At around 10 PM, I was informed that a 6-year-old child had been bitten by a snake and was being brought to the emergency department. It had been almost an hour since the bite. Both the child and the family were in complete panic. As I examined the child, he started to vomit. The symptoms of snake venom began to appear one by one.
Poor child... What else can I say but tough times? Snake bites are more dangerous for children than adults. When a snake injects venom, it doesn't consider the age of the victim. The same amount of venom is injected into everyone. Since the body is smaller in children, the venom is in larger quantities relative to their size, which naturally increases the risk of harm. Just like the parents, the doctor treating the child will also experience heightened stress. In the case of children, everyone will be more anxious than usual.
At 6 years old, it's the age that pediatric doctors need to look after. Should I handle it myself to avoid any tension? The treatment for snake venom is the same for both children and adults. If I don't manage it, it will take at least an hour to reach a hospital in Thrissur or Perinthalmanna. That one hour of delay would almost certainly eliminate the chances of the child surviving. The most important thing in my stress was that it was a young life. I didn't think much before deciding to handle it.
By the time we started the treatment in the intensive care unit, a call came in from the lab... the child's blood wasn't clotting. Seeing the concern on my face, the mother asked, "Is there a problem, sir?" It was a venomous snakebite. The venom had already entered well. For any doctor, the bite of a cobra is the stuff of nightmares. Even with all the existing treatments, some patients won't survive. Let it settle down... it may take a day or two to understand. How do I console the terrified mother?
I couldn't hide the reality. However, I couldn't panic the mother even more. I gave her a seat next to me and calmly explained. "We have all the facilities to provide the treatment. It was a cobra bite, which is a highly dangerous type of snake. Once we administer the anti-venom, we will see some improvement. However, we may later discover issues in internal organs like the kidneys due to the venom. Such issues usually show up after a few hours, or even a day. If the kidneys stop working, dialysis may be required. We do have the facilities for that. In rare cases, there could be a more serious condition called capillary leak. In such cases, treatment may fail, as there are no proper treatments available for that."
I explained everything carefully and made sure she understood. I called the child's father and explained the situation in more detail. Even after midnight, I stayed by the child's side, watching the response to the medication. I administered the maximum allowable dose of medicine. There was some small progress, but the child's condition remained worrisome. The signs suggested that things could get worse. I shared my concerns with the parents.
By morning, the child's condition had worsened further. The kidneys had stopped functioning, and the blood creatinine levels had started to rise. Dialysis was the only option. I told the father, as expected, that the child needed dialysis. As anticipated, the family was in an uproar. One of the relatives, who had been absent until then, stepped in. He didn't know anything about what had happened or what I had said earlier. As usual, there were a lot of questions.
"Should we take the child to another hospital?" "The treatments available here are the same as in any other place. Taking him elsewhere will not provide anything extra." "Is there a guarantee that staying here will save the child's life?" "I don't have a guarantee. In the case of such a critical situation, no doctor can give any guarantees." "Then should we take him elsewhere?" "If that's your decision, you may take him."
The relatives continued to discuss the matter for some time... Time should not be wasted. If you agree, we can start the dialysis right now. If not, you should quickly take the child to Thrissur Medical College. I have already informed the head of the pediatric department there and the junior doctors under him, and they are ready to take over the child’s care," I said. Since the time treatment had started, I had been in continuous discussion with the doctors who were part of the team, and they were happy to take over the child.
However, when they heard "Medical College," their reaction completely disappointed me. "We are not going there. We are taking the child to a private medical college in Thrissur." "No, no, go to the Government Medical College. You will have no trouble or delay there. They are waiting for you. Why go to a private college?" "No, there are experts there." "That's what I've been saying since yesterday. The treatment is the same everywhere. There is no difference. Whether it's the private one you're mentioning or the government one I’m suggesting..."
Then, the child's father said, "Sir, I’m ready to go wherever you say. But the others are not agreeing." To which I replied, "It’s your decision, isn’t it? The choice is yours."
