By Narinder
July 9, 2024 — Clinical Memoir

The Girl with Mononucleosis A Kissing Disease

Lieutenant Bopa Rai was an intern then, learning the rhythms of wards and clinics, memorizing clusters of signs like a drummer keeping time.

That day began with the arrival of a girl in her early teens. Beautiful Miss K was brought to the hospital clinic by her tall, strong Khalsa father. She was only thirteen, with large, thoughtful dark eyes and a quiet demeanor. She had a headache, fever, and throat pain. At first sight, it looked like another trivial viral fever, fit to be sent home with Crocin, hydration, and a few days of rest. But her flushed cheeks demanded a closer look.

On examination, she had a flat reddish rash on her cheeks — an erythematous macular rash — and redness at the back of her throat, suggesting posterior pharyngitis. Posterior cervical swellings were felt: lumpy, tender lymph nodes. Further probing revealed an enlarged soft spleen and liver. The clustering of these signs, together with her age, made the picture clear. This was no ordinary viral fever. It was infectious mononucleosis, the ‘kissing disease.’

The senior surgeon doubted him. ‘Are you sure?’ he asked.
‘Yes, Sir, I am,’ said Bopa Rai.

Her course was stormy. She worsened, developing jaundice, her rash spreading, her body wasting with weakness. Bopa Rai’s mind wavered, poring over Nelson’s textbook of pediatrics, doubting his judgment, confusing mononucleosis with its mimics: scrofula, lymphoma, serum sickness, hepatitis. Yet Major (Dr.) Mallik, with quiet faith, kept her on conservative management, teaching the young intern the virtue of patience. After forty-five days of illness, she recovered fully, hale, hearty, and smiling. Miss K would one day become a doctor herself.

Mononucleosis, caused by Epstein-Barr virus, is often remembered as the ‘kissing disease.’ It spreads among teenagers, sometimes mimics influenza or hepatitis, sometimes frightens with complications, but is usually benign and self-limiting. There is still no specific treatment. For Bopa Rai, it was the first encounter with the power of pattern recognition — a memory retrieved at just the right moment.

The Boy with Twisted Limbs – Dystonia and Drug Reaction

Later the same day, another child was brought in, this one barely five years old. His arms and legs were twisted grotesquely, his face contorted, his eyes upturned. He had vomited earlier, been taken to a local doctor, and injected with Perinorm. The reaction was catastrophic.

The mother was aghast, the father stood morose as if struck by some visitation. Around them gathered the usual retinue of well-wishers, ready to obey any command, if only someone could give it.

The command was given. ‘Load an Avil injection,’ Bopa Rai ordered. The nursing assistant obeyed. Slowly, half an ampoule was injected. Avil, an anticholinergic, is not a trivial drug. It can bring on tachycardia, and from there ventricular tachycardia is not far away.

Yet the effect was dramatic. The contortions eased. The twisted limbs straightened. The eyes settled. The boy drifted into an angelic sleep, as if nothing had ever happened.

The family stood in awe. The mother, overcome, touched Bopa Rai’s feet, embarrassing him no end. He explained it was simply a drug reaction reversed by another drug, nothing magical, and told them to let the child sleep in peace.

Lessons of an Intern’s Day

Two cases, one day.

One was a long march through fever, doubt, and patience — a lesson in waiting and watching.
The other was a sudden miracle, conjured in seconds, clothed in awe.

For Lieutenant Bopa Rai, it was a day that taught him that medicine is a dialogue between memory, chance, skill, and grace.

• What Bopa Rai the Intern Learnt About Life and Clinical Medicine
• The Road with Ghosts, Gods, and Delirium
• The Kissing Disease: Mononucleosis Explained
• The Enduring Legacy: A Historical and Operational Analysis of 302 Field Hospital (1940-2015)
• Rum Me Base Hain Ram