Emergency and…Homoeopathy? One cannot escape the derisive nature of the question. The average layman has this perception and so do some of our patients who, while on homoeopathic treatment for their chronic condition, resort to modern medicine to tide them over critical moments. The general medical fraternity undoubtedly believes in this as well. One suspects that most homeopaths also agree with this general belief. This belief has had little challenges from within the group of homoeopaths. Only after mounting the challenge can we test ourselves in front of the medical fraternity and society, and evaluate ourselves.
I have been hospital-based and practically living on campuses of various hospitals for the last ten years. I can assure you that this is not exactly pleasant; nor has it been a necessity forced on me by circumstances; I have done it only to experience firsthand and at close quarters the power of homeopathy in critical moments of life and death. The experiences have destroyed the last vestiges of doubt about whether homoeopathy works in critical situations. I believed that the Law of Similars of the chronic conditions should work in acute situations too. If it did not, then there were only two conclusions. Either we do not know the way of practicing homeopathy in critical situations or the science of homeopathy was incomplete and had a serious limitation.
It was relatively better to have the first conclusion than the second, because if we did not know the art, that was because we did not practice it for years. We have a chance of struggling and reinventing. But if homeopathy as a science had limitations, that would have been the biggest disappointment for me. I was willing to accept limitations of a homeopath but to accept homeopathy, as a science with limited scope, would have been very sad indeed!
To apply homeopathy in crunch situations I had first to get training . I got myself trained and acquainted with emergencies by working in modern hospitals. Working with experts in this field I would become fit by heart first, then the brain and lastly with my hands. The training is still going on. It is a life-long process and only a decade has passed out of it.
The First Emergency
It was only after years of training that I got a chance to manage a crunch situations on my own. I received an emergency call at 1am from the Paediatric department requesting help to save a neonate. I had respiratory distress and convulsions following a difficult and traumatic labour. I saw the scene, the mother was still in lithotomy as her perineal tears were being sutured. She lay exhausted and hardly in a position to speak. There was nobody to give the history except the resident who had delivered the baby. There were no relatives around. I stood there and examined the child and came to the conclusion that the child had cerebral concussion with cerebral edema. It was convulsing, had respiratory distress due to altered respiratory drive and impeding secretion in air passages. After clearing the air passages, the child still had shallow respiration. After supporting him with temperature regulation, oxygen and securing an intravenous line we sent for investigation. While doing this, simultaneously, I was observing the child. Some peculiarities in the pattern of the convulsions and its evolution were noted. The sequence of convulsive movements, like a Jacksonian March, and the areas of manifestation of the convulsive movement (predominantly in the face and around the mouth), were peculiar. Connecting these peculiarities with the etiology (cause) and the pathology (Clinico-pathological co-relation) I could see a clear emerging totality of Cicuta, which I prescribed in moderate potency with frequent repetition. (Read this case here)
The result was astonishing and far better than what could have been obtained with conventional management. Before my ‘boss’ arrived on the rounds the next day the child was fit enough to accept the mother’s breast.
When the euphoria settled down and I analyzed my actions, I realized what had gone into the management of this situation. Clinical assessment, knowledge of symptomatology and power of observation. Information on pathology and investigations, knowledge of clinical medicine ancillary measures, life saving support systems and skills to use them, the knowledge of Materia Medica, repertory and susceptibility – all culminated and got synthesized at one point to manage the child out of which the prescription of Cicuta was just one crucial action. That was the time I realized the difference between prescribing a homeopathic remedy and managing the patient as a whole. All the knowledge that my teachers taught in my undergraduate days came into use. This happened because through my training I had learned to keep my anxieties and fear at bay and my senses intact, to make those crucial unprejudiced observations. This perceiving ‘saw’ Cicuta.
Sliding deeper into Emergency
I went through a similar experience when we managed to salvage a lady who collapsed due to hypovolaemic shock. She was pulse-less; the B.P. was not recordable due to sudden acute gastroenteritis, which was so profuse and fulminating that a few profuse stools and copious purging vomiting had sent her into a state of stock and collapse. Veratrum album helped the revival. All the knowledge and attitudes of the physician mentioned earlier, helped to salvage the situation.
In another case a challenge was thrown at us by nature and due to lack of ‘ASV’ in town, when an adult male with poisonous snakebite was brought to the casualty with gangrene, rapidly spreading cellulitis, toxemia and vascular shock. Clinical assessment, sound observation, clinico-pathological co-relation, support and life saving ancillary measures along with judgment of susceptibility (a powerful prognosticating tool!) helped the first prescription of Anthracinum followed by Lachesis. Not only did we manage the acute toxemia, vascular shock, cellulitis and gangrene, his wounds and the ulcer on the leg healed completely without a skin graft! (Read this case here)
Dynamics of Emergencies: Role of the Self and Others
We are not necessary emotionally attached to the patients we treat, although we do care for them and sympathize with them. One is tested emotionally when one has to prescribe in critical moments for people to whom one is close. I have a deep respect for one of our friends for his sincerely methodical approach and simplicity. He was going through a critical time with a myocardial infarct due to triple vessel disease and cardiac tachyarrhythmia. He was in cardiogenic shock. He was thrombolysed, was on life support system and drugs but with no apparent success. He was advised to undergo emergency coronary bypass which could not be done due to his state of shock. Intra-aortic balloon pump was barely able to maintain his vascular and pulmonary pressures. If he did not recover from this within a few hours, he would succumb, the cardiologist announced. He also openly invited help from us as he had exhausted his resources with limited response and time was running out.
He allowed us to interview/observe him for not more than 5 min and briefed us about his condition. We observed him for exactly five minutes and had a few words with him. The case taking over, we spoke to the relatives outside. The same knowledge and correlations as described in earlier cases came into play. Naja emerged from the totality and a single dose every 30 min converted the arrhythmia into normal rhythm and he came out of the shock (Read this case here). Perfusion improved and the cardiologist happily took him for surgery. As if to test if Naja was a fluke chance, a similar state developed post-operatively and we got a second chance to prescribe Naja. This time it also worked and with the same intensity and pace. Once again Naja saved the grace and life of this honest man. This was a testing time clinically and also emotionally- to be in control and stable and to make the crucial clinical, unprejudiced observations that our masters have written about.
Another important aspect was collaborating with the modern medicine physician and understanding his briefing, approach to the patient, his needs and our role in helping him so that he could complete his job. Clinical knowledge, knowledge of pathology and Materia Medica- all of these play an important role. My experience working with people in ICCU and cardiologists allowed me to vibe well with his expressions, language and needs. I am he was confident that he was speaking to a homeopath who knew what he was doing and knew his job well. This feeling imparted professional confidence and mutual respect for each other, each other’s systems and their scope and limitations.
Having experienced a few hundred to a thousand such experiences collectively in the ICR organizations, a few key concepts started emerging through our discussion and teaching sessions. Looked at in one way, they are the same age-old concepts to be applied in a more critical and hurried situation. Yet, it is not so simple as it seems. One has to subject oneself to systematic and rigorous training if one has to reach the level of competency that is required. Then one can appreciate the difference between life and death, pain and peace.
1) Speedy & accurate clinical assessment (History & examination)