A LIFELESS SURGICAL SUNDAY!

Today, her death certificate was all but signed. She was, a deterministic and superstitious idiot would claim, doomed to death. After all, when she went to her physician in a town in rural Bengal, she was fine, except for a little cough. Her doctor somehow suspected something more sinister. She was found to have a large ovarian tumor. Advised surgery, she underwent removal by a local gynecologist.
In two months she was back in hospital, with another ovarian tumor. This time, things came unstuck. A major open operation to remove her tumor and her uterus got botched. Her intestines got injured. Post surgery, she leaked smelly juice from her injured bowels, and her entire belly burst over, as the sutures gave way in the mess.
After two weeks of treatment, her doctors shipped her over to the city.
She was found to have a huge collection of pus inside her belly, with an additional threat to her life: her kidneys were failing. Her serum creatinine was nine, when the normal would be around one!
I took over the case. I wanted to operate urgently to save her life. I was only too willing to blow a Sunday for her, not that it was a big price to pay to save her life. Just before the surgery, the whole thing fizzled out. The patient’s husband confessed his inability to pay for the treatment. I told him again (the third time) to shift her to a Government hospital.
For so many of us docs, it is common experience to find the relatives giving up treatment half way, with the treating doc stuck halfway with a patient who then slides downhill because of lack of treatment. Ugly, ugly! Even if a doctor waives his fees, the costs of the investigations and medicines, operation room materials, and hospital bills are unpredictable.
The patient’s husband said he would need at least two days to make the arrangements for the funds or even to buy influence to get a Government hospital bed. I told him she would die if she missed her surgery. He told me, “Sir, then let her. There is no way I can do anything before another two days.” I have been forbidden to treat her in the way I want, but she won’t be shifted before another two days. She is likely to die now.
If she does, and the husband refuses to pay for whatever costs have already been incurred in the hospital, guess who is going to have to foot the bill?
Yup, me! As the treating doctor who told the Hospital that we need to admit the patient, and that the husband has assured payment, I am responsible. Not the first, nor the last time. Losing money is never a good feeling, but losing a salvageable patient is horrible, even after so many years of seeing good people die from bad disease and human callousness.

www.planetbollywood.com
So, with no patient to save on a Sunday, I went off with family to watch Heyy Babyy, which was in the news the day the Google news feed went totally crazy. The plan was to, post movie, sample the new World Food Festival offered by Pizza Hut, as Krish Ashok has so funnily described.
The first half was going merrily and mindlessly, with laughs galore at the good old slapshit. I mean slapstick, don’t I? At the intermission came a phone call. Long story snipped, I had to rush to a hospital to rescue a case. A surgeon in deep trouble, with a patient bleeding to death during a planned gall bladder operation. I came in with no blood pressure on the patient, and somehow stopped further hemorrhage. After pumping in blood, she is alive and will, hopefully, live.
Pizza Hut will have to wait another Sunday. If I have the dough to pay for a meal, that is!

16 responses to “A LIFELESS SURGICAL SUNDAY!

  1. Hmm. Years of Bollywood and Kollywood has taught me that doctors did only two things in life –
    1. Take their glasses off and say “I am sorry. We tried our best” OR “Kongrechuleshuns. Ladkaa hua hai”
    2. Refuse treatment to poor hero’s/hero’s father’s/hero’s friend’s mother/sister/father because they could not fork over X Rs, where X is a large number that has evolved with inflation.

    It is indeed sobering and interesting to finally hear it like it is from the other side 🙂

    Ashok,
    Not enough!
    We all need more of your splendid blend of humor as comments!
    🙂

  2. Well done.

    Thanks, Paul!

  3. congrats doc ur featured !

  4. this is indeed a diff kinda post on ur blog
    very real! and ironic
    uve been featured on the wordpress global dashboard and ive a snapshot if u care to save it!

    Thanks, Prax!
    Welcome to the blog.

  5. doc – It was sort of humbling for me to read this. The situations and choices you guys face regularly – contrasted against the mundane stuff I face (and still crib, whine and complain). I knew that but still …

    You are a hero!

    Jeez, Arun, not you, too!
    No hero-sheero at all! Another type of job, is all, only that if you take a break from Red Alert, you get sandbagged by tricky cases. And you end up killing more people than flies.

  6. Thank you for posting this account. I enjoyed my read. Your tactful addition of wit is refreshing; not something you receive in the doctor’s office.

    ~smile~

    Norwegiandawn: 🙂

  7. Good read!
    I guess a surgeon’s life is all about sacrificing sundays! Finally at the end of it all I guess its about that feeling of doing something meaningful, of helping save a life.
    Some surgeons I know make sure they aren’t available on sundays! Guess thats understandable too!
    More posts like this doc!!

