She came at eight days of life, dehydrated and sick. The girl was vomiting bile since birth owing to a condition called ‘duodenal atresia’, marked by interrupted intestines blocking the inflow of milk. She weighed 3 kg at birth but dropped a kilogram in one week. The baby underwent rapid resuscitation, and investigations confirmed the intestinal block.
The surgery involved joining the intestines, before and beyond the block, to create a new channel for milk flow, applying multiple sutures. Unfortunately, the joining did not hold, and the intestinal contents leaked through the sutures. On the sixth day after surgery, the child underwent another round of surgery. The intestines were re-joining. The tissues this time were badly swollen. As luck would have it, the sutures leaked again on the third day after the operation. There was intense pressure and disappointment, but the father of the child, an army man, was of made of stern stuff. He simply told me to go ahead with a third round of surgery, reposing full faith in me. Indeed, such instances are extremely rare these days where many patients are baying for the surgeon’s blood at the slightest hint of a complication.
The family was incredibly supportive; and that was enough for me to undertake what was good for the child. I had to go in again and I performed a slightly complicated diversion procedure on the duodenum and the small intestines.
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It would be no understatement to say that it taxed me to the core. The tissues were unhealthy and scary. Post-surgery, I dropped an important outstation journey and waited with crossed fingers. And lo and behold, the sutures held.
The weight went down to 1.7 kg even as we were feeding the child through intravenous nutrition. The child was the best fighter I met in my professional life. There were moments in this saga where I almost expected an empty bed during the next day’s rounds. However, the girl was strong, and it was as if a divine power had taken over. Through the three surgical procedures, the baby’s cry remained consistently and amazingly strong — enough to shake up the Neonatal Intensive Care Unit (NICU)! As the days passed, hope surged; and we cautiously introduced feeds a month after she was born.
Gradually this increased to full feeds. And now, when there is even a slight delay the child bawls her lungs out and the hospital sisters rush to feed her. The cry of this child in the NICU is nothing but divine music of the highest order to all of us. I stopped going to the child during my rounds. When I go near the child, I simply fold my hands and pay obeisance. I do not listen to the nurse’s or the duty doctor’s drivel of the daily input-output status the child! It does not matter. The divine is deciding the course here; and nothing can happen to this child, perhaps.
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Such moments are rare in the life of a paediatric surgeon nowadays. The attendants scare us more than the disease. Tackling a disease or a problem to the best of our abilities is never an issue. However, patient expectations and the threat of legal suits have made medical practice growingly difficult.
A colleague recently received a child with dengue haemorrhagic fever in a shocked state, almost without a pulse and with unrecordable blood pressure levels. An aggressive resuscitation process ensued in the ICU. The child, who was put on a ventilator, unfortunately died the next day.
At least 50 people, along with camera-armed mediapersons, barged into the office room of the paediatrician, loudly demanding ‘justice’. The argument touted by the abusive crowd was that if the doctor was not capable of saving the child, why was the treatment started instead of referring the case elsewhere? How can anyone argue with this kind of logic?
The demand for compensation started at Rs. 10 lakh, then came down to Rs. 5 lakh, and then Rs. 2 lakh. Finally, a demand to waive the fees came even as the doctor insisted that there was no negligence and they were free to file a police complaint and go for a post-mortem. The police looked on helplessly in the face of such a vicious crowd. Doctors certainly are not trained to handle these disheartening situations. Alleging negligence and forcing the doctor to pay money by threat of violence have virtually evolved into a business proposition, unfortunately.
A heady combination of expensive private sector operations, costly medical education, overcrowded public hospitals, poor health access in the rural areas that allows quacks to take over, aggressive lawyers ready to sue, the insurance system enhancing costs by creating new protocols, pharmaceutical business practices, greedy doctors, and patients with expectations that exceed reality, have unfortunately eroded the trust between the doctor and the patient. Sadly, there is mutual suspicion and fear today in this sphere.
The family in this particular case came as a whiff of fresh air, giving me a renewed hope to continue with the treatment regimen, just as I was about to give up.
The author is a paediatric and neonatal surgeon based in Warangal.
pingaligopi@gmail.com