Like a Puzzle

I was a brand new pediatrician, the most junior faculty member in a medical college in India. The typical diagnoses were different from most that I’d seen in my residency, which meant that every case was like a puzzle. But I was enjoying the challenge, as it led to lots of interaction with faculty in other departments.

One case that has stayed with me to this this day was a 12-year-old girl who came in emaciated, jaundiced, and with a fever. It seemed likely, given those symptoms, that she had tuberculosis, as TB was rampant in that part of the world. But the pathologist who read her general blood picture suggested I give her a vitamin B12 injection and then repeat her reticulocyte count—a measure of how fast certain red blood cells are made. It turned out that instead of TB, the girl had megaloblastic anemia. I was thrilled once she started showing improvement, from day four onward.

But on day seven, I was called by a senior faculty member to her office. “You should be very careful in treating your patients,” she told me. Upon asking why, I was told that the department head had found some irregularities in the diagnosis and treatment of one of my patients when he’d made surprise ward rounds, and he had become very angry on the wards. The patient whose treatment he thought was “irregular” was this girl. I tried to explain what had happened to the senior faculty member, but in vain.

A week later, my patient’s parents told me how obliged they were for my treatment of their daughter, who had been suffering for the previous two months.

And at the same time, I was being issued a warning from the office of the director of the institute to improve my professional skills.

Sandhya Chauhan
Bareilly, Uttar Pradesh, India

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