Monthly Archives: August 2017

The Paragon of Courage (My Worst Night As a Doctor)

The Paragon of Courage
(My Worst Night As a Doctor)
© Dr. Rajas Deshpande

“She is sinking. Unlikely to survive” said a doctor who had come for second opinion. The parents broke down. The father, a gentleman, held his speech as tears ran down his face, but the mother, like all mothers, could not hold her pain.
“Why Us? Is this all really happening? Why did we even do this procedure? I don’t know anything, doctor. I want my little girl back” she said, crying.

That was the worst night of my career as a Neurologist.
It was 2 AM. Dr. Anand Alurkar and myself waited on the road outside Ruby hall Clinic, Pune. We both felt extremely low, tearful. The loss of a life as a complication of treatment is the worst nightmare of a doctor. To save lives, a doctor must take courageous decisions, do the best thing for the patient. Every doctor, especially a surgeon, has to face this cruel dilemma: to not treat, let things be and leave the patient to nature’s rules and agonies, or try to save a life with the two inherent risks: a medical complication and the reality that such a complication may make the doctor an instant villain.

Three days prior, Tanushree, a 17 year old student from Manipur had gone to Pune airport to see off a friend. She suddenly fainted there and had a convulsion. Her friend brought her to my OPD. Her examination was normal, but she seemed quite aloof and had mild headache. An urgent MRI showed a bleeding in her brain. She had a bunch of abnormal blood vessels in the brain, which form a tangle. Some such blood vessels may bleed as they have thin wall, or when the pressure inside the bunch increases. In such cases the abnormal blood vessels are usually closed with a glue injected inside them. It is a standard, but very complicated procedure that requires skill and experience of years. I had called in Dr. Anand Alurkar, he had treated many such cases successfully. He opined that the girl would need such glue injection / embolization.

The procedure is risky (one must enter the brain’s blood vessels with a thin tube / catheter inserted from the leg), and other than the usual minor risks of any hospital procedure, the major risk here was a possibility of fresh bleeding in the brain, which happens in 1 percent of cases even if the procedure is correctly done. Such bleeding can even be life threatening.

Tanushree’s parents, Mr. Khuraijam RatanKumar Singh and Mrs. E. Meghabati Rani ji, were in Manipur. They arrived immediately. Mr. Khuraijam is a highly placed officer, and wanted to give her the best treatment options, they didn’t care about expenses.

We could understand that we were quite new as doctors for the family, and far away from their home, in a strange land. In view of recent bleeding in the brain, it would be risky for Tanushree to fly. We had all the necessary facilities. We explained the situation to them, including the risks. Her parents told us that they had complete faith in us. They signed the papers, consenting for the procedure. Tanushree was fully conscious, and had no complaints.

A brave teen, she went into the cathlab smiling, at 3 PM.

The procedure took over three hours, at @ 6 PM Dr. Anand confirmed that everything was done well, she was stable. She was shifted out to the ICU for observation. I saw her after the procedure, she smiled back. We went home for dinner. I planned to return to see her late night.

The nightmare began.
Just before I reached home, I got a call from the ICU team. “Tanushree complained of a severe headache, and then has become unconscious” said the panicked ICU doc.
“Get an urgent CT scan” I said as I took a U-turn. It was 9 PM.
The CT scan showed fresh bleeding.

That one major complication, known to happen in extremely rare cases despite all precautions, had happened in this 17 year old teen. The bleeding was substantial. Dr. Anand came rushing back too. We started all the emergency treatments for reducing the swelling on her brain. The parents, lost and broken, supported each other. Her mother was upset with the whole thing, and felt guilty that they had consented for the procedure. I understood her feelings, but was helpless. I knew how my mother would have reacted, and this was not different. We now prayed that Tanushree improved, and desperately hoped that her brain swelling reduced. But things went worse.

