Case 1 :

Today, I'm a happy Obstetrician because, Little Miss Mona, gets to go home with a sister, who will lead an absolutely normal life, unlike her.

27 weeks back, I met Mona's mother, a beta thalassemia carrier with Anemia (Hb. 8.2g/dl, B negative blood group), around 11 weeks pregnant. She came with her husband and Mona. Mona looked pale, yellowish, had an unusually large head with prominent veins.

It wasn't rocket science for me to realise that Mona had beta thalassemia major. She was one curious little girl, wanting to know every tiny detail about her soon-to-be younger sibling.

She didn't want her younger sibling to do multiple visits to the hospital and blood transfusions and would keep saying, "Doctor ma'am, amar bon bhaalo hobe toh" (Doctor ma'am, I'll have a good/normal sister, na?)

We all know, there are multiple ways to diagnose thalassemia in the foetus but living in rural Bengal where access to healthcare is meagre, it all seemed rather out of reach.

Thanks to some contacts I had with a few genetic counsellors, I was able to get an NIPT (non invasive pre-natal testing) for thalassemia, dodging the ill effects of invasive testing like CVS, Amniocentesis, etc. The NIPT luckily turned out to be negative, and the rest was an almost smooth antenatal journey with a few bumps here and there.

Fighting Anemia, borderline gestational hypertension, sinus tachycardia, today my patient delivered Mona's sister, Birth Weight 2550g !!

Case 2 :

High Risk Obstetrics, for me, has definitely been the most challenging, interesting and exhilarating sub branch in the field of OBGYN, getting me high on an immense adrenaline rush, every single time. All thanks to my alma mater and my fabulous teachers and seniors, who have helped me realise that all we want at the end of any antenatal period is a healthy mother, but not at the cost of compromising the health of the baby.

Today, I am discharging a post op day 7 of an extremely high risk obstetric case.

This lady, pregnant for the third time (previous LSCS) came to a well known tertiary care hospital, with a blood pressure of 180/100, at 30 weeks gestation, despite full dose of two antihypertensives, with a compromised fetal blood supply. No points for guessing, our team at the hospital, performed an Urgent Caesarian Section, delivering a 1.2kg baby (who is now doing well, thanks to the excellent neonatologists and NICU staff at the hospital).

The intriguing part about this patient was despite full dose antihypertensives, her blood pressure would just not come down. At one point in time, her BP was 200/120, leaving us with a feeling of helplessness.

Sleepless nights and tremendous efforts, by our whole team and the anaesthelogist, the intensivists and the general physicians finally has lead to a happy and healthy mother getting discharged today, and I cannot not be thankful enough to each one of them for helping me sustain this adrenaline high!!

Case 3 :

The burden of the COVID pandemic, has made it almost impossible for people in the suburban areas to reach out for medical help, firstly due to unavailability of medical professionals in their area, secondly due to the in-built fear of exposure to the virus.

Amidst this, around a week back (before my much publicised holiday😆) I received a call at night from a nursing home where I practice, in the suburbs of Kolkata.

A first trimester post CS pregnant woman was complaining of severe pain abdomen and fainting episodes from the past three days. When she reached out to a local practitioner for help, he treated her symptomatically, and quite intelligently ordered an ultrasound scan of the abdomen after exhausting all efforts to find a Obstetrician locally.

So, when the patient reached me, i was already served with a readymade diagnosis. No points for guessing, it was a ruptured tubal ectopic with haemoperitoneum.

Tachycardic, tachypnoeic and pale as death, the patient was wincing in pain. I initially resuscitated her (securing an IV line with collapsed veins is a task) with fluids, and her investigation reports revealed a haemoglobin of 3.9 😅, while my quest for hunting blood banks for blood was on.

With every passing minute, my heart rate rose as much as the patient's. Who knew finding blood would be so difficult in the outskirts of Kolkata in a situation like this!

After we managed to procure blood, she was rushed into surgery. In-situ, she had a left cornual ruptured ectopic with a massive haemoperitoneum (evacuated almost 2 litres of blood from her abdomen). For someone, who has seen numerous such cases previously, it was a mammoth task performing the cornual repair and achieving haemostasis.

I should thank my stars, for an excellent anesthesiologist and the rest of my team for an outstanding effort in saving the life of this patient.

After transfusing 5 units blood and dodging dangers of fluid overload, with the help of excellent efforts by my intensivist and my team, this patient has come back today to me, with teary and grateful eyes, for suture removal.

I am not here to brag about my surgical or diagnostic expertise. Of course, the adrenaline rush I got while on the case has still got me high, but I only want to bring to the notice of my colleagues, that people need us, especially in remote places where we are afraid to go due to the fear of exposure. We've not got our degrees just to sit at home and chill, we need to stand up and support people in such times of need. The fear of exposure should not dampen the spirit of medical professionals. Aakhir desh ke log aaram se isiliye so rahe hai, kyuki unhe pata hai ki unke liye hum lad rahe hai ☺️