THIS CAN HAPPEN - PART - III
Dr. Gangadhar Sahoo
Ex- Dean, IMS & SUM Hospital, Bhubaneswar
Ex- Pro VC S “O”A University, Bhubaneswar
President, ISOPARB
It was the Durgapuja vaccination for a week long holiday. Roster duty was followed in the VSS Medical College hospital, Burla in the district of Sambalpur Odisha. Half of the staff were on leave and rest half on duty. I was availing first half leave. But I was in the campus as my family had no plan to go out anywhere on holiday trip .
One of my patients from the same town, wife of a local news reporter, well-known person to all sections of the people was admitted for confinement with history of raised blood pressure and blurring of vision. She got examined by the senior consultant on duty that day. He was an associate professor and unit head. Because of shortage of staff senior faculties were given roster duty. After thorough clinical examination and necessary investigations it was decided for emergency CS as the blood pressure was too high, blood reports, urine report and fundoscopy (an eye test to know the severity of the disease) were suggestive of severe pre-eclampsia.”
(Pre ECLAMPSIA is one of the varieties of Hypertensive Disorders of Pregnancy where along with Hypertension multiple organs are involved in which both the mother and fetus are at risk. So judicious timely intervention can save both the mother and the fetus. )
Since I was on leave but available in the headquarters her husband requested me to be present in the OT during operation. I obliged. OT was fixed at 7am, the best time for high risk cases. Because the husband was a very popular news reporter of the locality he had developed good relationship with many of the doctors. When I reached OT I could see a few doctor friends in the OT. Presence of doctors not only boosted the moral of the patient and her relatives but also the moral of the operating team. Operation started on time. ANAESTHESIOLOGIST preferred spinal anesthesia for reasons known to him . After the prick of the needle the anesthesiologist as per the procedure positioned the patient, adjusted the running IV drip , manually recorded the pulse and blood pressure, tested for successful anaesthesia by needle prick at different levels. Once satisfied he covered the face with a face towel and gave the green signal to the surgeon to start.
After 5 minutes a healthy male baby was delivered. Everybody ' s attention was drawn towards the baby . The pediatrician was busy in resuscitation, all the doctor friends including me were anxiously waiting to listen to the maiden cry. A loud cry with a vigorous body movement created a joyful atmosphere in the OT. Then the surgeon wished the patient, “Congratulations Mohini! You are blessed with a healthy male baby , looks so cute with dark curly hair, chubby cheeks and fair skin . Congratulations for being a mother. He is crying. Can you listen to his cry? “No response from the mother. Then the surgeon shook Mohini violently. Still no response. Surgeon felt as if an electric current passed through his body. He was drenched with heavy sweating. When he removed the face towel he saw her skin had mosaic pattern discoloration, breathing stopped, no heart beat felt .With a chocked voice called the ANAESTHESIOLOGIST who was conspicuous by his absence, retiring in his room. One of the onlookers in the OT ran to his retiring room and dragged him into the OT. He assessed the condition, incubated her and started CPR (CARDIO PULMONARY RESUSCITATION) . At that time there was no monitoring facility. Everything was done manually. Even the hard core teachers were fixing the left index and middle finger of the trainee on the radial artery of the patient. The ANAESTHESIOLOGIST told the surgeon, “Don’t worry. Carry on. Everything is OK. There was temporary shutdown which is taken care of ." After around fifteen minutes of vigorous exercise the heart beat returned. There was a sigh of relief.
By that time the news of birth of a male baby has spread in lightning speed. Sweets were pouring into the wards ,labor room and sharing OT also. All the family members have gathered to take a glimpse of the newcomer. The grandmother was waiting to perform some rituals. In the mean time the ANAESTHESIOLOGIST came out of the OT, called her husband and told, " The mother during operation developed certain cardiac problem. Everything is taken care of. But it will take time. Let's pray God. But she's not out of danger. I am trying my best. “This message spread like a wild fire within a fraction of a second. The euphoria all on a sudden died down. Some were panic. Some were apprehensive. A few had faith on medical science. But one thing was common, " All were praying. "
ANAESTHESIOLOGIST explained very tactfully to the patient party about the condition of the patient and at the same time the prognosis ," But she is not out of danger. “Many probabilities and apprehensions were hidden behind this diplomatic comment. The ANAESTHESIOLOGIST was monitoring and documenting the condition of the patient every five minutes and frequently looking to the wall clock of the OT , probably waiting for his reliever's arrival . His reliever reached the OT 15 minutes late and took over the charge of the patient. She documented the condition of the patient and shifted her to a special room , close to the OT because the recovery might be a lengthy process with unpredictable prognosis. At that time neither ICU nor recovery room was available. The concept was not there also. So the patient was manually monitored. Opinion of the cardiologist, nephrologist and the senior most ANAESTHESIOLOGIST was sought. All had the same opinion that the chance of survival was negligible and how long the patient can be kept with life support. All the three consultants and the ANAESTHESIOLOGIST on duty at that time had a closed door meeting. The decision was taken to break the news to the patient party. For that the anesthesiologist who was on duty was called. But surprisingly he was not traceable.
Let me not discuss what happened next and what was the aftermath of this incident. But I must give a take home messages from my experience what we learned from this incidence.
1. As a doctor casual attitude towards any patient should be abandoned.
2. As an ANAESTHESIOLOGIST never leave a patient one second when her life was under your care . Strict monitoring, documentation and prompt & timely intervention can save the life of a patient and the anesthesiologist from litigation.
3. Medical profession is full of problems .If any problem arises face it bravely, never escape. It creates more problems if one tries to escape.
After a few years I met the husband of Mohini. He wished me with Namaskar and told, “This is my unfortunate son. I am now taking him to the Kiddies Abode play school. In the mean time I had my second marriage. “Telling this he left. But left behind with me the bad memories of the dying mother of this unfortunate child. She no doubt, got her motherhood but could neither feel it nor enjoy it.
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