Author: Sr. Dr. Sally SJB
It is the story of a little life that I could save through a timely intervention; a life that wouldn’t have seen the rays oflight if not for a timely twist of fate. Pranita (name changed) the mother of a year old girl child hailing from a middle class family was suffering from Schizophrenia for nearly 15 years. Schizophrenia is a chronic mental illness that can so badly affect all of one’s normal mental faculties including interpersonal interactions, emotional responses, cognitive functions, voluntary capacities and socio-occupational well being. Such a chronic uncontrolled illness can even take away one’s capacity for adequate personal care and hygiene. To complicate the picture such patients can also have delusions (the false, firm and fixed belief which is not keeping with the existing cultural or social norms and believes) and hallucinations (experiencing or perceiving things, sounds, events which others around cannot normally perceive) and multiple behavioural and personality changes secondary to all these. (Remember John Nash from the Oscar winning movie, ‘A Beautiful Mind.’) They can be aggressive, disorganized, abusive, violent or at times totally lost to themselves, withdrawn and with not much awareness or response to what happens around them. Not every patient who has schizophrenia goes through all these in their life time as there are varieties of schizophrenia itself. There are patients with chronic schizophrenia on proper medications and follow ups, who do wonderfully well in all the above mentioned domains, having completed a certain level of education, holding respectable jobs and taking care of families at times better than a normal person can do. It depends a lot on early detection, proper timely intervention, regular medications and adequate follow ups.
Coming back to the story, this young woman Pranita was educated up to BA not completed, with adequate social support having had both her parents working in a government set up and now retired with not so bad amount as pension. She was married to a middle-class family, fortunately having good in-laws and a supportive husband. Since her insight or awareness into the illness was very poor she frequently defaulted on her medications and that caused her illness to go on unremitting despite the above mentioned protective factors. When her symptoms exacerbated she became very suspicious that her husband has another affair and her parents and in-laws are trying to poison her. She had frequent anger outbursts and abusiveness whenever her symptoms worsened. Despite all this, her married life went unaffected probably owing to the good will and resilience her relatives had developed over a period of time. Their financial status and educational standards may also have had a bearing on their coping skills.
She was being treated elsewhere for the past many years till we saw her. She came under my care after the delivery of her first baby almost a year ago. Since she wasn’t doing so well with multiple medications for adequately long duration in the past, she was considered as having resistant schizophrenia and was put on Clozapine, an antipsychotic medication which we keep as a last resort in such resistant cases since the response to the same is much better comparing to other drugs. We do not give it often owing to some possible life threatening side effects like the blood counts reducing drastically, severe skin rashes, seizures etc. Given all these, we still give to patients as these side effects are as low as less than one in ten thousand and we can monitor regularly for any such and stop the medicine as and when required.
So our index patient was started on Clozapine and was doing better on all symptom levels though not totally well. She had no major issues with the medicine and the family also felt happy with the extent of improvement she achieved as she was now less abusive, more cooperative with relatives, willing to take medicines and caring for the baby well. The baby was just few months old when she became pregnant for the second time, obviously an unplanned pregnancy. It was already beyond 2 months when she realized that she was carrying again. The relatives started panicking as her first baby was too small and still breast feeding and she was on medication which was controlling her symptoms to a great extent. They were in a dilemma as to continue the pregnancy or abort the baby. They went to a gynaecologist who apparently was their consulting doctor during the first delivery too. She counselled the patient, her parents and husband regarding the possible worst outcome of pregnancy when she is on an antipsychotic medicine and the dire need for aborting the baby as soon as possible.
Fortunately, before going ahead with the abortion, they came to meet me asking my opinion. I was horrified at the thought of the poor innocent baby in her womb getting murdered. I listened to all their fears patiently. Most prominent of it was the possibility of having a handicapped or mentally retarded baby. I kept counselling them as I was sure that the current medicine she was on was safe in pregnancy and may not cause a teratogenic effect (any organ related or limb related problem in the new born). They were inflexible in their decision having been totally brainwashed by the gynaecologist who probably knew very little about the psychiatric medicine or its side effects. They were hell bent on aborting the baby saying that they cannot afford to take care of another child as the first one is less than one year. (The relatives were sort of burnt out due to her continuous illness and taking care of her.) They were determined in their decision and weren’t open to other options. At the end I said , “I take the responsibility for this baby. If the baby is born handicapped or with any sort of retardation and after the delivery suppose you do not want this baby, you can leave the baby with me and I will take care of the baby.” I had in mind that neither the mother, however sick, nor her relatives would want to leave the baby once the baby is born. I also planned to find out the details of institutions where the baby can be placed just in case they did not want to keep the baby. By God’s grace, they took my word seriously and relying on me continued her pregnancy. The gynaecologist tried her best again to convince them regarding the terrible aftermath of their decision. But probably because I was much more convincing when I spoke to them, they didn’t lose their faith in me. More than anything else, God didn’t want that little life to be smothered even before it could protest or let out even a faint cry.
Pranita carried on with her pregnancy uneventful. At the end of 9 months she delivered a baby girl, so beautiful and totally normal that the gynaecologist herself was surprised. The patient and her relatives took an instant liking and bonding with her and needless to say, there was no place for the thought of abandoning the baby. After few days of her birth she was brought to me by her beaming grandmother. She thanked me profusely for the timely intervention that gifted them with such a treasure which they now wanted to cherish by all means. When I asked if they still remotely consider the option of giving the baby to me, the answer was a vehement ‘no’. Whenever they come to the hospital, the grandmother brings the baby to me saying “Aapki Betti” (your daughter). The little one gives such warm, capturing smiles that win all hearts in the whole of our department.
I feel content at the tum out of events which went so wonderfully well, as planned by God who takes care of even the least of organisms in the universe, who cares for the birds in the sky, who adorns even the grass in the field. (Mt 6:28-30) Every single being is kept safe and cared so marvellously well in His hands and He finds ways to protect life when human beings in their selfishness seek destruction. We may not be able to save all the lives in the world or reach out to all those in the hands of danger of death or abuse. But a single life saved, makes a world of a difference at least for that single human being.