All in a day’s work for this doctor

Two patients, the same kind of effort put in; one survives, the other dies

July 28, 2019 12:07 am | Updated May 26, 2021 07:43 am IST

Illustration: Sreejith R. Kumar

Illustration: Sreejith R. Kumar

The one-hour-old blue baby was brought in at 5 a.m. with rapid breathing. A quick examination and an X-ray established a diaphragmatic hernia — a defect in the muscle separating the abdomen from the chest. This allowed loops of bowel and other abdominal organs to enter the chest, compressing the lungs and the heart. The only course open was surgery.

As the paediatric and neonatal surgeon in the hospital, I gave the attendants a rough estimate of the cost, including the possible variances in the event of complications arising. I added that in case they are not happy to stay in that hospital, we would transfer the child to the government facility — and told the father to communicate his decision to the nurse.

The consent came after a few hours. The child was born after years of marriage. The father asked me to do my best; and sought a discount on the bill as he had limited means. I promised to do my best with the medical efforts and the bill too if everything went well. The child had a smooth surgery and went on elective ventilation.

I saw another patient just as I was coming out of the theatre, and as it happened, it was an exactly similar case. I groaned. The same bit of counselling went into the discussions with the family attendants. The father was absent in the proceedings. The attendants said he was working in Mumbai and was on his way. The treatment started and the child underwent surgery the next day. The surgical findings were very similar, and the child went on ventilatory support.

On the third day, the condition of both babies started deteriorating, the cause being sepsis. For the next few days, it was a see-saw between life and death for them, amid our efforts. The babies would improve, raise hopes, and then sink a bit. I spent two consecutive nights in the neo-natal intensive care unit (NICU) over endless cups of tea. On the seventh day, the first baby started to improve; unfortunately, the condition of the second progressively deteriorated. The attendants of the second baby stopped buying medicines, and we had to supply them from our stock. The number of attendants started dwindling at a slow rate.

Five days later, the first baby recovered and was ready for discharge. The father came to my room and spoke, with tears in his eyes, “Thank you so much for saving the child. You are but God to us.” Suddenly, he bent down along with his aged mother to touch my feet. I recoiled in shock. The father pleaded: he was extremely poor and had taken money from a loan shark. He built up his case slowly and finally managed to take a whopping quarter off the bill, and I approved it.

That evening, the second child died. The only person outside the NICU was an old lady to whom we declared the death. She said the attendants would come the next day. That day, two tractors filled with people landed at the hospital gate demanding to see me. My chamber was flooded with at least 20 people, smelling strongly of country liquor. And then came abuse, allegations of negligence, exploitation, and demands for compensation. A figure of one lakh rupees started floating around, an impossible amount those days. Members of the local doctors’ body and the police later added to the already cramped room.

Shouting matches between some of our more vocal doctors and angry members of the crowd ensued. The original attendants of the patient were completely missing from the scene of action now. After four hours, a deal was finalised on the intervention of some local politicians and the police. The hospital and the pharmacy are to waive the dues and pay some extra money for funeral expenses on ‘humanitarian’ grounds. There was a threat to me and the hospital from a mob. Amid slogans on loudspeakers, journalists taking photographs, and curious onlookers, the body of the child left the hospital.

I sat helplessly and burnt with impotent anger. The family had lost the child, but a doctor had just lost some faith. When a doctor hardens a little bit, what are the consequences for the medical profession and society? Two patients, the same kind of effort put in; one survives and makes me god and the other dies making me a devil.

Triumph and disaster stalks everyone, and it is well worth remembering the words of Lord Krishna: I am indifferent to triumph today, but still to handle disaster similarly. In their own ways, both the families managed a huge discount! I, god and devil rolled into one, went home, had dinner, and slept fitfully to see another day.

pingaligopi@gmail.com

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