Clotted brains

At least I am literate enough to read up on thrombosis and warfarin and tell the nurses about it. But what if a problem is compounded by the patients’ poverty and illiteracy

A few days after the April 25 earthquake, my sister developed a blood clot in her brain, in the vein that drains blood and cerebrospinal fluid away from the brain to the heart. She is right now on warfarin, an anticoagulant medicine that slows down the clotting process. One of the symptoms of the thrombosis (clot) in the brain is thunderclap headache, an intense pain in the head that reaches its peak within a few seconds and then comes down. Even after being on warfarin for almost two months, my sister gets these attacks, at least once a day. She cries uncontrollably whenever these attacks happen and we gently rub her head to distract her from the pain.

On Wednesday night, she had these attacks one after another within a span of a few minutes. And the fourth one just wouldn’t go away. The pain kept shifting its locale—from the back of the head to the front to the forehead to the bridge of the nose to above the eyebrows and back again—but the intensity remained the same. We rushed her to the emergency ward in a local teaching hospital, where she had been admitted for five days right after she was diagnosed with the venous thrombosis.

Right before we left, we had given her codeine, but she kept having these attacks—in the cab, at the entrance of the emergency ward and on the bed she finally lied down on. A nurse walked over, handed me a slip that read ‘ninja’ and told me to go get the medicine. I asked her what it was. She told me that it was a painkiller. I told her my sister had already been given codeine. “Obviously, codeine isn’t helping,” she snapped. Then I asked her if this new painkiller was going to interact with warfarin. She said, ‘No.’

I went out to the pharmacy to get the medicine—it read Diclofenac Diethylamine—but before I got back, she opened another vial of the same drug and injected the painkiller into my sister’s arm.

My sister calmed down, but no one came to see her. No one asked to read her medical file, which we had on us. The resident medical officer was not to be seen around. I was getting nervous because this was my sister’s brain that was throbbing so severely it gave her blackouts and no one was there to tell us what could have gone wrong. I was worried that the clot had been dislodged and had been stuck somewhere else or that another clot had been formed and that my sister could have a stroke any minute. Dissatisfied with the way things were being handled, I texted the only person I knew in that hospital—a medical exchange student here in Nepal from the US. After she arrived, we realised the extent of negligence that had taken place in the ward, on whose front door is a sign that reads: Emergency Room (Life in Danger).

The medical student said that diclofenac is a non-steroidal anti inflammatory drug that increases the risk of bleeding. Warfarin, a blood thinner, already does that. Together with warfarin, diclofenac could turn fatal, especially if the headache my sister was experiencing was a result of a brain haemorrhage, an expected deadly side effect of warfarin.

My friend hunted down the resident medical officer and then confronted the nurse about the painkiller and about the general disregard they were showing towards us, and, in fact, to other patients as well. The nurse denied that I had ever told her about warfarin. Angry at this blatant lie, I joined the conversation and it soon heated up into a loud argument. The nurse became defensive (so did the medical officer who had not realised how severe the case was) and angry because whether she had heard about warfarin from me or not, she should have asked us about my sister’s medical history and because she did not, my sister’s life could now be in danger. The next thing the medical officer said was that a shot or two of diclofenac was not harmful and that they would not be liable for anything that would happen next—imply my sister’s death.

Thankfully, my sister survived to see a specialist the next day. But, what if I didn’t have a friend there in the hospital? Why do I even need to have a friend in a hospital? At least I am literate enough to read up on thrombosis and warfarin and tell the nurses about it. Telling them didn’t really work that day, but what if the problem is compounded by the patients’ poverty and illiteracy? Whenever we take someone to the emergency room, we believe the lives of our loved ones to be in danger. Our anger is borne out of this fear of losing someone we love. We are the ones powerless here. Doctors and nurses are privy to the knowledge of the human body and drugs and we are not. They derive their power from this knowledge. Why keep us in the dark, unattended? Why, as in my case, abuse the power they have? Why not put it to good use like they promised they would while taking the Hippocratic Oath? A life lost is a life lost.

Don’t stand around like a clot, devoid of compassion.

Published on: 2015-07-25, The Kathmandu Post