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Her last ice cream

Greetings of the day !

     Mrs Radha (name changed) a 28 year old female was admitted with a history of recurrent vomiting and  Jaundice of one  day duration to our hospital. She had no  history of viral prodrome , fever or any offending drug intake .She was conscious oriented,  and had  mild icterus .

Her systemic examination was normal. An Ultrasound of the abdomen did not reveal any obstruction in the  biliary system .All routine investigations required were sent and the patient was started on supportive treatment.

Although she had  mild elevation of Bilirubin and Liver enzymes,  her INR (coagulation profile ) was 4 times the upper limit of  normal. 

While peeping into her liver cell function tests  , it was obvious that her liver was failing .She was managed as a fulminant liver cell failure in the Intensive Care Unit of the hospital.  

What led to her Jaundice and high INR left all of us clueless.  

In the evening at around  8pm the resident doctor on duty got an alert call from the central laboratory.

“Doc! INR of Mrs Radha has prolonged further and it is now 18 times normal”, the technician on duty informed the doctor .Repeat blood test   confirmed  the deranged coagulation pattern . 

She was conscious but this high INR  was making her prone to develop an unprovoked internal bleed and death, so the resident doctor called  the head of the dept.  

“Dr Ibrahim are you at home? Let us see Mrs Radha together,” Prof Prasad  (name changed) the head of the department, called at around 9pm.

I immediately changed my dress  and headed towards the hospital which is at a walking  distance  from our residence. 

Prof Prasad had examined the patient during the day time but her alarming INR made the  astute clinician restless at home  .He  drove  from his home which is nearly 10 kms away from  the hospital.

We went together near her bed in ICU and  started discussing  various causes leading to such a clinical scenario but there was no clue to the diagnosis.

With an infectious smile , Prof Prasad approached Mrs Radha .

He affectionately kept his hand on her forehead. 

My dear daughter ,has  your vomiting  settled”? .

Yes doctor, I feel better now.

Did you consume any  medication before admission, we are not getting any clue of your illness till now  ?

“No doctor” , Mrs Radha replied .

“Doc ! Do you perform a kidney transplant  here in this hospital”? Mrs Radha inquired.

Yes, we do . Prof  Prasad replied  .But why , Prof Prasad  asked her . "You do not need a renal transplant".

Doc! I had an ice cream yesterday .

Yes, yes ,  tell me more , we are here to help you ,Prof Prasad  affectionately said. 

What happened then” , everyone takes an ice cream , no need to worry.

Doc! Do you perform Kidney transplantation in this hospital? She again asked the same question.

Yes! my daughter,  we are routinely doing a kidney transplant here. 

Your kidneys are alright and you do not need renal transplant .

Tell me more , what happened then ,yes go on, we are here to help you” 

Prof Prasad affectionately went on in this vein.

I want to donate my kidney to clear the hospital dues  because we are poor.  

Her voice started breaking .I do not want anyone to be in trouble and a stream of tears started rolling from her eyes on her anxious face. Doc! Please don't  tell my home people. 

Doc ! I am fed up with family stresses  . I do not want to live any more.

Doc ! yesterday when I purchased an  ice cream from the market I mixed a bottle of  blackish colored rat poison with it .I  consumed the whole of it .She went on weeping bitterly . 

I know I am dying, let me go peacefully from this world. I request you not to tell my home people.

Our jaws fell  in shock, both of us  felt speechless . 

The answer of high INR was thus  solved in a jiffy by her. 

But unfortunately  we had nothing to offer her . 

Intake of Rat poison  is fatal and invariably  the victim dies.

With every tick of the clock she was certainly treading towards death . 

She was too anxious and a dying look was obvious on her innocent face as if  she was threatened by  the look of an obese person  in a jet  black  dress with moustaches upwards , waiting  to pull down the gallows , closing her story for ever.

 Only a liver transplant could help her out,  but who would donate her liver? 

With such a high INR who would be the daring surgeon to operate upon and conduct this hours long surgery. Added to this, they  had bitter poverty. 

You guessed correctly , it was to ask for the moon.It was shocking to listen to her painful story 

We immediately went to the counselling room and called her parents and husband .It was hard to break this  sad news . Despite our all efforts days later she breathed her last and that ice-cream proved to be her last ice cream. May her soul rest  in peace 

           To conclude I must emphasize an empathetic approach in any clinical  encounter. Alcoholism is disastrous despite its lusty tax returns to the Govt. Further , we must focus to reduce domestic violence .We must identify people with suicidal tendencies .They go aloof for a few days before, appear withdrawn and their sleep pattern changes .Such people must be admitted    in a psychiatric hospital before their suicidal attempt.