Recovering from a Paralytic Stroke: A Diary

M.A. Moid

4th: My mother – aged 67, weight 80 plus kilograms, diabetic and having BP but generally an active lady, felt giddiness in the evening while going to the washroom, lost her balance and fell. She was made to relax for an hour, and then got up again to walk but this time could walk very slowly. She was embarrassed by her slowness.  In the night she had her regular meals and slept well.

5th: In the morning she was taken to the family doctor, who after listening to her asked whether she was taking the blood thinner tablets regularly. My mother replied that she stopped since last fifteen days. It was mainly because of her carelessness rather than any other reason. The doctor asked her to immediately start taking it and said because of thickness of the blood, clots are formed in the brain that causes giddiness and headache. He found the blood pressure and sugar levels of my mother normal.

6th: In the evening her condition deteriorated. She was not able to get up from the bed nor able to move her left arm and leg to the full extent. The left side of her face was also showing a slight change. We were thinking of taking her to another hospital but before that asked the advice of a doctor friend. This doctor preferred to come home and look for himself. He conducted some tests—asked my mother to lift her arms in particular ways, hold the key bunch etc—and announced that it is a paralytic stroke, cause by blood clots in the brain. He asked us to immediately admit her to a hospital and warned that her condition would deteriorate further if we didn’t.

We took our mother to a nearby star rated private hospital at 10 pm where the duty doctor did a CT scan. He communicated the result to the neurosurgeon on phone who suggested her immediate admission. By this time her left limbs were completely affected and her face also was visibly changed. The duty doctor said that it is an evolving disease and reaches the final stage within twenty-four hours. Timely admission to the hospital won’t make any difference. After being hospitalized she was given blood thinner injections immediately. Meanwhile my mother was constantly sleeping and not able to answer any questions properly.

7th: There was no improvement in her condition. She was constantly in a drowsy state and lost her control on her urinary and bowel functions. Urine and blood tests were conducted and medicines were given. Outside food was stopped and she was fed a minimum hospital diet. A neurosurgeon and a doctor of internal medicine were supervising her.

8th: There was no improvement in her condition. The doctors were of the view that she should stay for two more days in the hospital, whereas our doctor friend said there was no point in wasting money. Her condition will not improve even after two days. Rather she would feel better in the home environment.

Meanwhile, our relatives who came to see my mother unanimously talked about the effectiveness of Unani medicines in this particular disease. Luckily we found a Unani doctor, expert in treating paralytic cases, known to some of our relatives, based at Charminar Government Unani Hospital. We were entertaining the idea of shifting my mother to Charminar hospital, but before that we thought we should see the hospital ourselves and meet that doctor. We found the hospital looked like a palace from outside but a ghetto inside, with bare minimum facilities at every level—nurses, assistants, ward boys, beds, medicines, supplies, toilets, drinking water and even electricity, but with an abundance of mosquitoes! We were told that 90% of the inpatients are paralytic patients from a poorer background and a few of them were staying since more than a year. We felt discouraged about bringing our mother here. The doctor very kindly offered to come and examine her at the other hospital.

The Unani doctor confirmed the diagnosis of the allopathic doctors and suggested to have my mother discharged. According to him my mother’s drowsiness was also caused by the hospital environment, which allows a limited number of visitors only for two hours a day. He prescribed Unani medicines for fifteen days and said that it can be taken along with allopathic medicines but with a gap of thirty minutes. However, Unani would take longer to show effect. When we inquired about the use of ‘pigeon’s blood’ in this disease, he said that it was an old practice, but after the discovery of new formulas, not used any longer. It is also avoided because of infections.

My mother was discharged in the night after two days of stay and the total hospital bill was twenty six thousand rupees.

9th: My mother was completely immobile and was able to talk but with difficulty. She was not able to eat properly and the food particles fell from her mouth. We met the allopathic doctor (internal medicine) to understand the administering of the new medicines that he has prescribed. He advised that the fan should be off in my mother’s room to keep it warm; that we continue the diabetic tablets, but stop the BP ones. According to him controlled higher BP is good for her. In the food he asked us to stop giving my mother meat, spices, and oily foods and instead give her more vegetables. He also suggested we start physiotherapy exercises. When asked about his opinion about the parallel Unani treatment, he refused to answer and said ‘how can we say, it’s up to you’.  We felt that he was not encouraging it.

Later in the day we met the Unani doctor who explained how to take various powders, concoctions and capsules, which he was giving for fifteen days. We realized that these medicines were for improving digestive system, liver function, and strengthen the immune system. He said he would give medicines for paralysis after fifteen days. In food, he said that lemon, sour things, curd, brinjal, gongura (roselle) leaves, and all roots and tubers should be avoided. He asked us to defer physiotherapy for a few days because at this stage it was likely to create more pain in the body. He also wanted us to massage the left limbs with Unani oil twice a day.  He had no objections to taking Unani and allopathic medicines together. The allopathic medicines cost two thousand rupees for fifteen days and Unani eight hundred rupees.

Fifteen days later: After two weeks, both the doctors changed the medicines for the next fortnight, which cost nearly the same as it did earlier. My mother’s movement of her limbs was improving along with her appetite. She developed a liking for oats, which the doctors approved. The house was always full of relatives in the first two weeks and made my mother comfortable even though she wasn’t able to talk much. Her drowsiness was reduced and she was spending a lot of time watching TV.

Now: This is the third month now and the month of January; physiotherapy and massage, Unani and allopathic medicines were continuing and will continue for a month more. According to my mother she started improving fast when the second fortnight of the Unani medicine began. The average expenses were twelve thousand rupees per month. Now my mother is able to move her left limbs comfortably, walk with the help of a walker, climb a few steps, eat and go to the toilet on her own. She cannot yet change her clothes, take a bath or comb her hair. Her face is becoming normal though the effect of the stroke is still visible. Her voice is changed a bit and she looks an old woman.

***

People adopt different practical strategies to deal with illness in their families. These strategies follow a pattern that more often than not crosses the boundaries of different systems of medicine [allopathic, Unani, etc.] depending on several factors: perception of seriousness, expense, acceptability to the family, community, etc.  In Moid’s case above they sought allopathic care during the crisis. Once diagnosis and stabilization occurred, the family took a decision, keeping in mind the condition, age and prognosis to move the patient to a less aggressive system of care.  This decision may not have been taken if the patient was deteriorating.  There are definite benefits that accrue due to this strategy in Moid’s situation (though not necessarily in all situations). The risks of continuing hospitalization in the current historical moment include:  brain surgery which may not be very effective; prolonged hospitalization; secondary infections; referral to a government hospital by the corporate hospital as a final dumping ground; lack of information about the patient’s actual status; many other new problems.  Unani here gave hope and provided community endorsement to the caring process.  It allowed the comfort of the family, a system of medicine that was relatively more gentle, a better control of other ailments and saved the patient from complication and prolonged hospitalization.  However, it must be clearly understood that these are benefits that are specific to this case and not generalizable across illnesses.

These strategies are not just economic, but also indicate preference, comfort and an ethically valid form of care.  People who would follow these ‘unorthodox’ strategies include those who can fly their patients to Kottakkal or Vellore as the situation demands.  Woven into these strategies may also be pledges to the Gods with a plea to help a dear one to recover.  On the other hand, a person like Hina Begum (the extract that follows) learns to use the allopathic system strategically for symptomatic care.

In any case, however, it seems as if in practice, whatever systems of care people adopt, critical treatment for life-threatening illness is invariably sought in an allopathic hospital.