Survival Of The Quickest

© Dr. Rajas Deshpande

This young and brilliant man, Adil Masalawala, suddenly appeared to have changed. His behaviour became different and unusual. He started mumbling and replying irrelevantly. He also had fever intermittently. His caring and worried wife Mrs. Venus consulted a physician who sent them to a psychiatrist.

The psychiatrist checked Adil and advised him admission. He started with some medicines, but suddenly Adil’s behaviour became hyper, his body started becoming stiff. Then he became drowsy, and his body started shaking violently. An MRI of the brain was reported normal. That’s when the psychiatrist advised a reference for neurologist.

When I first saw the patient, he had many features that could also be caused by side effects of some medicines. Sometimes it is impossible to conclude whether it is the disease or the medicine which is causing certain symptoms. I suggested that we stop all antipsychotic medicines. That could also be a dangerous decision. The family was counselled, and they agreed. Adil’s drowsiness improved, but he became very agitated, and his stiffness and shaking worsened.

There are many neurological diseases of the brain which start as abnormal behaviour. Strokes, some infections, tumors and swellings are examples of treatable, but there are many untreatable and dangerous conditions too. The only way was to urgently investigate the patient further. Although the family was baffled and panicked, Mrs. Venus expressed complete trust in our decisions, and allowed us to shift the patient to the ICU. I could not answer many of their questions, I did not clearly understand what exactly was happening, but this uncertainty and challenge is what medicine is all about.

There is fluid in and around the brain, which nourishes the brain and also acts as shock absorber between the skull bone and the brain. Many diseases like cancers and infections can be diagnosed by studying this fluid, which can be taken out by inserting a needle in the lower (lumbar) spine. We checked this fluid, and we got the first clue: that we were possibly dealing with a viral infection of the brain. Many more costly blood tests were required to find out which virus was causing this. The family clearly stated “Do whatever is needed in your opinion”. We sent the tests and found the answer: Adil had one of the most rare and dangerous viral infection of the brain, called Japanese Encephalitis.

About 30-40 percent of patients with this diagnosis do not survive. There is no definite treatment for this virus, but many of the manifestations can be treated and excessive care is required to avoid life threatening complications of the swelling that it can cause in the brain.

On the fourth day, Adil had convulsions. His condition worsened. We kept on treating each complication as fast as possible and tried to balance the effects and side effects of the many strong medicines that were being used to control convulsions, shaking, and the brain swelling. Besides knowledge, wisdom and experience, our major strength was the trust of patient’s family who never questioned any decisions.

Many patients who develop abnormal behaviour are mistreated as having a psychiatric problem. Most qualified psychiatrists are aware of the red flags and refer patients for a Neurologist’s opinion. However, a majority of patients with psychiatric problems in India are first taken to quacks, magic healers, mantrik-tantriks, who delay the whole process of correct evaluation, diagnosis and treatment. This leads to many deaths, and this is worst in case of cancers treatable in earlier stages.

False advertisements, some even approved by highly placed offices, celebrities and authorities attract people from all classes and cause severe delay in initiation of the correct scientific treatment. While our governments rightly pressurise allopaths to write generic medicines, they mostly turn a blind eye towards rampant misleading false advertisements claiming cures of incurable diseases and centers that flourish reaping from the hope of millions of illiterates.

We almost thought we had lost this case to a permanent disability. Adil’s body had become completely stiff, his memory had become unreliable to a great extent, and he had an incapacitating tremor. After a few days we could gradually stabilise his general condition and shift him out of the ICU. In a few weeks he was discharged, improving slowly. His family, especially his wife fought for his normalcy like a true warrior, and once he resumed his senses, Adil too made every possible effort to recover fast. One day after a few months, he was back to normal again, we declared him cured and fit, physically and mentally. He resumed his job.

Today after about ten years, Mr. Adil Masalawala and his wife Mrs. Venus came over for some trivial issue, and we recalled the horror that we went through and his victory over it. In this case, I thought it was the “Survival Of The Fastest” as the family did not waste any time in quacks, arguments, objections or mistrust, and let us doctors do the best for the patient in the fastest possible way. We are grateful to the family for this trust, and Adil’s survival and recovery itself is our reward. God bless the couple with a long and healthy life!

© Dr. Rajas Deshpande

Real Story, Real Names, With Patient’s Express Permission. Grateful to Mr. Adil and Mrs. Venus for the permission to share the story of their victorious battle.

Please share unedited.

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