Scene from Dante’s Hell……

I was settling down as the Dean. The work was extremely challenging.Every day would bring in a new problem that needed a solution ‘right here, right now’ In the initial days I found it overwhelming but had gradually grown into the job. Making on the spot decisions had become a routine. The hospital employees, doctors and nurses seem to accept me and actually looked to me to usher in a new era.

It was a gloomy rainy day in August. The hospital seemed to be sullenly quiet. It was mid morning. The MICU in-charge called me. “Sir, We have had five patients of some kind of food poisoning admitted in the last hour. All of them are in respiratory paralysis. We have put them on ventilators. The ambulance person who brought them has warned me that there are more than hundred patients who are being transported. We have a capacity to admit only five more patients. I cannot transfer any patient out of MICU. I need urgent advice.” I told my secretary to cancel all my appointments and rushed to the MICU.

The scene in the MICU was one of utter chaos. Since the phone call, ten more patients had arrived crowding the MICU. I took in the scene. The patients were all in their thirties, evidently laborers. They were in a state of severe delirium with rolling eyes and flailing limbs. Five were inert, on ventilators. We had used up all the ventilators that we had in the MICU. Their pupils were dilated and fixed. Their skin was very hot to touch and their pulse was racing.

“All these patients have been transferred from Bhiwandi, Sir” Dr Bhise informed me. Bhiwandi is a township around 200 kilometers from Mumbai. It is famous for the hand loom factories. The employees were migrants from Uttar Pradesh who lived alone, far away from their families. They would have their food in a common canteen called the ‘Bhissi’ On the fateful day, many had their lunch in the canteens and fallen seriously ill. One of the Bhissi owner had tasted the food after some customers complained of an odd taste. He too had been affected, and tragically died.

I needed a place to treat these patients as the MICU was overwhelmed. I gave orders that the ENT ward be emptied forthwith and all Bhiwandi patients to be shifted there. Since the ventilators were in short supply, residents were bagging the patients. We needed ventilators fast. Fortunately, we had around twenty ventilators that had been brought in by various companies for demonstration and trial. We were in the process of purchasing extra ventilators for the MICU and the Trauma ward. All the companies that I contacted agreed to loan the ventilators till the emergency blew over.

Dr Bhise, Dr Gokhale our microbiologist, and I held a conference. At first glance, it looked like Dhatura poisoning. Delirium, involuntary movements, dilated pupils were classical signs. Dhatura is a plant that has been known to ancient India as a potent poison. Unwary travelers were poisoned by thugs by mixing dhatura seeds with sweets and other food. At the same time there were signs that did not fit in. Most patients went into respiratory paralysis, which suggested a neurotoxin. Was this botulism?

By next morning, we had around 100 patients in the wards. Nearly three fourths were seriously ill. Around thirty were on ventilatory support. Only a handful were stable and were fit for discharge.

The press and the other media descended in full force. Each day, I had to give out medical bulletins and answer the same questions: What was the cause? Have we managed to diagnose? How many patients died?

By the next two days, we had lost nearly one fourth of our patients. The  postmortems were of no help. The toxicology laboratories from Mumbai and Delhi could not tell us the cause. By this time, Dr Bhise and Dr Gokhale agreed that this was not a pure Dhatura poisoning. They were very strongly inclined to believe that this was possibly Botulism. “We need the botulinum antitoxin, Sir. Though we have no proof that botulinum is involved, we will give the antitoxin empirically. If it is indeed botulinum,we would have hit upon the cure” Dr Bhise told me. The main problem was that no one manufactured botulinum antitoxin in India. Dr Gokhale triumphantly produced a printout about a company from Poland who could supply it. We immediately wired them the order and the money. It would arrive the next day. By this time, we had lost thirty patients. The antitoxin was duly administered after two days. It was a dud.

There were plenty of armchair diagnosticians. “This is toluene poisoning, Guru. It must have contaminated the cooking oil” was the advice from one of the senior physicians who had not even visited the hospital. I assured him that we would seriously consider the possibility. One local Ayurveda physician offered to treat them with Ayurveda medicines that were guaranteed to cure. I informed him that I would call him back.

Dr Gokhale was to travel to Atlanta, stopping in London on the way. We collected samples of blood and requested her to get a tox screen run on them at the Tropical Diseases Center in London and the CDC in Atlanta. She had to smuggle them in as they were bio-hazardous material. She called back after two days to inform me that both centers were unable to isolate any possible toxin and that they were equally mystified. The story had even made it the New York Times.

At the end of one week, we had lost more than fifty patients. The rest seemed to be recovering, but still had twitches and ticks that wouldn’t go away. The police had arrested the owners of the Bhissis on suspicion of poisoning their customers. They too had struck a wall.

I had a visitor. He was resplendent in his ocher robes that proclaimed that he was a  God man. “Child,” he intoned, this is Kaliyug. “People have become sinners. This is the result of profligacy and ungodliness. You should conduct a Mahapuja to propitiate the Gods.” I assured him with a straight face that his suggestion would be given the most serious consideration and that I would write a proposal to the Municipal Commissioner to get funds sanctioned for the event….

Author: drshirahatti

I am a surgeon, specializing in Gastrointestinal Surgery...I have headed the Departments of GI surgery, General Surgery and Medical Education.....I also was the Dean of two large government hospitals in Mumbai.....I like reading about cultures and like to travel....

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