Medical encounters of the drugs kind

Not all stories will be pleasant, but there probably will be cases that, like the lady I treated, have also been redeemed. Each stakeholder has his role to play in this battle, and that of the doctor can be most gratifying in at least some cases if not all

 Despite the spate of arrests of drug peddlers and the confiscation of their consignments by the various authorities concerned with this problem, there seems to be no limit to the inventiveness of the traffickers as regards their logistics or hiding places for the drugs, which include body cavities. They take risks knowing full well that they may be caught and get the severest punishments such as life imprisonment, which obviously disrupts their family life if they had any. Common sense would tell us that there must be something higher at stake for them to take such risks, money being probably the most important one. In the process they are least concerned about the damage and destruction they cause to the people they force into addiction, not to speak of the suffering that this inflicts on parents and whole families.

Each stakeholder in this saga of tackling the drug problem faces a different aspect of it, and health care professionals are not spared either. From medical practitioners who face the wrath and threats of the addicts to pharmacies that complicate the problem by the inappropriate sale of over-the-counter potentially addictive medicines such as cough compounds, and methadone dispensers who have to manage the caprices and tricks of the addicts that they are called to serve at unsocial hours, the encounters cover a wide range. During my years of hospital service here, I too have experienced them in various forms, and they give a glimpse into a phenomenon which shows, alas, no signs of abating.

A murky world

My very first peep into this murky world was when I had just returned as a specialist in 1980 and was posted to the SSRN Hospital. I had been on night call, and during the ward visit the next morning I saw a sixty-plus year old patient who had been admitted the previous night after a road accident. He had suffered rib and lower limb fractures. When I was leaving the ward at the end of the visit, the Charge Nurse asked me whether I knew who this person was, to which my answer was in the negative. Well, he volunteered, he is so-and-so, a notorious drug dealer; everybody knows, he added. Clearly, I was not part of that ‘everybody’ universe, being a very naïve returnee to the island after studies that were gruelling enough to consume all my time, with little left for attention to anything else.

A few days later when the celebrity had started to settle down, I suggested that, according to the protocol of the Ministry of Health, he should be transferred to the regional hospital that fell in his area of residence, namely Jeetoo Hospital. ‘No, no!’ he said, ‘I am fine here, please doctor, let me continue the treatment here!’ I was surprised, having thought that he would welcome the move to be closer to his family, especially as the hospital stay was likely to last several weeks.

Anyway, I did not force him, and I must say he was an affable kind of guy, and as happens with many patients, we developed a relationship of trust so that he opened up to me about his ‘business’. ‘How is it going?’ I ventured to ask one day as I was examining him. ‘Not too good these days doctor, it’s the lean season, Rs 20-30,000 per day.’ I nearly had a cardiac arrest! My monthly flat salary then, as a Registrar Specialist, was a princely Rs 3750!! ‘And what about during the good season?’ I asked him. ‘Oh, then it can be about three times that amount.’ I admired his candidness. I also learnt from the nursing staff that during working hours, someone or the other used to come ‘pou donne li so dose’ (‘to give him his dose’).

‘And who are the people who you deal with?’ I had the occasion to ask him as well. ‘Aio docteur kimo pou dire ou banne noms!’ (‘Oh dear doctor! What names will I tell you!’) Then he asked me whether I had a TV set at home and whether I went to Port Louis from time to time (I was living in the doctor’s quarters at the hospital then). Upon my reply in the affirmative, he told me, ‘Bésa meme sa banne grand dimoune ou trouvé lors television la ek bann ki dans gros l’auto Americain kiroulé dans la ville!’ (‘these are the big people you see on TV and those who ride in big American cars in town!’).

I never met this person again after he was discharged and most likely he must have passed already, but he shattered my naivety about an issue that till then I had no awareness of at all.

This is the seemingly ‘benign’ face of the drug world that presented itself to me nearly four decades ago. But it was during my posting at Jeetoo Hospital that I was confronted with the ravages and human tragedies that drug addiction led to. One of the most dramatic of such cases was that of a young man in his late twenties who had been ‘shooting’ himself in the elbow and forearm. He had come in with a swollen hand and forearm that were also harbouring infection, and it did not take long to diagnose that he had developed what we call venous gangrene. There was no other treatment option than amputation of his upper limb above the elbow, which was carried out.

I can never forget the face of his young wife who met me with a 9-month old baby in her arms, with tears in her eyes. First it was to plead with me to save her husband’s arm, which of course I had to tell her the raw truth about, and afterwards to ask me for a medical certificate so that she could obtain some assistance from the Ministry of Social Security, as her husband had been the sole earner of the family. He had also shed his tears – but unfortunately they came too late.

Redemption

Another episode that comes to mind was that of a sex worker, but fortunately it had a good outcome. It was nearly 11 pm one night when I was on call that the resident doctor contacted me about this lady. She was a hit and run case that was brought to the hospital by the police, having sustained a fracture of the femur, pelvic injury and chest injury with fractured ribs as well. She was in a state of shock from the blood loss that she had sustained, and as she had also been a drug addict, all her veins were thrombosed – that is, they were not patent, and so a needle could not be introduced to give her much-needed fluids that were required to prevent her condition from deteriorating, with the risk of imminent death.

A quick splash of cold water to rid my eyes of sleep and change into street clothes – and I was on my way from Curepipe to Jeetoo Hospital, reaching there at nearly midnight. My colleague Consultant in General Surgery was already there, along with the several other medical and nursing staff busy around the patient. Our immediate, grave concern was to save her life. After struggling for about fifteen minutes, we managed to do a ‘cut-down’ on a vein and get a cannula in, to the relief of all of us. And we literally poured normal saline solution into this wreck of a patient.

I will cut short the account to say that we managed to save her, and get her to recover from her fractures well enough so as to walk out of hospital in a fit state, having put on weight and looking like a normal human being. Given that she had to stay for nearly two months in hospital, we – meaning the nurses and doctors – ‘worked’ on her patiently and with compassion after we had heard the story of her life that was revealed to us in bits and pieces.

Gently and gradually, we managed to convince her that she could have a better life than the one she had been pushed into, and it was with a degree of pride and joy that we saw her leave the ward when her treatment was over. She had regained her confidence, had groomed herself to look as a woman should do, and left us with a smile. When I saw her a few months later in the outpatient clinic, she was a transformed person, and if I may say so – a real smart looking lady who had started on a new life path. She reassured me that she had reformed, and that she had now found her way again. She had stopped smoking, shooting, and drinking, and was living a normal life. God bless her, wherever she is today.

These are some of my own experiences, but I am sure that many colleagues will also have their own stories to tell. Not all will be pleasant, but there probably will be cases that, like the lady I treated, have also been redeemed. Each stakeholder has his role to play in this battle, and that of the doctor can be most gratifying in at least some cases if not all.

RN Gopee