How it all started – just a minor bruise

February 13, 2009

Zarif is restless, like most of the children of his age. Having a cut or bruise every now and then isn’t a thing to take in to any serious notice. I didn’t bother much with new marks on his legs. I thought it could just be that he has got hurt somewhere, somehow. Then within two-three days there were more. It startled us. It could just be due to vitamin c deficiency – he’s not a fruit lover, prefers fries and chocolates and all sorts of junk you can think of. However, it’s time to go to a doctor and I take him to a dermatologist thinking it could as well be an allergy of some kind.

The dermatologist advised a blood test and told me to consult a hematologist. Why the hell? He’s just alright – a usual chatterbox with me, playing games, making weird montages with photoshop or tweaking 3D models. He’s energetic and making everyone around him crazy at times. I listen to the doctor and go for an immediate blood test – a CBC profile. Zarif won’t let anyone poke him with a needle. A long persuasion of a whole evening and several hours in the next morning plus promise of buying a caged bird made him agree.

He gives blood sample in the morning. But in the very next evening the diagnostic lab calls saying that we need to give the blood sample again. I feel dizzy – it was a tormenting affair already, how can I make him go through this pain again? Being upset I demand explanation from the lab personnel. He mumbles “the blood counts are not normal, we just want to reconfirm. It’s all for your good, Sir.”

With literal ache in my heart, and much pain to that little kid of mine we go through the same ordeal again in the next morning. His platelets count shows a mere 10,000 where the minimum should be 150,000. Not knowing what to do I call Dr. N K Bhowmik – a doctor, a family friend, a saintly persona. He is one of the very few doctors, that I know of, who “lives” like a doctor every moment of his life. He provides courage – “call God, pray and consult a hematologist. Don’t worry, every disease has a cure. No need to worry when we don’t know the cause yet.”

Zarif's second blood test. 23rd April.

Zarif's second blood test. 23rd April, 2008.

In the evening, the hematologist opines that it’s ITP (idiopathic thrombocytopenic purpura) a disease where platelet counts get lower without having any known cause. He prescribes Prednisolone – a steroid and advises another blood test after a few days. I call Dr. Bhowmik and everyone else in the family and ask for their prayers. I resort to internet to know as much detail as possible about this ITP. The second blood test shows no improvement and other counts also go down.

The hematologist prescribes continuation of the steroid along with some folic acid and vitamin-c. I suspect the doctor’s diagnosis having known, from the internet, that in ITP it’s the count of platelet that goes down. In Zarif’s case all the other counts were going down including haemoglobin, red and white blood cells – all. However, we go to the same doctor insisting for a proper diagnosis and he prescribes a bone marrow test. This makes us more panicked. How can Zarif go through this when he cries at the prick of a needle?

I look for reference of another hematologist. Three persons refer to Dr. Afiqul Islam – a pediatric oncologist at PG Hospital. We take Zarif to him. A long queue of parents with their children in front of his chamber makes me worried. Dr. Bhowmik told me not to expose Zarif to dust and fumes and keep him away from crowd as much as possible. If possible to keep him in total isolation. I go to the reception and inform the person that my child can not stay outside for long. He arranges a quicker appointment on an urgent basis. Within half an hour we meet Dr. Islam. Having gone through the reports, he stops the steroid immediately and gives no other medicine.

“Mr. Hossain, it’s not ITP” he says. “What is it then?” I ask with trepidation and with a prayer that he doesn’t say of anything more worse. “For that we should have a bone marrow test”, looking at my panicked face he adds “not to worry, it’s nothing, the procedure involves pricking a needle in to the hip-bone and local anesthesia will be given.” But, I have to know what else could it be if it’s not ITP. On my incessant query and insistence he says “pray that my prediction be proven wrong, it could be aplastic anaemia. But don’t be panicked and don’t worry for nothing until anything is proven without having the bone marrow test yet.” Something tells me that I can rely on his advice. I ask him if it’s possible to do the test under his supervision. He refers me to PG Hospital for the bone marrow test.

This is how the bruise marks looked like. This one is on Zarif's shoulder. There were many on his legs. Doctors call it petechea and/or purpura.

This is how the bruise marks looked like. This one is on Zarif's shoulder. There were many on his legs. Doctors call it petechea and/or purpura.

Almost three weeks have gone since Zarif’s first blood test. I spend my sleepless nights in prayers and reading everything about ITP, Aplastic Anaemia, Leukemia, Bone Marrow test and the relevant things from internet. Very early in the morning on the day of bone marrow test, I reach PG Hospital. My uncle is waiting there to be with me, to facilitate whatever we had to do. We deposit money in a designated counter, take a slip from paediatric oncology department. The slip is a list of the things we have to buy from an outside shop – mainly the bone-marrow extracting needle, local anesthesia etc.

