THIS CAN HAPPEN VOL XI
This can happen vol XI
Dr. Gangadhar Sahoo
It was in early 1990s. VSS Medical College Hospital Burla was a soft target in the eyes of the public. There were a few persons who were looking for the muddy water situation in the hospital to catch fish. They might be of different political party supporters but at that time they were united as one party. We called them as UMBRELLA PARTY .There was an incidence in the casualty related to the death of an emergency case last night.
In the morning the so called umbrella party activists sat on a HARTAL in front of the hospital as a mark of protest against the negligence of the emergency doctor on duty. They were sloganeering against the hospital and hospital authorities. Some of the leaders were sitting on DHARANA in front of the superintendent office. It was totally a chaos. The protesters, who were in no way related to the patient, were demanding action against the erring staffs, failing which the dead body would not be taken from the casualty. However after intervention of the police and district administrators the situation was brought to control. But the agitation continued. On that fateful day I was on emergency duty in my department of Obstetrics and Gynecology. The emergency duty period was from 2 pm to 9 am next day.
The emergency duty in Obstetrics and Gynecology department is always a nightmare. All neglected and complicated cases are referred to our medical college and they reach the hospital at about midnight. On that day from 2pm to 9pm I had finished one CS, one ruptured uterus and one burst abdomen from the indoor. There were still two pending cases. Only one senior anaesthesiologist was posted for whole of the hospital. After finishing the cases in our department, he had to attend a case of road accident with head injury. So he informed us to post the two pending cases after eleven. We obliged as there was no acute emergency in both the cases.The anaesthesiologist was very punctual. He reached the OT exactly at 11pm and asked the OT sister to put up the Breech with leaking membranes case as it was a local patient. I was tired so also the anaesthesiologist.
He suggested that he would administer general anaesthesia (GA) to the first case. "Why GA?", I asked. Whimsically he said, “To save time. You will finish within 20 minutes and I will be preparing the other case. After closure of the peritonium of the first case , you will take charge of the second case. So both the cases will be finished by 12 mid night. I am too much tired and fatigued. I will get sufficient time to take rest. Therefore I am planning in this way.”
He administered GA, the indication being to finish quickly and retire to bed at the earliest. Within half an hour the operation was finished. A matured, healthy female baby was delivered. Baby was shifted to labor room for completion of prescribed rituals. Till that time the mother was not extubated. The anaesthesiologist was looking tense, anxious, nervous and panic, administering drug after drug but of no avail. To any question his only answer was," Patient is OK. Please wait for a few minutes. " After that few minutes the situation was same. The senior consultant was called to sort out the anesthesia problem. By that time, it was around 5am. He examined and advised to shift the patient to the recovery room and continue with artificial ventilation till she recovered. There was no ICU facility in any hospital or private nursing homes at that time. So she was kept under ventilation in the recovery room. At about 12 noon the whole anaesthesiologist team came to see the progress of the patient. They had a closed door meeting with the concerned anaesthesiologist on duty. What was there discussion, we didn't know. But in the intra operative anaesthesia note it was written that the patient had a cardiac arrest during operation which was revived. It might be due to excessive blood loss. But it wasn't the fact. I objected to the intra operative finding reported by the anaesthesiologist. But to save their skin they had manipulated the facts like that .
The patient was in ventilator support. Cardiologist and neurologist consultation was done. Their opinion was kept confidentially to avoid any legal problem. But it was not full proof. The condition of the patient was deteriorating. That news spread like a wildfire. Once it reached the agitating public, it added fuel to the fire. In no time a group of so called leaders reached the OG department. All of them were known to me and most of them were having direct doctor patient relationship with me. They sat in the office of the HOD Obgy. The HOD Anaesthesiology and the medical superintendent also joined the meeting. I being the operating Gynecologist was present. But the concerned anaesthesiologist on duty was conspicuously absent. Any how the public representatives were convinced that their was a heart attack during operation which was taken care of. There was no negligence neither from the surgeon's side nor from the anaesthesiologist’s side. They assured all help from their side to the husband of the patient and requested the medical superintendent to render all necessary help to the patient. Then they left the office. I breathed a sigh of relief. But it was a temporary relief. My conscience bit me repeatedly that justice was not done to the patient. To me the decision to administer GA to that patient was whimsical without any scientific background . The poor patient's life was left to the mercy of the treating anaesthesiologist. To save from the public eye the anaesthesia note was manipulated. But can it be forgiven by the Almighty? Can the erring doctor forgive himself ? If one is a habitual offender it will not make any difference. But for a sensible person the ghost of that patient must be haunting him at his subconscious state very often.
Lessons Learnt :
- Medical profession is the only profession which deals with life and death. There is only a thin margin between these two states.
- Whimsical approach, over confidence and ego have no place in medical science.
- Moreover in emergency situations one should be more judicious and defensive.
- There is no place of heroism in emergency situations.
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