It was 3 am in the morning and i was really tired after a heavy emergency shift in the casualty. All I wanted was for the clock to strike 8 o’clock, which would signal the end of my Emergency shift and a journey back to the ward.
As I was about to move to the refrigerator to open the bottle of Thumbs up (mandatory for every call night for all those who don’t drink tea/coffee), there came a frail, young, 30 something man with 2 other men who were much older.
“Saheb, admit karvaney ko leke ayya hai,” the older man said. (they wanted to get him admitted to KEM). After a brief history and a rapid perusal through his previous files, I deduced that this was not going to be a simple case to manage. It was a case of Jaundice due to a tumor in the hepatic ducts with some doctor in ORRISA (their hometown) having told him he is INOPERABLE and hence placed a permanent metallic stent in his billiary system. The first thing I thought to myself was to send him away. It was 3 am, my wards were overflowing, we had a specialist cancer centre right opposite KEM and this man did not present with any emergency.
But, my heart told me to do otherwise and I admitted this patient. Little did I know at that point in time what would follow.
After initial investigations and following the routine protocols the patient was transferred from the emergency ward to the Male ward.
The evening after, having not caught a wink of sleep and with 50 new patients admitted, i needed all the strength that I could gather. After gulping up a litre of Thumbs UP, i went to the routine wards to round the patients and make the pending decisions.
The patient with the jaundice I had admitted the previous night was there in the ward, lying down in a corner on the floor (as there were no beds available). The patient was running a temperature, he had a high pulse rate and was breathing funnily. “Surprising,” i thought to myself and leaned over to reassess his condition. The same patient had developed all the signs and symptoms of an infection in the hepatic ducts. After frantically mobilising the sisters, the ward boys and the relatives to help me shift the patient to a better bed, my junior colleague and I shifted the patient and started the resuscitative procedures. The patient needed an urgent procedure to drain his billiary system and clear his infection i.e a Percutaneous Transhepatic Billiary Drain. Urgent calls and messages were sent out to the concerned departments while resuscitating him and eventually after 2 hours of chasing and pleading we got our way through and decompressed his system. The patient was placed on strong antibiotics and fluids and fortunately survived the acute episode.
The patient stabilised within a week and was planned for an elective surgery to remove his tumour the following week.
On my evening round in the following week, we noticed something was wrong with the patient. He didn’t seem comfortable and as happy as he had been. His relatives had all disappeared and he cut a very lonely figure.
The next day his relatives came up to me asking for a discharge. On further probing about the reason, I was told that the patients village had been wiped out by the Orrisa floods and that several of his family members had died or were injured. All their money was washed away and now they were left with nothing but a few thousand rupees on hand. They wanted a discharge against medical advice and wanted to go to Orrisa. However, after a long session of brainstorming and coaxing to stay put in the hospital, they finally agreed to it.
The patient was operated, free of cost with all the unit members chipping in for the essential surgical materials, in the following week and indeed did turn out to be an inoperable cancer. No sort of curative surgery was possible and hence the surgery was abandoned at an early stage. The patient had 6 months to maybe a year to live and the best we could do to alleviate his suffering was to not do anything more.
His relatives understood the situation and made a decision to take him to his native place and keep him happy there. They did not want to go through the palliative chemo-radiotherapies and see him suffer and die away from his homeland.
Inspite of our best efforts, his life couldn’t be saved and hence many would question the title ‘Saving Lives’. However, I strongly believe that we saved him from a lot of unnecessary suffering in the form of palliative treatment. We did manage to save his life from any more pain, suffering and misery than he would already go through. Thats, where I believe we saved his life.
Sometimes its harder to hold back and not do something, rather than do something that you know will be futile. A lesson learnt in this case and will be a lesson for life.
No matter who you are or where you are from, you always do deserve a chance to live your life with dignity and pride and not as a dependant and a cripple. By allowing my patient to live his life with the dignity and pride he wanted we eventually did land up “Saving his Life”!