Running for blood

If you see a first year post graduate student of surgery running in the hospital, it’s probably due to one of three reasons. The first, is if there’s a patient dying, probably due to a sudden cardiac arrest – this is not very common in the surgery ward. The second, is if the PG is late, and there’s a senior waiting for him- this is very very common. The third, is if he’s running for blood.

If you think you know how much blood it takes to keep the hospital running, your wrong. It takes more. That way, the blood bank is like the heart of the hospital, constantly circulating blood from donors and giving it to the needy. Its like a Robin Hood of sorts- take from the rich and give to the poor. Give to the poor…that’s the complicating part. Because the poor are so many. Not only are there those who have no one to donate for them, there are those who’s blood group is so rare that its hard to find blood for them. That’s what happened to a patient of mine recently.

This patient was an 18 year old girl with tuberculosis of the abdomen. Her gut was so horribly stuck together that no food could pass through. She had started to develop signs of infection that ran into the blood vessels and was circulating to the rest of her body (septicemia). We had tried to operate her once, but we avoided aggression, lest the bowel tore in its place and we made things worse. She improved after the first operation for a few days, but soon, it became clear that she would need another surgery.

On the morning of the second surgery her Hemoglobin level ( a measure of the red pigment in blood that carries oxygen to our organs), was 8.5 gm/dl. The normal for her would have been 11 or 12, but 8.5 was a safe enough level for her to have emergency surgery. We sent a repeat hemoglobin level just before she went into the Operation theatre which was at 11 pm at night. An hour into the operation the report revealed a level of 6.8. And, she had probably lost one unit (about 1 more point), during surgery already. The anesthetist freaked. But there was a solution of course. The patient had a lot of donors, and we had been prepared for such an eventuality. We called our blood bank and sent for blood, only to discover that the blood needed for her type-O negative- a very rare blood group, was unavailable. They had just sent it for two women who had had too much blood loss during childbirth. We had least expected this. The anesthetist literally had a stroke. Get me blood Nishant, she screamed. I don’t care how you do it, just get me blood.

Thankfully the guy at the blood bank had a solution. The Red Cross blood bank had the kind of blood group she needed. But they needed a stamp and signature from someone at the hospital. So I ran. I ran to the Emergency officer who didn’t have the stamp. I ran to the Boss of the Emergency officer, who didn’t have the stamp. Finally I woke up a senior consultant and drove my bike to his place and had him stamp and sign the blood requisition form half asleep in the middle of the night and then back to the blood bank. They were ready and waiting. They sent their guy and got 2 units of blood. I came back with a sigh of relief. The blood would arrive soon. I changed into my scrubs waiting to be proclaimed a hero. But our patient had bled more than I had expected. She had lost at least another two units more. More blood Nishant, we need more blood!!

I called the Red Cross blood bank personally. They had no more O negative blood. The two units they gave us were their last. The blood bank in our hospital called everyone they knew. All the major government hospitals. But they were at a distance. I looked at the blood soaked towels in the operating room. Something had to be done. I looked at her family waiting outside. Something had to…wait.. Her family wasn’t poor. It wasn’t rich, but it wasn’t poor. I could tell from the clothes they wore. Maybe they could buy the blood. But this had never been done before. None of my seniors had told me about this route. I didn’t even know if people could sell blood legally. There was only one way to find out.

At three in the morning I called the only people I trusted for information about pizza places and movie shows in and around Delhi. Just Dial. You know those phone based companies that give you information about places you want to know about in your city. This was the one we used in Delhi. I called and the response was prompt. I explained to him the situation, the urgency and the need for fast information. As soon as the guy realized that this wasn’t the usual call for late night eating joints he started speaking quickly and vociferously as if a timer had been set and he was about to win a million dollars. I liked him. There was indeed a blood bank close to our hospital that sold blood. The Lions Blood bank.  I called them. They had the blood. They charged 1900 Rs per unit. It was worth it. I got the address and sent the relatives who probably drove like madmen, because they reached there much faster than I’d expected them to. Back in the OT, the anesthetist was looking for me. She needed to vent, and I was the chimney. There aren’t too many places to hide in the OT complex.

The Relatives were taking too long at the blood bank, so I called them. The technicians there were making them wait, because they had a 40 minute processing time for matching the patient’s blood to the blood they were giving us. This was longer than usual, so I asked them what the holdup was for. “We have a world class matching process sir”, said the voice on the phone, “ We test for antibodies that few centers do in Delhi, giving you quality matched blood”. He sounded like a salesman. “ Listen my friend”, I said to him, “ This girl is being operated right now. She’s losing blood fast. And she needs blood. Those extra antibodies you test for to prevent reactions in 0.0001% of patients won’t really prevent anything if she dies.  Just do the usual cross match and give us the damn blood”. I heard a few ‘ but, but, buts’, on the phone, but there was nothing more to be said. He probably followed the whole procedure anyway. I wouldn’t know, because I was called back into the OT. The operation was over. She was going to be shifted to the Intensive Care Unit. The Anesthetist was still tense, but at least there wasn’t going to be any more bleeding. By the time we shifted her, to our grand elation, there were two units of O negative blood waiting for her. It was our very own hospital blood bank. They had managed to find O negative blood at the Army Hospital blood bank nearest to our hospital. It had been unconventional for them, but hey, it had been a weird night. And by the time we gave her those two units, the blood that her family had gone to purchase had arrived.

After fighting a significantly long battle in the ICU, the patient, I’m glad to say, did well and is to be discharged soon. I had promised the anesthetist and her PG assistant a Samosa treat if this patient made it. Guess I’d better go buy some. I’ll be relaxed when I do. Not like when I’m running for blood. The patient’s attendants wanted to thank me for my efforts. Instead I redirected them to some real heroes. The people at the blood bank. They run for blood every day. They don’t even come to know if they manage to save the patient most of the time. They just run.