At @ 4 AM her brain swelling started to cause pressure effect on the brainstem: the area that controls heart, breathing and blood pressure. Once that area fails, the patient is unlikely to survive. She became almost comatose. In an unfortunate twist, a doctor called in for a second opinion told that parents that there were no chances of survival. The parents lost it.

I discussed with Dr. Anand. We were not willing to give up. There was a very small chance of her survival, if her skull was opened to relieve the pressure effect of the bleeding on the brainstem. But this is a major surgery, and has more risk than the earlier procedure. We explained the situation to the parents. Her mother was disturbed beyond decision making. Her father told me: “Do what you think is the best. I will leave it upto you”.

Once again, I had to risk her life in an attempt to save it. Only a doctor would understand the full implication of these words.
I called our senior neurosurgery expert, Dr. Ashok Bhanage. He arranged for an emergency surgery within a few minutes. He spoke to the parents, explained that there is risk of death even during surgery, and took her in. I waited with the parents in the waiting room.

“Save her, I beg of you” I kept telling my God.

After three hours, she was wheeled out to the recovery room, on a ventilator. In two days, the ventilator was taken off. She had developed paralysis of the right half of her body, and lost speech. In a week, she started speaking a few words. In a month, she started walking and regained almost complete speech, but her memory was still not well. She was stable. I thanked Dr. Bhanage for his timely response. Accepting the risks, he had turned the game over.

Every doctor has to play every day with these fears: of mistakes, of complications, which will ruin his / her career within moments. It is a stress beyond description, and amplified in case of surgeons. The more aggressive and distrustful the relatives or the patient, the more difficult the decision making, the higher the risk of a decision in favour of avoiding risk, even if life saving.

On the day of her discharge, Tanushree’s father and mother became emotional, and thanked our team with beautiful, heartfelt words. Her father also gifted me a Reid and Taylor suit fabric, which I will pass on to my son as my precious treasure.

In a year, Tanushree recovered nearly completely, and joined back her college. She went to London to explore possibilities of further education, and now has chosen to pursue law. In spite of some mild effects that the event has left upon her, she continues to be brave and bold, and takes on any challenge with the grit of one who has already defeated death.

When she followed up yesterday, she was smiling as brightly as she ever does! “Sir, I am sure I can defeat any problem in my life now, after what I have overcome” she told me.

Her father told me: “You are God for us”. As much as I love and respect those undeserved words, I am keenly aware that there is only one God that looks after both: the patient and the doctor.

I cringed at the thought: “What if, out of fear that night, I had decided not to advise her that second surgery?” I will never forget that being a doctor I am also assigned this extra responsibility: to take the best decisions fearlessly for my patients, to explain them well to the family, and to hope for the best.

I was lucky that my prayers were answered, and I learnt that my God also meets me in the life of my patients.
© Dr. Rajas Deshpande

PS:
Thank you, Ms. Tanushree Khuraijam, Mr. Khuraijam RatanKumar Singh, and Mrs. E. Meghabati Devi Ji, for the permission to share this story.

There must be far better doctors and teams in India and abroad, I am sure. This article is to highlight the plight of what a doctor feels when things go wrong, and to tell the world about the exemplary courage of a teen.

The Beacon Of Good Doctors

The Beacon Of Good Doctors
© Dr. Rajas Deshpande

At 3 AM one night, the patient in the ICU called me. “I am very worried about my kids” he said.
He was a chemistry lecturer at a government college, a job quite prestigious, but underpaid like every govt. job except the ministers. They didn’t yet have their own home, and he was the only breadwinner in the family. They did not have the political and power resources to afford a heart transplant outside India that could have saved him.
He had multiple medical problems, and was one of the most complicated cases I had seen. Along with other medical problems like high sugars and blood pressure, he also had a dilated heart that was failing by the day. My teachers had explained him and his family about a bad outcome, and reassured that we are trying our best to change it. I was in the last year of my residency, doing M.D. Medicine at Govt. Medical College Aurangabad.

