Dengue Shock Syndrome

It was a cold morning. It was raining.

I have a love-hate relationship with morning shifts. I hate it for the fact I have to wake up too early in the morning to make it at the casualty by 7. I love it cause I’d be off by 4. Pretty good deal. But would be better if it was to start at 8.

His card was the first card I saw lying on the table. Couldn’t recall the number, except for the fact he fell under the G2 category. Mildly serious with stable vital signs. But I didn’t see any vital signs documented. I sighed. Lack of people, lack of efficiency.

He was wheeled in by his father. Clutching his stomach, he writhed in pain. Told me he was in pain. I could see as much. I scanned the referral letter, which was written the day before: AGE. I frowned. he wouldn’t be in so much pain just for a simple diarrhea.

Night shift people were such angels. They approached me with a vital signs machine. Together we set the patient up on a bed. Chap didn’t look so good. “Pain. Cannot tahan, doktor.”

I started the series of questioning. Deepa strapped on the BP cuffs while Jas was busy getting the branula. “How many days already diarrhea?” “Five.” “How many times per day? Vomiting.” “A lot la doctor. More than five. Yes, yes. Vomit too.”

Five days of being friends with the toilet is not cool. “Got fever or not?” “No doctor. Pain, doctor.”

“Okay, V****. I’m sorry but I have to ask you questions before I can give you anything. No fever today, you mean. Before this you got fever or not?”

“Last week got la doctor.” “How many days?” “Three days like that. I was in my polytechnic.” “Before your diarrhea?” “Yes.”

I didn’t feel so good. That was the time when Deepa chirped in. “Girl, can’t get BP.”

I touched him for the first time. Cold and clammy. Pulse, thready. I told Jas, be quick with the branula, girl. I’m going to get the stretcher.

By the time Deepa and I brought the stretcher to green, Jas has managed to get the branula and bloods. To make the day worse, FBC (full blood count machine) in casualty was not working. FML, I thought.

Pushing the case to yellow zone, I presented it to Dr. A, our MO. I was just following my gut instinct, hopefully he won’t chew my head for pushing patients unnecessarily to yellow.

I began the series of questionings while my colleague set the patient up in yellow. Father said, he just came back from polytechnic after three days of fever. Started having diarrhea on the fourth day. They had visited four different clinics. No attempts of blood taking done. Was given oral rehydration salts like nobody’s business. I wonder if it was due to the fact that family members and patient himself was poor historian, only providing me the fact that he had history of fever after much prodding.

Meanwhile, chap was quickly deteriorating. Becoming drowsy. BP recorded in yellow was 140/90. Pulse was 130. Fluids in with two large-bore branula. Deepa the angel tried her luck tracing the FBC. And what do you know, it was done. Puji Tuhan.

“Total white 2.2, platelet 11, hematocrit 49, hb 13.”

Goodness. It was dengue, plain as day. What’s more, he’s approaching dengue shock. I grabbed the phone as Dr. M issued the order, “Laily, page medical stat.”

He was becoming more delirious. Dr. M made a quick call, decided to intubate the patient. From yellow, off he went to red zone.

It was a flurry of activities. In less than an hour, a G2 patient was converted to yellow, and eventually to red. Intubated and boluses of normal saline run, as per ordered by medical. Anaes team was referred. Eventually, he was pushed up to ICU.

Breaking the bad news is still awkward, even after two years. “Ayah, I’m sorry we have to insert a tube to help him breathe. He was not doing so good. We suspect that it’s dengue, and he’s leaking his blood away. We are pushing him to ICU.”

“How come, doctor? He only had loose stools only.”

“Ayah, abdomen pain and persistent vomiting following fever are the warning signs of dengue. I’m so sorry.”

The next day, I was night shift. I went up to visit poor guy in ICU at about 3 am. Was still ventilated, dialysed twice. Kidney was gone. Liver’s transaminases and bilirubin was sky high. Heart went into myocarditis. Developed DIVC by 11 am, a few hours after being sent to ICU. Hb dropped to 7. Transfused 7 pints. He was only 20 years old.

V**** passed away peacefully on the third day in ICU. To say I was frustrated was an understatement. He was so young. Studying mechanical engineering. Loved so much by the family.

Dengue mortality is a national mortality. Being a HO, I was saved from being called for enquiry. Dr. A wasn’t as lucky, but he assured me we did all we could, and the blame wasn’t on us.

V****, rest in peace now.


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