Having finished all this, I call Zarif’s mother to bring him to the hospital. Zarif won’t come. I talk to him over phone to convince him. He replies “Baba, I am not feeling bad. I am alright and will be okay. I don’t need this test.” With a griping pain in my chest and tears rolling down, I try to be strong but fail. I leave it to his mother to convince him. She succeeds to bring Zarif to the hospital one hour later than the appointed time. My sister, a friend, a nephew and my uncle – all are there. Zarif looks pale and panicked. We try to cheer him up. Wait another hour or so. At last they call him in. We are not allowed to be beside Zarif.

A stranger comes and says “I had my relative’s child go through the same test. There will be a lot of screaming. Be ready for that and don’t worry.” That raises my pain and panic even more.

You can guess what we had to do to make Zarif agree to go inside the procedure room without us. Within minutes we hear his scream – calling his mother. Someone shouts back at him and another comforting voice follows. But again his scream surpasses all the voices. It was inhuman. I suspect if they have applied the local anesthesia. If they were patient enough to wait for the anesthesia to start working. Zarif’s mother was weeping outside, near the door of the procedure room. My sister takes her away. After around fifteen minutes – that seemed like ages – his screaming turned to sobbing and a prolonged wail. We are called in. The first thing the doctor did was to return the bottle of local anesthesia to me saying “we didn’t need this”. I didn’t say anything but took a vow that I will get hims someday and make him feel something similar – WITHOUT ANESTHESIA…

I jumped to Zarif’s side and, as instructed by one attendant, held the bandage pressed against the wound to stop bleeding. “Baba, why did you lie to me?” Zarif managed to utter these words while sobbing. “It was so painful, I felt the needle inside me like a screw-driver. They kept me pressed against the bed and I couldn’t even breath. And they shouted at me. “Baba, you felt more pain because you were scared” I lied to him again…

“THEY RETURNED THE ANESTHESIA BOTTLE BACK TO ME” was a single sentence kept hitting me like a bullet in my head. I tried to comfort myself thinking that maybe they used one from the hospital stock. I asked another guy who was inside during the procedure. “Sir, please don’t ask me these things, I am not in a position to tell anything about anything” he answered with a sad and helpless look in his face. I keep looking for excuses not to suspect the doctor who conducted his test. “Maybe the locally made local anesthesia wasn’t good enough” I think and feel relieved. It’s so agonizing to lose trust.

Dr. Afiqul Islam appears in the room. He inquires and comforts us and Zarif. He does a bit of kidding with Zarif – “Beta, you are far braver than your father.”  He also advices that we should transfuse him with platelets.

We take him to Square hospital and learn that we have to find a donor first and will have to deposit Tk.18,000 for aphaeresis – a procedure to separate platelets from whole blood.

Zarif fell sick in the worst time of my business with some accounts receivables, even more work-in-progress and no liquid cash.

We take Zarif back home. We have to look for a donor. He is too tired and weak right now. We decide to transfuse him the next day.

The next day my nephew goes to PG Hospital for the bone-marrow test report and learns that they need to run the test again!! AGAIN?!

We call all the doctors we know and all of them says that if the first test shows scanty bone marrow sample it’s more urgent to do the test again. I don’t know what to do. But not again to PG hospital. I came to know it could be done at Dr. ABM Yunus’s Green View Clinic at Green Road, at Dr. Jalilur Rahman’s Padma Diagnostic Clinic at Malibagh or at BIRDEM Hospital.

Within a few days Zarif complains of head ache and other symptoms. We admit him to BIRDEM hospital. They transfuse him once – with whole blood as his haemoglobin fell pretty low. And did a bone marrow test.

This time the bone marrow test was done by a senior doctor (Dr. Siddiqur Rahman, if I can remember correctly) – a hematologist trained from Japan. We were allowed to observe the whole procedure from outside the glass shielded room. A lady doctor from the pediatric department kept caressing and talking to Zarif. Dr. Rahman was also chatting with him from time to time. “Dadu, it’s gonna be just like an ant-bite” he assured Zarif as he approached with a syringe of local anesthesia. A small “ouch” and nothing else. The doctor waited around five minutes or so and then gently plunged the bone-marrow needle in to Zarif’s hip-bone. Zarif didn’t move even.

The doctor took bone marrow a couple of times, his assistant put them in to some tubes and some on some slides. After ten minutes or so. He put the bandage and told Zarif to get up. “Why? Won’t do the bone marrow test?!” Zarif asked in surprise. “We already did” the doctor answered.

What was wrong with PG Hospital’s bone-marrow test? What did this doctor at BIRDEM do differently? I kept thinking…

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