A Matter of Destiny - 4


Dr Sharad Panday

The next story I wish to relate is of high educative value to parents on children born with congenital heart defects or CHDs. Some parents that they have an absolute right over their child's life and instead of allows their doctors to decide upon the suitability of operating upon such children, they try to dictate terms to the doctor. "Can we not delay surgery, till the child is a little older?” and so on and so forth, I realise that very often his is due to misplaced affection for the little one. Of course, ignorance of such a disease also plays a significant role in such matters. A mother or a father wishes to delay the child's surgery notwithstanding the fact that such a delay could lead to an irretrievable situation when no amount of surgical intervention would be of any use. The child's condition would  have deteriorated to such an extent that no doctor would risk taking the child on the operation table. No amount of coaxing and cajoling seem to work on such parents and they are satisfied that their child is alive even though the quality of life is poor. Many such children having grown up into teenagers and then undergone surgeries have asked me whether they would have grown up normally had they got operated earlier. There is an arcurrent of resentment towards their parents. Of course, parental concern is understandable but it should not be to the extent of working to the detriment of their children. They often wait till the child's conditions becomes inoperable and when they learn about this, panic grips them and they run from pillar to post, trying to get surgical help.

Recently, a mother came to see me with her young son. He was suffering from a condition called Patent Ductus Arteriosus (PDA) and had been visiting almost every doctor in the city, in what is commonly known as doctor-shopping. The mother had even shown her son, Jitendra, to some doctors who participate in charitable camps organised by social organisations.

She had the indoor papers of Bombay, Nair and K.E.M. Hospitals and prescriptions of some private city doctors. Finally she came to me and certainly not of her own will. A junior doctor had told her that Jitendra's condition was very complex and the surgery entailed would be very complicated and that she should therefore seek a senior expert's opinion. Since the son was obviously failing in health, she finally agreed, although reluctantly, to get a cardiac catheterization done on him. This investigation revealed the necessity for a surgical intervention-albeit the risk to Jitendra's life was extremely high.

I first gave a piece of my mind to the foolish mother who had insisted upon the delay in subjecting her son to surgery. Her silly, superstitious behavior had caused much physical and emotional trauma to Jitendra. I then explained to her the risk involved in operating upon Jitendra so late when so many complications had set in. I even told her that we could have a mortality (death) on the table. She gave me a firm assent for carrying out surgery, although I did not fail to notice the tears brimming in her eyes. But I had to be a little harsh while explaining, in order that she did not expect a miracle in the post-operative period.

I am describing this story at some length not to highlight any technical point but just to show that despite all eventualities, some people are fated to live-the Good Lord above just does not welcome. prematurely!

My anaesthetists and my perfusionists were mentally or serious problems during surgery. I even cancelled a social programme in advance as I was sure I was in for a real marathon session. Soon enough, surgery commenced and even before I could proceed fragile ductus ruptured. An adult ductus—the boy was not even old—when it ruptures creates a situation similar to an aortic mun life-threatening one). Without going into technical details, I can landed in a very sorry mess and to extricate ourselves from this st affair was going to be painfully difficult. But we tried our level best did manage to save Jitendra. But at what cost? Loss of sleep not only for the parents, but to the surgeon, the anaesthetist, the perfusionists and the nursing staff and even to the theater attendants—a little slip on their part could have cost Jitendra his life. But do people ever realise what doctors go through when they take upon themselves the responsibility of their patients? When we succeed, we become heroes-next only to God! But when we fail, we are most cruelly accused of "criminal negligence”.

When Jitendra came to the clinic for a follow-up visit, he seemed totally unaware of the serious situation he had been in during surgery. However, his parents knew about the grave risk to his life during surgery, in Jitendra's surgery. more so the mother, who was mainly responsible for the inordinate delay in Jitendra’s surgery.

I must admit that there was a radical change in her behaviour in the post-surgical period. One day she approached me and said: "Doctor, had something gone wrong with Jitendra on the operation table (she meant death') I would have died of remorse. I would have never forgiven myself considering that I was the one who had put my son in such a grave situation by my own ignorance and selfishness".

My only appeal to such parents is that they should allow surgery to be performed on children when the conditions are optimum for it, not to unnecessarily delay it till the child's case becomes inoperable.

Compilation of professional reminiscences of specialists - edited by M.V.Kamath and Dr.Rekha Karmarkar