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)
2) Observation of patients for PQRS symptoms
3) Critical interpretation of clinical investigation results
4) Skill of clinico-pathological co-relation
5) Life saving skills & procedures
6) Assessment of susceptibility & Miasm
7) Exercising Judgment in order to arrive at a homeopathic prognosis
8) Accurate remedy response analysis in order to move on to cure.
Emergency Homoeopathy: The Agony and the Ecstasy
Emergency medicine can generate various responses in doctors. It can excite the young at heart as it sounds challenging and looks glamorous. It can send shudders through the spines of the inexperienced and untrained but who face the heat of it in their practice. It can evolve into an art in the hands of a scientific clinician. Some would enjoy it enough in order to be wishing to repeat it. Some prefer to take risks and feel happy taking up challenges. They wish to test their nerves and enjoy being on the edge. One should be willing to put in that extra bit each time he/ she is handling a patient.
One should be a die-hard optimist and positive even when the situation is grim. It is akin to looking straight down the barrel of a gun. One should accept failure and death with equal grace, as one would celebrate one’s victory like a soldier on the battlefield. Such are the people who are fit to venture into this zone.
This zone is tireless, thankless, and testing, hence not suited for all. It is clear that one has to pick mature physicians to perform this job. The training will have to be to build up stamina, install the internal discipline to develop systems within, be alert not for a few moments, but for a lifetime. Imagine being a commando for the rest of one’s life!
Training for Homoeopathic Emergencies
If training of this nature has to occur, the training modules, teachers, faculty and infrastructure has to be in place.
Do we have it in place right now? I doubt it.
Do we understand the thin line between dependence, independence and interdependence? Are we interdependent in the true sense or are we still living in the shadows of modern medicine? Do we receive, diagnose, investigate, prognosticate and manage the patient? Or do we just prescribe? We need to understand the difference between management and just prescribing! Training thus becomes a crucial need of the day and training teachers and building infrastructure to train students becomes an important area for our future development.
We need to transfer technology and skills from the experts in the field. We need to customize it for homeopathic needs and not to simply copy it. Experience of this order is scarcely available amongst the homeopaths of today. Training with the help of experts in this field is essential.
Value-addition of Emergency Homoeopathy to the Science
Value of such trained Homoeopaths in rural areas is very high as compared to urban populations where there are other options. Doctors trained under these programmes should be posted in rural areas, where they will get an excellent opportunity to sharpen their skills. The needs of the community will get fulfilled and lives will be saved.
All this highlights the role of organizations along with individual doctors. It will be essentially a teamwork between clinicians, teachers, nursing administrators and rescue personnel. If the team performs well, life saving and reducing morbidity will become a realistic possibility in a systematized way, even in the rural settings. Nobody is going to build up all this for us! We, the homeopaths and our institutes will have to develop it ourselves.
Right now what we have is the work of our brilliant masters who have struggled on their own to come out of the embryo. We as a system are yet to be born in the field of Emergency medicine. Unless we develop our own system, use it, test it, evaluate it and then teach it we will not be a system useful in emergency medicine (and cannot come close to being a mainstream medicine). If we are happy being second best, then so be it. If not, then the time has come for awakening, to search the truth that lies between life and death.
[This article was presented at the National Conference on Homeopathy in IPD care, in Ahemadabad, Gandhinagar]
Dr. Navin Pawaskar
M.D. (HOM) Practice of Medicine
Consulting Homoeopathic Physician
Member Institute of Clinical Research
Director Clinical Services, Dr. M. L. Dhawale Memorial Trust’s
Rural Homoeopathic Hospital, Palghar, Thane District
Reader Department of Medicine, MLDMHI Mumbai