“She needs urgent admission and treatment, as she might be developing a
stroke”, the doctor told the relatives of a 70 year old, otherwise healthy,
lady who was having recurrent episodes of tingling/numbness all over her body,
with slurred speech.
The disturbed family, including the patient as well as her son and
daughter (staying in different cities away from the patient), were not too
pleased on hearing this. “You can suggest us the treatment and tests, doctor,”
the son, who is based abroad, said, “but it is difficult to admit her as there
is no one to stay with her in the hospital. I am in India only for three days,
and I reached here only yesterday. I am very worried about my mother, so got her here
today, but I have to return as we have an important project going on, that
depends upon me.”
“I am not sure if she will agree for admission, doctor as she is very
independent and never liked hospitals,” said the daughter, and asked her
mother, “Do you want to stay in the hospital mom?” The question had anxiety,
reluctance, formality and suggestion for a negative answer, all at the same
time. The patient looked at the doctor, embarrassed smile and confused, “Well,
if it is necessary…” she started, only to be cut off by her daughter, “Let the
doctor write the treatment and tests, Ma, then we will decide outside.”
The doctor suggested an urgent MRI and few other tests, and gave a
prescription. The son, before leaving the doctor’s chamber added, “Do we have
to do the tests here only doc? Because we know this particular trust and its
chairman is very close friend of mine.” The trust is known for free-of-cost,
average quality MRIs. “It is your choice” the doctor had to answer legally
correct, even if he may not have liked this decision. The doctor wrote notes
and suggested urgent admission to start treatment.
Four days passed, with no word from the patient. Then out of the blue, there
was a call from the doctor on duty in emergency department, “Sir you had seen
this patient in OPD four days back, she has been brought here and is in coma. We
are planning to put her on ventilator.” The doctor went there, anguished to the
core but trained to shut up well when dealing with patients. The daughter
rushed to provide details, “Doctor she was not willing for admission. We got the
MRI done at the trust hospital yesterday morning, but she was very ‘sleepy’
since last night. We got the report in the evening. We thought she must be
tired, so we waited till now. But now she is not waking up. Then we thought
that you had advised admission, so we brought her here.”
The patient had had a brain-stem stroke, one of the worst forms of
stroke. “When did she become unconscious exactly?” the doctor asked, to see if
she was in the “window period” for clot-busting treatment of stroke. “The
servant says about two days, but I saw her day before yesterday, and she said
she was okay. I stay in a nearby city, and am in constant touch with her and the
servant on phone.” There was no
point in any discussion, they had all explanations about all decisions, and why
things were delayed.
The patient required ventilator. The “busy” son kept on calling from abroad,
and had his “expert doctor” talk with the doctor, conducting a
cross-examination on phone, and telling things what were already known to the
doctor.
On the third day, the family gathered its socio-financial-politico-legal
experts in clever talk, and asked for a meeting. The discussion ensued,
summarily, “When exactly will she regain consciousness?”, “How many more days
in ICU?”, “Will she ever talk or walk again?”, “Will she become a ‘vegetable’?”
The answer to all of these by the doctor could have been nothing more than,
“Can’t say”. One smarty-pants asked with dismay “But Doctor, medical science
has made such great advances in the USA, they say stroke patients can be
treated completely, they have even done stem cell transplants etc. And you are
saying we can’t do anything”
The doctor knew a hundred hurtfully true answers that could have been a
handy reply, but again, his teachers shouted in his mind to “shut up”. And he
just replied, “At this stage, after the stroke has happened, we cannot do
much”, which was the technically correct answer. The family exchanged
meaningful glances. “Doctor please understand the family’s situation. How long
can we continue like this?”, the man conjured up the big courage, “We are ready
to accept the inevitable. It is okay if you tell us she is not going to survive.
We are prepared”.
All that was going through the doctor’s mind at that moment was to tell
them, “But you all already had dumped her, killed her by delaying her
treatment”. But he just could not say it openly.
The relatives waited another two days before requesting not to
resuscitate the patient. Besides the question “When was the inevitable going to
happen”, they were not interested in anything else. The more the doctors tried,
the more that family started to hate the staff, constantly alleging and questioning
them. If the doctor advised any new medicine, the first question was, “Will it definitely
make any difference, or would it be alright not to try any new stuff and let
fate take its own turn?”
So many patients die/develop disabilities because the family denies them
medical care in time. Precious time is wasted in second opinions, finding
cheaper options to everything, and idiotic presumptions and self medication, adding
to which are the alternative medicines that are cheaper and available at home. Many
parents don’t ensure the important drugs like medications for epilepsy of their
own children, they do not stock medicines in advance to be used in case of any
emergency and take huge risks by trying on their own to stop these medicines. Most
of the elderly population is “killed by neglect masked by beautiful sweet
language and excuses”, with only a few exceptions seen in real life. Critical/crucial
surgeries are avoided, advice to patients for admission are neglected because
the people keep on searching for cheaper options.
Patients continue to neglect doctor’s instructions not to eat sweet, to
exercise regularly, not to drink alcohol or smoke. They just tend to quote,
“It’s my life”. Then the doctor should not be held responsible when one develops
complications of such a life? These instances are also of medical negligence,
dumbly ignored by the Indian legal systems, causing more deaths than medical
negligence by doctors. There must be a law to record and punish these too.
Hospitals must also have a record of admissions advised, investigations
suggested and in case of the patients not being compliant, reporting such cases
for medical negligence. People admit patients at the last moment, and want the
system to be responsible for a guaranteed good outcome.
In a country where the court decides the punishment amount for doctor’s
negligence by calculating how much the dead/disabled person would have earned,
what else can one expect from the general public? This is like open statement, “If
a doctor neglects the health of a non-earning or an elderly person, it deserves
lesser compensation, but if an earning member is affected by negligence, the
hospital/doctor has to pay huge amounts.” Like the lives of our non-earning or
retired parents is of a lesser value than our lives, and can be handled with a
casual attitude.
If that be the case, the elderly do deserve
to die by our own hands for failing to inculcate the right values within us.
(Courtesy
Dr. Amandeep Aggarwal, Joint Secretary, IMA, Punjab State)
No comments:
Post a Comment