RM is only 21. “Don’t be surprised doc. He’s tiny!” His nurse informed me before I stepped into the room. So he was. Tiny (barely over 5 ft, under a hundred lbs) and young. His innocent face belied the colorful life he’d led so far. RM had been admitted because he had popped a couple of fentanyl tablets he’d bought on the street (the same drug that was found in Prince’s and Tom Petty’s system). When I inquired why, he said he’d been taking the drug for the past 6 months or so; 2 to 3 a day “to get high that’s all” he informed me as if talking about the weather. “No, I don’t want to kill myself but I get depressed sometimes;” was his response when I asked if he’d had any intention to cause harm to himself. I tried to maintain a straight professional face but I was flabbergasted. I was shocked he was still alive. The lethal dose of fentanyl is very small– a quarter of a milligram, and this young man had consumed several times that. He was one hell of a lucky boy.
On Call is a series where I present some interesting cases I saw in the course of my practice.
Case #1: A Young Woman with Fatigue and Shortness of breath
Mrs. S, is a very pleasant 35 yo young woman. She is married with two young children and is a school teacher by profession. She was referred to the hospital by her doctor for evaluation of new onset shortness of breath and concern of a serious heart condition.
When I interviewed her she told me the shortness of breath has been now ongoing for about a month and steadily getting worse. In the beginning she noticed she was unusually exhausted when she reached home from school and didn’t find the energy to prepare dinner and play with her kids (something she really loved to do). She also notes headaches, irritability of mood, difficulty concentrating which has been affecting her work as well as dizziness. She is also very concerned that she is losing hair. She denies that she is under much stress and says her family has just returned from a two week holiday. Unfortunately, she couldn’t enjoy herself very much because of how exhausted she felt.
Her symptoms have progressed to the extent that now she is out of breath when she walks up a short flight of stairs; she also notes a feeling of tightness across her chest. She also feels her heart racing and puffiness in her arms and legs. She is worried she has a serious heart condition especially since her father died of a heart attack in his 60s.
When I examined her I was struck by the pallor of her skin. I also noticed her tongue was swollen and her nails were thin and brittle and there was definite swelling around her ankles.
Her heart rate was regular but fast– 90-100 beats/minute, she had a normal blood pressure and oxygen level.
This is a guest post by Sonali Dhir on the current times and how it has changed us and our lives:–
I have lived and worked in New Jersey my whole life. Covid-19 changed our way of life drastically here since mid -March of this year. Pre-Covid-19, if we did not feel like cooking, we could head less than a few miles from home and find a fast food joint or restaurant open to grab a bite to eat. Our waiter or waitress would ask us what we wanted and we would simply order what we liked on the menu. It was not just the food but the experience that led us out of our homes. It was normal, it was a break from the usual routine of work, school, running errands and then returning home. However, post the eruption of Covid-19, the new normal is cooking at home, going out for essentials, working from home if possible and homeschooling children. There were closures of beloved small businesses we used to frequent when it was actually safe outside or to go somewhere when we felt the need to go. Now everything must be meticulous planned prior to going anywhere. Want a haircut or nails done? Make an appointment. Want to go shopping? Wait in line six feet apart until there is enough room for you to enter.
Indian women pioneered many things not just in India but also in the west becoming a source of inspiration for women and women’s movement across the world. Early in my residency and sometimes even now, I’m made to perceive that I’m not good enough to be a doctor just because I’m a woman. Once an elderly lady told me to my face that she’d prefer a male doctor to do her gynecological exam. I was stunned to comprehend the degree of prejudice women have to face particularly those in the fields of science. So when I read about Anandibai Joshi and women like her, I’m dumbfounded by their bravery and the degree of resistance they had to overcome.
Anandibai Joshi was among the first Indian women qualified to practice western medicine.
Dr. Joshi belonged to an orthodox Brahmin family of rich landlords in Kalyan. At the tender age of nine she was pressured to marry a widower, a man twenty years her senior Gopalrao Joshi. The beginning of a typical Indian story? No. Anandibai was just thirteen when she had her first child.Unfortunately the child died when he was just ten days old. She was heartbroken and angered to realize that her son would have survived if he had received proper medical care. This sparked in her the desire to study medicine and her liberal husband stood fully behind her.
Why would an Indian woman go so far away for medical school?
Because it was the best way to serve her country was the gist of Anandibai’s answer. The reason Anandibai had to look to the west is because in India, Hindu women, particularly those belonging to higher castes were not welcome in the profession.They were pushed to become midwives instead. If they insisted they could enroll in Chennai, to be taught by reluctant male instructors, and receive an incomplete training. It was easier if they converted to Christianity as they could wear a dress and that wouldn’t cause a scandal. Since Anandibai and her husband had no desire to convert, she decided to turn to the America. She applied with the assistance of Presbyterian missionaries. She enrolled and subsequently received her degree in 1886, from the Women’s Medical College in Pennsylvania. Her achievement was lauded, to the extent the dean of her school wrote about it to Queen Victoria, Empress of India. Anandibai was invited to become the physician-in-charge of the women’s department at the Albert Edward Hospital in the princely state of Kolhapur, where she also had the opportunity to instruct women medical students. Unfortunately, before she could embark triumphantly in her career, it was destroyed by the diagnosis of tuberculosis and she breathed her last in the arms of her mother, a month before her 22nd birthday.
Dr. Anandibai Joshi lived a very short life but she achieved a lot. She broke barriers not just for women but also for the Hindu community. Even now we can look to her life and gain strength and inspiration.This is a fight which will go on until we get what we want–what we deserve–equality.