© Dr. Rajas Deshpande
Rimless spects, ipad, T-Shirt and denims. Brilliant face, thinning hair. Attitude. A face carefully wiped off of any expression. The typical new age intellectual waited outside the ICU. Body language: severe anxiety.
“Doctor, do whatever you must, his convulsions must stop” said Mr. Prasad. His father was having continuous fits for over three hours, he was just admitted directly in the ICU after all the home remedies had failed. His oxygen levels had dropped to dangerous levels. Patient had ready aspirated during his convulsions. His food had regurgitated and entered his windpipe.
The last treatment for continued fits is completely paralysing the patient with general anesthesia, intubating and starting artificial respiration with a ventilator. There is risk, but lesser than if the patient continues to have fits. Every doctor, for every patient, must make a decision based upon the risk-benefit ratio. Every treatment, medicine or surgery, also has potential risks. The decision that can potentially cause someone’s death is not easy to make. Every doctor lives on the edge of this risk.
Add distrust and suspicion, and we are dealing with law more than with medicine. Welcome to the medico nightmares! © Dr. Rajas Deshpande
The critical care team had already explained the risk to the Mr. Prasad. He had signed the consent, including understanding of the critical condition. We intubated the patient and ventilator was started. The fits stopped. A chest physician was also involved in the treatment. Monitoring of the brain waves still showed abnormal currents in his brain, so he was kept paralysed next two days.
On the third day, the patient developed fever, most likely he had developed a chest infection, so common after aspiration. His condition worsened, his blood pressure dropped. We informed the family.
“Why didn’t you prevent this?” asked Mr. Prasad.
“Sir, have you ever had any cough, cold, fever?” I asked.
“Yes, many times. What has that to do with my father’s infection?“ he replied.
“Why couldn’t you prevent it?” I asked, “Anyone can develop an infection or a heart attack anywhere outside the hospital and it is ok, but if it happens inside a hospital, why does it suddenly become a doctor’s fault? Hospital acquired infections are possible in spite of all precautions, in the best of the hospitals across the globe. The elderly population is especially more prone for infections.”
This being a routine question, there was no reason for me to lose my patience. © Dr. Rajas Deshpande
Our team worked hard to maintain the unconscious patient alive. His heart rate fluctuated, blood pressure dipped to non-recordable sometimes, blood sugars went high, liver and kidney functions were deranged, but we kept on playing the “Medical Chess”, where one doesn’t know what move nature will make next, the only possible next step is to accurately, promptly and wisely counter that complication.
His lungs started failing, the chest physician advised steroids. At this stage steroids could either be life saving, or could cause havoc by worsening the infection. Mr. Prasad was explained the situation.
“What are the chances of survival and complete recovery?” he asked.
“Unpredictable, Sir” I replied.
“Then why use steroids?” he asked.
“If we don’t, the chances are less than if we do”. I replied.
Steroids were added. The patient stabilised and then started improving gradually. Over next five days there was a dramatic recovery. Steroids were stopped.. Mr. Prasad remained expressionless, questioning every move. Three days later, once he started breathing by himself, the ICU team informed me that the patient could be extubated- the tube for ventilation could be taken out. I was in the OPD, I okayed the decision.
In a few minutes, Mr. Prasad rushed into my OPD.
“Doc, my father cannot speak. He has lost voice”. He was quite angry and anxious.
“Let me check” I said and went to the ICU.
The patient was otherwise fine. The throat tube inserted for ventilation sometimes causes swelling in the throat, involving the vocal cords, and such “hoarseness” or loss of voice is common after this procedure. Using steroids facilitates recovery, but in this case, it was now risky to use steroids. We explained the situation to Mr. Prasad. © Dr. Rajas Deshpande
“When will he recover from this?” he asked.
“Usually two weeks, but still one cannot say exactly” I replied.
“Why didn’t you tell this to us earlier? This is atrocious. I will file a complaint. We will go to the court. My friend is a reporter. I will also write on social media about this, that because of the treatment here my father lost his voice” he started shouting.
He did file a complaint with the hospital. Everything was on paper, everything was medically and legally correct. Still the administration must ask me questions and I must reply. Many long emails and documentations followed. One reporter called and enquired about the case, I explained her the situation.
I didn’t sleep well those five nights. Medicolegally we were safe, but who was to deal with the media allegations, the resultant defamation, irresponsible hurtful comments by every TDH on the social media?.
The patient was still under my care. I saw him daily, he was making good recovery. His voice became normal in next three days. He was shifted to the wards and then discharged. He was advised to continue anticonvulsant medicines. Mr. Prasad did not say a goodbye, didn’t write a feedback, he didn’t withdraw his complaint. They just disappeared, and did not follow up. I kept on dealing with the paperwork for a few days even after discharge. I still had a thin bleeding layer of patience left. © Dr. Rajas Deshpande
About a month later, at late night, I got a call from the casualty. The same patient was convulsing. Mr. Prasad had requested to call me.
He revealed that after the discharge he had searched for ‘the best’ neurologists in India, took his father to two of them, and was advised to continue exactly what we had advised. Then he researched internet, found an “ancient remedy” for epilepsy rediscovered recently by a famous baba, that guaranteed complete cure. They had stopped the anticonvulsants advised by me three days ago, as the Baba’s site blasted all modern medicine and the dangerous effects of allopathic drugs.
My remaining patience was destroyed, However, the patient was my first responsibility. I advised the treatment, we intubated the patient and started ventilation again.
“What are the chances, Sir?” asked the rimless eyes with expressionless face.
“We have started with the emergency treatment, the patient will be shifted to the ICU. I cannot accept this case, please admit your father under another specialist” I said. © Dr. Rajas Deshpande
“Look doc, I am sorry if you felt bad about last time. We paid full bills and we will pay again, we have mediclaim. I want you to treat him” he said.
“I don’t work for the mediclaim companies. You cannot pay me for the damage you caused to my peace of mind, the waste of time you caused by writing falsified complaints. You cannot pay me for the sleepless nights because of your threats” I told him.
His face changed. Panic appeared on that expressionless face. He folded hands. There were tears in his eyes. “Doc, I am sorry. I got carried away by what people say about modern doctors. I will do whatever you want. Please save him. I promise I will immediately write an apology to the hospital ”.
Needless to say, a doctor’s heart has many hard scars, but it is the easiest to melt. It did, once again!
© Dr. Rajas Deshpande
Real experience, some facts changed to mask identity.
Please share unedited.