After much discussion, they finally decided to go to the private medical college in Thrissur. Once everything was arranged, we left from there in the afternoon. Unfortunately, when we reached, there were no machines available for dialysis — they were all in use. That’s when things started to slip out of control. The child’s condition worsened. But they still hadn’t thought of the nearby medical college. I then contacted the head of the nephrology department at Kozhikode Medical College. There, too, all the machines were in use. So, we headed straight to a private hospital in Kochi. By then, we had lost precious 9 hours. On the way, the child passed away at a private hospital in Chalakudy.
The next day, I received a phone call from the general manager of my hospital. "Who will answer for the death of the child who was treated there?" I felt deep frustration, sorrow, and helplessness upon hearing this. If they had asked me who was responsible, my answer would have been: "It was the snake that bit, the relatives who delayed the treatment, and the parents who left the decision to others when it came to their own child."
This is just one example of such incidents that occur regularly. Our society believes that large hospitals provide better care, while smaller hospitals offer lesser treatment. But how often do people trust fabricated stories told by those who know nothing about the field, rather than doctors who have years of experience? No doctor would ever say that a treatment doesn’t exist, and even if they did, they would not be brave enough to say so. A doctor would never gamble with a life, knowing that it also risks their own. Denying a patient the treatment they need can lead to the closure of a hospital or even the end of a doctor's career. Therefore, if your doctor assures you that they have the resources for the treatment, you should trust that assurance.
When should a patient be transferred from one hospital to another?
1. If the treatment facilities are not available.
2. If the doctors are unable to make a proper diagnosis.
3. If the doctor or hospital is not preferred.
4. If there is a hospital with better treatment facilities closer to home.
It is essential to know a few things about snake bites.
If you examine the records of any hospital, in the majority of cases, it is usually bites from non-venomous snakes that are treated. This is because Kerala has many species of non-venomous snakes, but only a few venomous ones. The main venomous snakes found in Kerala are the Cobra (Moorghan), King Cobra (Rajavempala), Viper (Anali), and Krait (Vellikkattan). Among the Vipers, there are three types, but two are commonly seen in Kerala. The Russell’s Viper is the most dangerous of these. The Pit Viper is the one with relatively less venom among the Vipers.
The venom of the Cobra and Krait primarily affects the nervous system. The victim may lose the ability to breathe, and death occurs due to suffocation if the right treatment is not received immediately. However, the venom of the Viper affects the kidneys, blood vessels, and the heart, which leads to damage to vital internal organs. The patient might take a little longer to reach a critical condition after being bitten by a Viper, but the treatment is far more complicated compared to the venom of a Cobra or Krait. The chances of death are much higher. If the victim of a Cobra or Krait bite is taken to a hospital with immediate treatment before breathing completely stops, the chances of survival are much higher. On the other hand, if bitten by a Viper, people who reach the hospital quickly also often succumb to the venom.
When a Cobra or Krait bites, the victim may need a ventilator. In contrast, if bitten by a Viper, dialysis may be required.
Do not waste time trying to catch the snake that bit the person.
Even if you manage to catch the snake and the doctor cannot identify it, there is no need to lose confidence. Snake identification is not essential for treatment. As mentioned earlier, there are many non-venomous snakes around. It’s not necessary for a doctor to identify them perfectly. However, it is not difficult to identify venomous snakes. Some non-venomous snakes can look very similar to the venomous Krait. I’ve heard people ridicule doctors for saying that a snake is non-venomous when it looks like a Krait. Remember, not all snakes with a silver stripe are dangerous.
Is it necessary for a doctor to identify whether the snake brought in is venomous?
Identifying whether a snake is venomous or not is not the primary job of a doctor. Even if a venomous snake bites, it doesn’t always inject venom. It is estimated that in about 30% of snake bites, no venom is injected. In such cases, there is no need to administer anti-venom. The doctor's task is not to identify which snake bit the person, but to determine whether venom was injected. This is done by observing the symptoms of the patient. Symptoms include swelling at the bite site, severe pain, tissue swelling, abdominal pain, dizziness, headache, blurred vision, double vision, eyelid drooping, difficulty breathing, inability to move, and so on. Blood test reports may also provide some indications.
The decision to administer anti-venom is based on these symptoms. It is not essential for a doctor to know which snake bit the patient. In India, the available anti-venom is a mix of the anti-venoms for the three types of venomous snakes mentioned earlier. There are no specific anti-venoms available for each snake species individually. So, even if the doctor is not sure about the snake species, there is no need to worry.