English Version-Translation

In our busy schedule, evening rounds is a time for visiting patients as well as a chance to meet and renew friendship with our fellow colleagues. On one such day, I met and had a chat with my friend who is a surgeon. Though we see each other in the morning, we don’t chat considering the patients waiting eagerly for us in the O.P.

From a nearby room, I could hear cries and a lot of noise. I sharpened my ears in an attempt to comprehend the situation. “It is a patient, referred to me by the R.M.O,suspected of having kidney stone and I am going to visit him. He must be crying out in pain.” said the surgeon.

“Shall I join you? I am curious to see the patient causing this commotion because of his kidney stone” I said.

“Of course, it would be an asset to me as you can talk to him in his language and get more details” said the surgeon, who is not a Malayali.

The patient was around 50 years old. He was not crying, but he was very disturbed and was evidently creating a racket. It was obvious that he was not completely conscious. He could not understand our questions and his replies were vague. His bystanders were not able to give us any information about him as they did not know him personally. He had come to Ottapalam from Kozhikode for official purposes.

I enquired from his bystanders and understood that the patient had told them about having headaches and fever for the past couple of days. Another bystander reported that the patient had vomited at-least twice.

“These symptoms does not match with kidney stone. Fever, headache, vomiting, lack of conscious behaviour... it could be something more like Meningitis Shall I take a look? ” I asked the surgeon.

“Of-course, see what you can find, I shall assist you”, he replied.

Clinical examination showed more signs of meningitis. To be sure, I needed to insert a needle into his vertebrae and extract a sample of his cerebrospinal fluid for detailed examination. Prior to this I had to take a C.T scan. But I could not administer the tests as the patient was not cooperative.

We tried to devise a plan to conduct the tests. We went to the operation theatre and, to our relief, the enthusiastic and energetic lady anaesthetist, who was always awaiting new challenges, was there.

“I need to take a C.T. scan of a patient who is creating a racket. As soon as the scan is over, I need to conduct a lumber puncture and aspirate his cerebrospinal fluid. Altogether, I would need the patient under control for atleast 20 minutes. Can you help us?” I asked. The reply, as expected was, “Ofcourse, I will give it a shot”. Such team work is the reason behind the success of any medical institution.

The patient was immediately taken for scanning and was given an anesthesia, effective for over 20 minutes. As soon as the patient was under control, the C.T was taken which showed no abnormalities. The CSF Sample collection was done immediately and as expected, the fluid which should have been crystal clear appeared turbid. The CSF sample was sent to test for meningitis. I had never seen such an unclear CSF, ever in my life. My clinical diagnosis was meningitis and the lab results showed the same. The patient was immediately taken to the ICU and the treatment commenced. Soon, the patient’s wife and elder brother arrived. I told them all the details.

“Doctor, is he in critical condition?”

“Yes, unfortunately. Meningitis is a very serious illness”

“Should we take him to some other hospitals?”

“There is a method of treatment for meningitis that is used across the globe. I am doing the same here. All that is required for treating this illness is available here, as in any other hospital. In the past two years, we have treated at-least 8-10 cases of meningitis and we have 100% success rate.”

There was a sigh of relief from the relatives, however, they are not supposed to take the case lightly. Therefore, I told them, “Each patient is different and his case might end up differently from the rest. We shall give him the same treatment and hope for the best results”

As more relatives arrived, so did the number of opinions along with the names of many other hospitals. They confused the close relatives with tales of doctors pulling bunnies from hats. The brother enquired with a doctor from one of the famous private hospitals in Ernakulam who, in turn, enquired the details of the patient’s admission into the hospital. He told them that if meningitis was diagnosed within three hours of admitting the patient, the doctors are capable of treating it too, therefore it is better to let the doctors continue the treatment.

But another group of relatives who arrived at midnight restarted the discussion, leading to the discharge of the patient the same night. He was taken to a private hospital in Kozhikode.

After a couple of weeks, the patients’ brother came to get some files related to the treatment.

“How is the patient? Is he discharged?” I enquired.

His head bowed and in a very low voice, he replied, “No doctor, my brother died just two days after he was discharged from here”

Though meningitis can lead to death, I was stunned to know this. I had hopes that he would survive.

“That is not what is disturbing me” continued the brother, “All those who were treated for meningitis here survived...If my brother was not discharged from this hospital, he would have...”

“... been the first case of death here”,I interrupted –“Modern medicine is the same everywhere. He would have received the same treatment here too”.

If I had not said that, I would have done injustice to those doctors who worked hard for two days to save his life”.

This is our natural reaction to crisis. Most of us fail to take strong decisions during stressful situations. Our opinions and decisions are influenced by others who have no knowledge about the issue at hand.

Some deaths are inevitable. It does not matter even if one runs to the edges of the cliff; we might still succumb to death. Once a disease is diagnosed and the doctor gives assurance about the treatment, there is no need for confusion. No doctor would risk his own existence with lies of possible treatments. Death is as real as life and one cannot escape it by running from one hospital to the other. Once the doctor assures that the hospital has all the requirements to treat the patient, the bystanders need to trust him and provide support. We shall be joyful and thankful to the lives we save and accept inevitable deaths with patience and acceptance.

[Independent Translation of the FB post by Dr.Jamal]

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