About 2 months ago, Mr. Kamal came to our emergency department. He was a young man of 23 and had been a regular consumer of alcohol for about 5 years. He came with acute severe pancreatitis, which as most doctors know can be a killer. He had not passed urine for 2 days at home and his abdomen was distended like a balloon. We admitted him and began the supportive management that is all we have for this condition. He seemed to be improving for the first 2 weeks with his renal function improving and his distension gradually coming down. Then he began to worsen and we found on a CT scan that he had the dreaded complication of pancreatitis - pancreatic necrosis. He was taken to the operation theatre and the necrotic tissue was removed along with the placement of drains in the pancreatic bed to remove whatever further necrosis occurred. And now, 2 months down the line, Kamal has nearly reached the end of the road. His organs which were holding up till now are slowly shutting down. It will take a miracle for him to live for more than 2 or 3 days.
My thoughts have returned to Kamal and his family many times today. It is terrible to see a man in the prime of his life deteriorate from a healthy 90 odd kilos to mere skin and bone in a matter of weeks. To watch helplessly as a disease that is impervious to all the medicines that we can throw at it, ravage his body to the point of death. But I have seen this many times. And what makes it all the more difficult to swallow is what it does to the family. Kamal's older cousin is the one taking care of him. He has sold all his land and all the gold of the family to come up with the huge amount of money that it has taken to keep Kamal alive all this time. The month and a half in the ICU, the hugely expensive medicines and the long term ventilation have often come up to more than 30-40,000 Rupees every day. All the times I have talked to the family, they have been very clear that they would go all out - whatever the result. And now that it looks as if the end is near, I feel terrible every time I meet them. I no longer have any hope to share with them.
The other day, Kamal's cousin was in the room with him describing to the doctors the struggles the family was going through. Kamal can no longer speak as there is a tube in his trachea helping him to breathe and as the cousin told of all they had sold to keep the money flowing in, we forgot for a moment that Kamal could hear him. When we looked at him a few minutes later, there were tears streaming down his face. There were tears in our eyes too.
The tragedy of the situation is two-fold. Kamal's deterioration and impending death is one thing. But what makes it so much worse is the devastation his illness has had on his family. They have sold their land and gold, taken huge loans at astronomical interest rates and will take many years to recover from this blow. It is a story that medical professionals throughout the world (except in the very few welfare states) are familiar with. And though it happens many times, it never makes the pain easier to bear. Medical care should be life-giving and not life-spoiling. The Hippocratic principle - first do no harm, should apply even to the family - who are often the worst harmed by any illness. The inhumanity of our medical costs, driven by greedy medical professionals and unscrupulous corporations is something that has often troubled me. And every time I see someone like Kamal, I am reminded again of the painful irony we face every day - where saving a life often means despoiling a family.