I sat besides him and held his hand. Due to his heart condition, he could not lie down at all, his breathing would worsen. Tears flew from the eyes of that brave soul, who had accepted his own fate, but was only feeling bad about the future of his wife and three kids. I tried to reassure that learned man, far above me in age, experience and wisdom. This is often a difficult task a doctor must stand up to.
“I understand fate, but I cannot accept the suffering of my family” he replied.

His son, Abhay was studying in the second year of MBBS. Clearly aware about his father’s condition, Abhay stood up to the responsibility bravely, and kept smiling in front of his father, while attending him all the time after college and in the nights. The medicines required were costly (of course not available at the govt hospital), but we found a kind hearted pharmacist who would give these to us at the company rates.

There are two types of death, sudden and slow, and both kill some part of those who love the dying person. But to witness a beloved father slowly succumb over weeks is a horrible punishment, and Abhay and his family endured it, God knows how!
After a few weeks, fully conscious and aware till the last day, surrounded by his loved ones, Mr. Suresh Pohekar left this world. The family stared into a darkness that had no respite. Abhay’s mother, Mrs. Ratnaprabha, took charge bravely. She joined as a lab assistant in the same college, and sailed through the difficult times, coping with the educational expenses of their kids.

I had completed MD by then, and had joined Abhay’s college as a lecturer. One rainy morning, on the way to the hospital, my scooter slipped as someone ran across the road. I could not get up, I had torn a ligament. A stroke of luck, one of the best orthopedic surgeons in Aurangabad, Dr. Jagannath Kaginalkar was riding on another scooter behind me. He picked me up and plastered my leg at this hospital. I informed the authorities that I won’t be able to work on that day, for which the hospital cut my salary. This was ridiculous, and I quit that hospital.

I started teaching medicine as private tuitions. This would help me prepare for my DM entrance exams too. Abhay joined that class, we stayed in touch. I had a special affection for him given what he had endured. Nothing bonds like shared pain.

Most doctors come from poor families in India, and passing MBBS at the age after 22, face this universal dilemma: whether to start earning by going into practice or pursue postgraduation / superspecialty. It is a difficult decision. (The answer, for those who face this dilemma, is only one: get the highest degree possible). He passed MBBS with excellent marks, and got admission in MD Medicine. Working hard there too, he passed his MD exams from a rural medical college. By then, he had fallen in love with his college-mate Dr. Jayashree, a pathologist, who gelled with his thoughts perfectly. He started his practice in a rented small single room in a remote area in Aurangabad.

They never returned a patient for lack of money. Never asked twice for fees, and extended all help to the poor patients vising them.
“I believe I won’t ever grow any poor by helping those who cannot afford. Nothing I want can be at the cost of insensitivity to others. Everyone goes through pain and suffering, and to ignore it when others need help is inhuman. Fortunately, God has provided me with all that I want, and money has never been our driving principle” Abhay says. It is difficult to do this especially in these days where the tendency to take advantage has become rampant among both doctors and patients, but Abhay and Jayashree, guided by their mother Mrs Ratnaprabha, have continued extending to the society what it lacks the most: love and healthcare. Guidance by Mr. Agashe, a well-known spiritual soul highly renowned for his godliness, helped Abhay overcome many a turmoils in his life.

Dr. Abhay Pohekar now has his own home and a Hospital in Aurangabad, and continues the holy medical tradition of silently extending humanity to those who need it. In an era of fake prizes and medals for faker people, we hardly get to know the real beacons of good in our society. So many hundred doctors coming from humble backgrounds in India want to do so much good, only limited by the society’s attitude towards them, and the atrocious regulations and laws being made without involving the ground-level medical practitioners out there.

Abhay, I know that your father, Mr. Suresh Pohekar, looks upon you and your mom proudly from heaven. You must feel very proud too, that you have converted your father’s tears of agony in those of joy!
God Bless!

© Dr. Rajas Deshpande

PS: Thank you, Dr. Abhay Pohekar, for the permission to write your true story.
Please share unedited.

Boost Post