Wednesday, December 15, 2010

When doctors just don't care

Yesterday was a late night. And a sad one for me. For I came face to face with some of the shortcomings of my chosen and beloved profession. And I was unable to understand it at all. We finished our list of operations quite late and just as I was leaving to go home, there was a call from the emergency saying a 4 month old baby had just come in with features of intussusception. This is a condition where one part of the intestine telescopes into the adjoining part and is a medical emergency. When I saw the baby, he was dehydrated and in septicaemic shock and we (the nurses and I) spent the next two hours resuscitating him before we took him to the operation theatre. There after we opened the abdomen, we found that that the terminal portion of the small bowel and the first part of the large bowel were gangrenous due to the intussussception (looking something like the picture below) and we had to resect them - what in medical terms is a right hemicolectomy. A major operation even for a healthy adult, let alone a sick little baby. Due to his poor condition, we shifted him to the Intensive Care Unit with the breathing tube in his lungs and knowing that his recovery or deterioration were not in our hands.

But though it was a tiring day and I was totally spent by the time I rolled into bed, that was not the reason for my heaviness of heart. Rather, it was a state of shock at the callousness of the medical professionals who had been managing (or mismanaging) this baby. For as is often the situation, we were the last resort that the baby's poor parents had turned to. The symptoms had first started 5 days ago and unlike many medical problems that are difficult to diagnose, this baby had classical textbook description symptoms - bouts of crying, red currant jelly stools and a mass that could be felt in the abdomen. The first hospital the baby was admitted in, kept him for 3 days on medication. The investigation that would have clinched the diagnosis, an ultrasound, was not done. The baby was then referred to a higher centre, one that has the most modern facilities and is supposedly equipped to handle even the most complicated problems (for obvious reasons, the names of these centres have to remain unknown). Here, after a days procrastination, the ultrasound was done, but by then it was already evening time. The parents were told to take the baby somewhere else as there was no surgeon who could operate the baby. And so, the parents landed up in our emergency, with the baby on his last legs.

Time and again over the last two years, since I left the cosy cocoon of CMC, Vellore, I have been confronted with the dirty underbelly of medical practice in our country. Where medical professionals blatantly disregard the most basic principles of medical ethics for personal gain or due to ignorance or just because of rank laziness. This little baby boy with a potentially life-threatening problem was treated with useless medicines for 3 days, obviously without a diagnosis being made. It is a sad reality that many of our doctors are not well trained enough to identify and treat properly even common medical emergencies. And then there is the even worse scenario of a referral hospital refusing to operate a patient and giving the flimsy excuse of the absence of a surgeon when everyone knows very well that there are a large number of surgeons trained in reputed colleges there. The real reason for referring the patient was obviously the reluctance of the particular doctors to spend a part of their evening or night in the operation theatre.

As I hear more and more stories of medical incompetence, ignorance, negligence and malpractice, I begin to fear for the medical profession in our country. The supposed watchdog of medical practice in the country, the Medical Council of India, was itself recently embroiled in a scandal that saw huge amounts of money changing hands in order to accredit new medical colleges. (That may have been a blessing in disguise though, for I hear now that new and upright people have taken over the functioning of the MCI and some many positive changes are being made). Our medical colleges often charge astronomical fees and donations that make the primary goal of many doctors to make as much money as they possibly can in as little time! (Our strongest similarity to our political class!!) And the government system in many places is filled with doctors who are either too lazy to do the expected amount of work or too busy with their private practices to have much time to spare!! And with all this laziness and profiteering, medical education is given the last seat on the bus, which means that not only are our doctors of the future poorly trained, but all that they have to emulate is the same laziness and profiteering. And so the cycle is perpetuated.

I do not know what lies ahead. But I do know that there are a few notable exceptions. Among institutions as well as individuals. And it is they who keep the flag of the vocation of medicine flying in spite of all that seeks to corrupt it. May this breed never die. As for me, while I was deeply saddened by the callousness and incompetence that had adversely affected the life of this little boy (had the condition been operated on in the beginning, it is likely that the bowel would have been viable and no resection would have been required), I knew there was much to be thankful for. Especially for the help that I received from my colleagues here. The nurses who quickly and competently assisted with the resuscitation and investigations allowing us to get to the theatre at the earliest possible. The paediatrician who advised me on the right dosages of the antibiotics, IV fluids and blood required. The anaesthetist who expertly brought the baby in its weakened state through this major operation. The other surgeon (on holiday) who gave me moral support on the phone. For family who upheld me and the baby in prayer through the night. And most of all for the knowledge that there was a good God in whose hands the health of this baby lay. So all we could do was to quickly and carefully do what we had been trained to do and then rest in the knowledge that healing comes only from God.

Please do pray for this little fellow as he slowly recovers. There are still may things that can go wrong before he actually goes home, but by the grace of God, he now looks as if he may make it in spite of all the efforts of the medical profession otherwise.

UPDATE: Thank you for all your prayers. By the grace of God, this little boy went home fine.

3 comments:

  1. sad. true. makes you so angry. waiting and working towards the kingdom where the tree of life will have leaves that will heal the nations.

    on another note (far less important). When a person 'likes' your article (currently 4 people have recorded that they 'like' it) do they mean they like what you said? how you said it? the issue itself? Perhaps you need to recatagorise your options...

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  2. Liked your post.
    Unlike any other profession, doctors dont have bosses (at least not as bad... i guess).Medicine as a profession requires a sense of responsibility towards oneself.

    Wish we could create a society where money was not everything.

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  3. Thanks Andi. Tried to figure out some way to recategorise, but couldn't find anything simple enough yet encompassing all you said. Any ideas?!!
    And Ron - your wish is what we all dream of - making it a reality is difficult, but I believe is worth the effort, at least in our own lives.

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