    Thanks, Nita!
    I was kinda telling myself not to gross out my readership with medical stuff. Looks like you guys are made of sterner stuff!
    🙂

  8. Sir doc, once again my humble self is resonating with Arun’s comments.

    It is great to know about the other side. How do you deal with all the stress from facing such critical emergencies all the time, writing scholarly articles, being dished out puzzles by your fellow bloggers, and yet maintain such a wonderful blog?!

    Mahendra,
    So our unplanned conspiracy to say nice things about each other continues successfully!! 🙂
    Thanks, yaar!
    I have, after long years of agonising, got a grip on stress, and am absolutely controlled and calm in the face of adversity. I think it has made me a more reliable surgeon in the last few years. So, even when I am facing disaster, I manage, and don’t carry my cases home. Whatever calls I need to take at home don’t affect my equanimity. I usually manage to avoid disasters, and hence can afford to say this. Mind you, there are lots of calls from people for some slight or complaint against the nurse, the Resident, the lift man, and God… I just keep nodding, smiling and blogging!!
    🙂

  9. I know you have a light way of saying things, but I also know you do not say things lightly. And from what you’re saying about being able to handle stress and remain controlled and calm – my respect increases manifold!

  10. You have a difficult job to do @rambodoc. The whole day yesterday I was feeling sad about a theatre director who is always short of money because he directs socially relevant plays. I realise that is nothing.
    As Ghalib said-
    Gham aur bhi hain duniya main mohabbat ke siva.

    Prerna,
    ‘Short of money’ is very important! You can’t hope to do well if you are not sensitive to what the market wants. Then be so good that the market starts wanting it. Not to be taken as a comment on this particular director, just a general observation.

  11. so how do i send u the pic?
    do i post it or wat cause i see no email add

    Yeah, Prax! I did email you, but you probably didn’t see it yes’day!
    Feel free to post it, or mail it to: rambodoc@gmail.com.

  12. I read this post yesterday and I took some time to comment. I wanted to absorb the full impact of this post.
    It was a quite a shock and an eye-opener to me. I never realised that the doctors are expected to foot the bill of the patients , incase they fail to pay.
    I know a few cases we deal at office where we waive the fees and even pay the court fees , but when the claims or settlement is granted , we get the court fees reimbursed and dont charge the client if he/she is not well to do.
    And unlike the other professions where the fees would be fixed to all , we weigh the financial position of the client and charge accordingly. So like in Adam Smith’s cannons of taxation , a murder would be more expensive for a jeweller than for a farmer and the pinch in the pocket wld be more too.
    But u have brought out the plight of a physician when faced with such a helpless situation…really….it shook me out of my reverie. I was always under the impression that the front office takes care of all the payment matters and the doctors are concerned only with the treatment part.
    When we lose a case , we feel bad about it….but we know we have done our best. In ur case , giving up on a good case just becos of lack of funds must be so damn painful.
    Its not a surprise that doctors have no weekends…but I am not sympathising with u…nice to have someone in the same boat .
    Expecting more of such posts , Ram .

    Sree,
    This is all the more valid if the surgeon lands in a complication after his surgery. He has to foot the bill in case the party refuses to, and the hospital looks at the surgeon and says, “We can’t waive off so much, we are not authorised to. No one is. So we will adjust this with your monthly cheque.”
    In the capitalist US, this funda has just sunk in. The insurance companies (a collective noun for vultures) have now put in a clear rule document where specific complications are not covered for in-hospital patients. For example, a fall from the bed leading to a head injury, bed sore, etc. Thereby, they hope that hospitals will be more diligent with their patient care, and prevent treatment-induced complications in the first place. Sounds great, is’nt it?
    It ain’t so. The hospitals now seem to be set on refusing admission to high risk cases. This, they aver, will reduce the chances of expensive complications occurring. Patient care is set to take a hit!

  13. Rambodoc, I was all set to write another comment on how much more meaningful your life is compared to the stupid things I do with mine. But two things happened:
    (a) About 77 people said it already, so all I can do is wholeheartedly agree with them. and
    (b) A vision of my father at his cynical best saying “Look at the big picture I say. Evvvverything is irrelevant.” flashed through my mind.

    So Im ektu confused. But great going. Ive always enjoyed reading your blog 🙂

    Dude,
    A pleasure seeing you here!
    The polyglot in you sneaks out, eh?
    🙂

  14. chk ur email hope u got the pic.

    Prax, thanks!

  15. A sad story. And you probably encounter it all the time.

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