By Dr. Aftab Naz

It was 1981. I had finished my residency at Cook County Hospital Chicago 2 years ago & was struggling to find a private practice. Those days were rather difficult to establish a new pediatrics practice as most of the Family practice docs would take care of the kiddos. After working as part time attending physician at Cook county Hospital Chicago with moonlighting here & there, I decided to move to California. In fact a friend of mine Dr M Ashraf, who was already practicing Cardiology in Madera California, invited me to visit the town & take over a small practice which was for sale.

So 43 years ago June 1, 1981 I started my practice. It was slow going but steadily improving. One day an 11 month old girl Maria was brought it with fever & jaundice. Since Hepatitis A was common at that time in the area, I diagnosed her with it & advised routine dietary management. A week later she returned with ascites.

Her liver was failing, so I admitted her in the community hospital & initiated the workup. Her LFT,s were slightly abnormal, bilirubin was about 8 mg/dl & hemoglobin was about 10gram. All other tests were normal. Due to increasing ascites, I transferred to local Children hospital in Fresno

At the children hospital a GI fellow would come twice a month from UCSF San Francisco. He decided to transfer Maria to SFO as her ascites was worsening inspite of treatment with diuretics & whatever else they had.

At UCSF, a liver biopsy was done & found to have nonspecific inflammatory changes. In the next 3 weeks, her ascites got significantly worse. Parents were advised that she had liver failure & she was not going to make it . So they decided to bring her back home to Madera AMA as it was easier to transport a live person than a dead body.

MARIA IN MADERA

By this time about 2 months had passed & patient was really uncomfortable due to increased intra-abdominal pressure. She has persistent cough due to shortness of breath. She was brought back to my office for cough. I advised them that she needs relief of pressure from her abdomen. Parents did not want any heroic measures done as “ she is going to die anyway “. I advised them that “yes. But let her die in peace”.

I called FRESNO children hospital & UCSF & they both refused to take her in as she was terminal anyway. Our local Gastroenterologist & surgeon also had their hand up by saying they were not pediatrics specialists. I asked an old FP how to do an abdominal paracentesis & admitted her in my local hospital.

This was my FIRST & LAST abdominal tap of my life. I took out 700 CC fluid first day & another 300 CC. the next day. She was comfortable & was discharged home.

I saw her in my office a week later. Her abdominal girth was the same as at the time of discharge. A month later her abdominal girth was normal & she was an active happy toddler. At age 16 Maria had splenic infarction & had splenectomy done at our hospital. At age 18 she had her first child & after 3 children she moved out of town & got lost to follow up.

I had been a “PEER” for the family. They sent me so many patients. And my practice flourishes until now thank God. All I did was make her comfortable.

I informed the UCSF about the happy outcome and they asked me to send her back for further biopsy which I did not comply. They were not helpful when I needed them the most. Unfortunately I never thought of getting all the medical records & write it up for a journal. Now our hospital has been closed also. This story is all from my memory.

Aftab Naz–