. It becomes routine, the adjusting we do. It becomes an accepted collateral damage. It becomes one with our understanding of the medical science.

If that is the spectrum of the olfaction, the auditory is a lighter bearing, usually. Sounds from shouts, to cries, to indignation, to energetic yells, to sadness, to weeps, to trilling sharp overtones of different phones and rings, speakers, crass-calling, swearing are too much insanely routine too. But some days, the voices shun when a trauma of the inexplicable broaches in.

The woman lay there, still. The triage is filled with the wails of her mother and father. The mother is a hapless human, in fits and fits of overwhelming sadness. Her tones capture her grief and it’s an absolute numbing reality as she questions on why this happened. She just lost her daughter to a self-attempt whose C1-2 is beyond repair and similarly the cord and above it. Her voice carries painful tears that could resonate with any living creature and the tears are too raw to offer any consolation. Nobody approaches her. Nobody says anything. Privacy is just a layer of curtain separating from another booth. The whole surrounding is quiet except for her wails and the hustle-bustle of the trolleys and gurneys. I am affected, despite my outer choice not to be. Days like this, one is reminded of the hard, harsh pain left behind on the family of the lost soul and the importance of life. Bereaved, broken and bereft. One’s passing can have such a disastrous impact on the souls they leave behind.

#lossisdeadening

A proff of mine used to say, surgeons choose their fluids – urologist has to accept urine as part of his/her life, a gastro-surgeon – bowel liquids, a Cardiovascular – blood (even though blood connects all, in equilibrium), a neurosurgeon – CSF. And for neurosurgeons, CSF, despite the extensive research and still poorly understood pathophysiology, represents a way of life, it’s our bread and butter, it’s our harness, and we can circus on every one of its pathways to create, make and build fluid dynamics. Fluids are an entity of resuscitation and carry so much weightage that one cannot simply take it for granted. Ask any intensivist or anaesthetist.

I’m in the OPD seeing patients. A young girl walks in. In her teens, thin built, hardly any fat to her bones, I can tell she has some developmental anomaly by the way she walks and turns her spine. There is a very off-putting air about her. She is leaking urine. Right through her clothes. Onto her legs. Openly. A graduate student, all of 17 years old, and she is completely non-chalant about it. She has grown accustomed to it for over 15 years now. The reek is obvious. It affects me, but I have learnt to school my features with time. Anorectal anomalies, thoracolumbar scoliosis with tethered cord and with diastematomyelia are some of the few diagnoses she has. She tells me her history in vibrant detail and continues to leak as I examine her, offering no explanation or apology. Sitting there, diagnosing her, understanding what caused her LMN bladder, so clinically, all the whilst she leaked and reeked urine onto the plush new chairs, was…a novelty for me and an experience for the books.

#fluidsmatter

A shake is a nice touch when it’s a Taylor Swift song. But never, in reality. So entuned to the movement disorders I see in patients, that it’s become a harsh fact where I assume every other movement as a seizure. ‘Seizure-crazy’ might be a better monicker for me. But I think it pays to be extra careful and let the seizure be considered one, than not.

Young gentleman, 22 years, came in seizing. Loud gasps, tonic clonic movements, all limbs in disarray, violent grasps, trembling trunk muscles, frothing at the mouth, lips open, gurgling breaths, up rolled eyes, completely helpless. His mother was beside herself, and unsure what her role should be. In all the recent 3 years he has been suffering from this, she has never known what she should do and how to react to a seizure despite having seen many such episodes. We had just seen him in the OPD and then a sitting man on the stool suddenly turned into a collapsing mass of movements. Rushed to the ICU at a speed I knew not our helping staff had, an iv-cannula secured as he seized, an oxygen mask fitted over his distorted face, as we loaded and loaded him with medications and he slowly came undone into a drowsiness that was a welcomed scenario. Low grade glioma on follow-up (and despite urging, the family had not been keen on surgery), now with intensity changes on MRI with possible grade change, his fate was probably sealed. Surgery was just the first step. The seizures were just a manifestation. A shake is actually the brain telling me something is terribly wrong.

#shakeitoff!

Images – Google

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