HIV Tales from my Diary

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HIV Tales from my diary -Tale 23

Suba Singh was in his thirties , a truck driver by profession . He used to go on for long journeys and be absent from home for long time. In November 2000, he was ,however,desperate to cut short his journey and return home early. His wife was all set to deliver him the gift of fatherhood and like any living ,he ,also ,was anxious to see his progeny. This was the time to have some spice added to his life , which so far , was like any other trucker- dull, boring and monotonous. It was as monotonous as that of a pulley which is used to take out water from the well seeing the role going up and down day in and day out. Like all other extremely mobile truckers ,who will ferry endless cargos of freight the length and breadth of the country, he will also , ship tea from Assam, computer parts from Bangalore and exotic flowers and vegetables from the far southern states of the subcontinent, have a very stressful life away from home. Distressing moments ,will come only ,when he ,like all others, will stop ,at dhabas ,on roadside,

to shower for the first time in weeks, eat daal n chapatis and sleep on knitted charpais there. With little else to do ,it was also common ,for him too , to buy sex. Sex would cost peanuts ,literally and was the cheapest entertainment on the highways. The local women and teenage girls used to cost as little as 30 rupees, At times , he will have fun with his helper boy as well.

Suba Singh's marathon was like an unending race yet he could romp home ,in time. His wife also waited till his arrival. She presented to him , the much awaited gift ,the very next day of his arrival. His joy knew no bounds. He was blessed with a daughter ,with all fingers and toes intact, a nose like him and big eyes like her mother , hale and hearty. He was a proud , happy father now. He was enjoying the break , carrying the little bundle of joy in his arms. He made merry and had feast for full one week, almost. The gay period was over soon and the time to start a new journey ,to Mumbai , arrived like a pre-monsoon shower without warning. He wanted more rest and to stay longer but his employer was getting restless. The employer wanted the shipment to be delivered before the onset of foggy winters. Reluctance was writ large on his face ,when he had to leave behind the joys of his life. The unhappiness of separation ,stretched a little too far ,as he fell sick on the very next day of his journey. He had loose motions and vomiting . The highway doctors suspected food poisoning and treated with antibiotics, ORS etc. Treatment helped him to carry on with the journey , although slightly behind the schedule, yet reach the destination. His health did not recover full and final. Upon touching his destination, he rushed to a hospital. The journey ,which landed him in the hospital ,looked like reaching the dead end. The doctors of the hospital ,declared him ,to be carrying HIV. Distressing moments of highways ,were turning into most stressful times of his life . The announcements of bad days were loud and harsh. They were harsh for many other reasons too. The treatment of his ailment was either not available or was insufficient world over and costly too. Those were initial years of managing HIV and were characterized by treatment failures and disappointments. Although, 1985 was the year when clinical trials began with direct acting dideoxynucleoside reverse transcriptase inhibitors (NRTIs), the first being azidothymidine (AZT) and by 1987, treatment with AZT, later called zidovudine (ZDV), was approved for use in patients with advanced HIV. In short succession, three other NRTIs were approved for use in HIV-1 infection: zalcitabine (ddC), didanosine (ddI) and stavudine (d4T). Each had its own particular toxicities and none is widely used today. To avoid the toxicity profiles, attempts were made to administer drugs sequentially and to alternate therapies. But the availability of those drugs at affordable prices in India was still a distant dream even in 2000, when Suba Singh needed them. At most Cipla was making dual combination of AZT and 3TC ( Zidovudine and Lamivudine) by the name Duovir, available those days. The cost was 4000 Rs. Per month. Dr. D. G. Saple ( a national authority on HIV management) prescribed him the same and he remained in Mumbai for three months or so. His resources started drying up and the employer also refused to help further. Friends started showing chameleon colors. Suba Singh's parents however were the rock in which he could rest his body. They were ready to sell off their ,whatever ,land for the son. Dr. Saple asked him to see me while in Amritsar as were running a NGO and Dr. Saple was aware of it. Suba Aingh returned home and reported to me. I could arrange the same Duovir to him through the company at half the price. The antiretroviral drugs started showing its effect and he regained his health to quote an extent. His faith in me and drugs increased. He could resume his journey again. His visits to me became scarce. After many months , one day he reported sick to me. He suddenly felt like running out of steam. His body used to tire with the ease he used to control the tyres of his truck. He was feeling like filling diesel in his body all the time. Although, he was regular in his HIV Medicnes and was feeling good all along, yet a fear creeped in his mind after this weakling episode. Routine tests revealed severe anaemia and some chest congestion. His blue nails and pale conjunctivae were pointing towards the drugs , he was taking. Zidovudine is known to cause bone marrow depression and this anaemia. The chest congestion was adding salt to the injury. Hospitalization was the natural consequence. HIV patients are best treated as a team. The involvement of chest physician thus was a must. The hospital admission worked wonders for his recovery till a fateful night. It was a cold foggy wintery night. Me and the chest physician were delighted to see his recovery. Hemoglobin levels were , however still away from the satisfaction level. We two decided to infuse another unit of blood to him. I proposed to do that the next day , but my co consultant looked like in a hurry. The resident also sort of connived with him , as the blood was already available. Both wanted to transfuse blood that night only and discharge the patient next morning. They wanted to save his hospitalization money. Their intents were beyond doubt. But , my doubt was directed towards a possible transfusion reaction. It is always difficult to manage reactions at odd hours in all middle level hospitals where resources are in a crunch at nights. Two is to one vote and I was defeated. Defeat ,however ,came in pairs. Even Suba lost his battle for life. He did not develop reaction but died of , may be due to overload . An early morning call from the hospital to the two consultants was a mere formality. We could only see his pale , motionless face with no pupillary reflexes numbing our own reflexes. We were looking for a place to hide our faces and face the widow of Suba Singh with one and a half year daughter in her lap.

Even after passing of so many years of that night , I get goose bumps, imagining my spineless action of that night. I wish , I could have vetoed the blood(y) action that night. It is said that extra ordinary people burn fingers while doing fire worship हवन करते हाथ जलाना ) and the doctors learn by mistakes. This mistake was unpardonable.Although , I was not the direct party in the act, yet ,can not wash my hands off ,the mistake too. Facing the widow after few months was the real task. As a face saving I am helping the widow and the orphan by way of free medicines. Rest of their needs ,are taken care off by the deceased' younger brother , who has taken them in his fold and accepted to grow old with them. Suba Singh's daughter , who is HIV positive too is now in plus two and appears determined to be a doctor one day. I long ,to live to see her ,find a cure for HIV. Till then , Suba's debt to me will remain unpaid.

Rakesh Bharti