anonymous

20th December 2019

“Why Did You Save Me?" - 1

"Why Did You Save Me?" - 1

Dr.Shantu J.Vaidya

 Of all the afflictions human beings are heir to, burns is perhaps the most gruesome, awful and painful. A person can suffer from burns by pure accident but often there is a personal tragedy behind a burns case.

As surgeon-in-charge of the Burns Clinic at Bhatia General Hospital, I have had opportunities of treating scores of burns cases. In the process, I have had the satisfaction of saving many lives. Many cases were personally gratifying and professionally satisfying. But there is one case which had continued to haunt me down the corridor of time.

Fatima was a young Muslim woman, 20 years of age. She was admitted under my care with very severe accidental burns acquired while working in the kitchen (mental tension and distress are pre-disposing factors for such accidents, whether at home, on the roads or elsewhere).

The severity of a burn is assessed in terms of percentage of body surface area affected. If the percentage is over 60, the case is considered to be very severe and likely to be fatal. But fatality even in a near 100 per cent burns case is hardly immediate. Death gets prolonged depending on how good and energetic the treatment is. In an organised and specialised Burns Care Unit, resuscitation and initial treatment is standardised and carried with vigour. And so it was in the case of Fatima.

The details about the patient's personal life and the factors that led to the burns accident get to be known only days later. The patient usually confides in the nurse rather than in the doctor. Sister Mistry-nurse-in-change of the Burns Care Unit—was my excellent, professionally competent and experienced associate. She was known for being kind and humane discretion. and patients invariably confided in her their personal problems trusting her discretion.

Fatima had been married for three years when her husband started an affair with another woman. Worse, she was not in the good books of her in-laws. That was partly the reason for her distress and mental tension which may have contributed to the accident. Following her admission to the hospital, her husband came to visit her, twice a day, taking care to bring the prescribed medicines. As the surgeon in charge, it was my duty to explain to him the severity of the case and the expected length of treatment. It was made clear to the husband that Fatima would survive but the costs of treatment would be high.

I do not know whether this was the cause of the husband's disinterest in his wife but within a couple of days, his attendance at the hospital began to get irregular and finally ceased altogether. Meanwhile Fatima had been given a general ward status. During the first four days, she had to be administered several bottles of glucose and received many blood transfusions. This is a period of tremendous agony for the patient.

Fatima hung on to dear life but around the eighth day, the staff had begun to despair. By the 12th day, it seemed to us that she would not survive long. We put her on slow glucose drip. But obviously there was something inside Fatima that was fighting the onslaught of infection and toxaemia arising from the large part of her rotting, burnt skin that still clung to her body. On the 14th day, Fatima lay unconscious and delirious but still her body was fighting the infection. It enthused us to redouble our efforts to help Fatima live.

Three months of hard work, devoted nursing, dozens of small and big operations and dressings, many blood transfusion and administration of costly drugs, paid. Fatima's survival was assured, but there was no escape from the extensive and hideous scars she had sustained in addition to contractures, limitation of joint movements and disfigurement spread on her face and 60 percent of her body. Every change of dressing was painful. But my whole team was supporting Fatima. She received special care, attention and importance. For us, her survival and treatment became a challenge and we knew we were winning. Fatima often talked and occasionally smiled. Her appreciation of our efforts and her obvious gratitude for all our labour and effort were encouraging and gratifying.

In severe burns, the first objective and priority is to save life. This can take anything from three to six months. The patient can then be sent home for convalescence. The second stage consists of correcting functional disability and improvement of joint movements and this is undertaken after an interval of about six months. Fatima had reached that stage where she was ready to be sent home. We now began to give her broad hints to that effect. The care of the nursing staff began to dwindle. There were other cases demanding attention. It was at that point that Fatima began to police her dreadful dilemma. She was not going to be taken in by her husband who had long ceased to take any interest in her well-being. and her parents, being too poor. Were in no position to give her shelter either. Once out of hospital, she would have nowhere to go. The city pavement would be her home, if she could sustain herself. Fatima lived now in terror.

A day was fixed to discharge her and Fatima was given a hint as to he when it would be. We had finally to tell her as gently as we could when that actual day would be, with a sense of finality. It was painful to both sides. It had to be explained to her that there were other cases that needed looking into and that we had done for her all that was within our power to do. She had an obligation to the hospital to leave. Fatima looked at us with unbelieving eyes.

On the scheduled day I went to see her to take leave of her. It was to be the most painful encounter I had with a patient in all my life. Fatima clung to me in desperation. In between sobs, she poured out her distress. Did I realize what I was doing to her? Did I know that when she suffered burns, she was already not wanted by her husband and his family? Did know I that her disability will not allow her to work or to earn? Was I not pushing her on to Bombay's pitiless streets to beg? Why did I save her? Why did I not let her die when she wanted to? What was she to do now when she could not even earn a livelihood as a prostitute? At times, her voice was raised to a high pitch. There was nothing that I could say or do. Slowly I disengaged myself from her grip. And dumb-founded and in despair I walked out of the room. I ask of my readers: was I right in saving Fatima's life? You be the judge!

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