A remarkably similar experience happened with two different persons from opposite corners of the Indian sun-continent- One from Srinagar and other from Dhaka, Bangladesh.
Mr H, a 55 yr old gentleman, came to me two months back (August 2012) from Dhaka along with his wife and a young son. Both father and son were pilots in a commercial Bangladesh airline. Mr H was earlier a pilot in Bangladesh Air Force. He was suffering from chronic anal fistula and somebody told him about me and they came to Chandigarh fully prepared for operation.
We were sitting in my office in the evening and after exchanging courtsies, we came to the main issue. He narrated his history in a doctored manner which I patiently listened. I examined him in detail and then studied the MRI which was recently done. Surprisingly, Mr H had no symptoms of anal fistula for the last 9 months, though the MRI showed a tract (fistula). It is a known fact that a MRI can show even a healed tract for years.
I told them that no intervention was needed as there were no symptoms for nine months and a significant (about 70-80%) chance was that his fistula was healed and might not trouble him for the rest of his life. Mr H looked upon me in disbelief unable to hide his disappointment. He apprised me of the difficulties they had encountered (getting an Indian visa for a Bangladeh Air Force ex-pilot was the biggest of them) and the logistics exhausted (expenditure and the holidays) on the trip. He literally pleaded me to operate on him as coming again would be an impossible task for him.
I clearly understood what he was saying and feeling. Empathizing with him, I explained to him that while taking decisions for surgery (whether to operate a patient or not), I only take medical factors into consideration and with great effort, keep all other factors (social, financial, logistic, various pressures etc) out of this process. I always think if my brother/relative is sitting in front of me instead of the patient, what would I advise him. The same advise would be the best for the patient.
It did take some time and effort to convince the patient that when chances of getting alright are quite higher without operation (though not 100%), it is better not to operate. I also requested the family not to take too many opinions because some surgeon may operate on him seeing the MRI report and he would be legally justified in doing so.
Next morning, Mr H and his family flew to Srinagar to spend the rest of their vacation.
I was caught in a similar situation 3 years back when Mr Z came to my office with his father from Srinagar. Mr Z is an editor of a leading weekly magazine in J &K (Jammu & Kashmir). His father was suffering from a Recurrent anal fistula and was advised an immediate operation after a MRI showed a fistula tract.
On detailed consultation, the 70 yr old gentleman (Mr Z's father) had no discharge or symptom for the last 16 months. As mentioned in the above case, I advised them to sit back and observe and not to go for an operation. The patient looked at his son in a disapproving manner as if saying " where have you brought me, my lad?". Without any effort, I could read them with ease. It took me about 20 minutes to explain them the risks of operation especially when it is not needed and the chances (more than 75%) of his getting alright without surgery. Mr Z asked " Agreed that my father is alright, what about the MRI which shows a fistula tract?". "I operate only on humans, not on X-ray Films !" was my candid reply. While departing, the old gentleman tried to touch my feet acknowledging his gratitute. I escaped this embarrassing situation by jumping back and folding my hands in respect.
Mr Z sends his magazine regulalry to me by post which I accept with great happiness and pride.
Mr H, a 55 yr old gentleman, came to me two months back (August 2012) from Dhaka along with his wife and a young son. Both father and son were pilots in a commercial Bangladesh airline. Mr H was earlier a pilot in Bangladesh Air Force. He was suffering from chronic anal fistula and somebody told him about me and they came to Chandigarh fully prepared for operation.
We were sitting in my office in the evening and after exchanging courtsies, we came to the main issue. He narrated his history in a doctored manner which I patiently listened. I examined him in detail and then studied the MRI which was recently done. Surprisingly, Mr H had no symptoms of anal fistula for the last 9 months, though the MRI showed a tract (fistula). It is a known fact that a MRI can show even a healed tract for years.
I told them that no intervention was needed as there were no symptoms for nine months and a significant (about 70-80%) chance was that his fistula was healed and might not trouble him for the rest of his life. Mr H looked upon me in disbelief unable to hide his disappointment. He apprised me of the difficulties they had encountered (getting an Indian visa for a Bangladeh Air Force ex-pilot was the biggest of them) and the logistics exhausted (expenditure and the holidays) on the trip. He literally pleaded me to operate on him as coming again would be an impossible task for him.
I clearly understood what he was saying and feeling. Empathizing with him, I explained to him that while taking decisions for surgery (whether to operate a patient or not), I only take medical factors into consideration and with great effort, keep all other factors (social, financial, logistic, various pressures etc) out of this process. I always think if my brother/relative is sitting in front of me instead of the patient, what would I advise him. The same advise would be the best for the patient.
It did take some time and effort to convince the patient that when chances of getting alright are quite higher without operation (though not 100%), it is better not to operate. I also requested the family not to take too many opinions because some surgeon may operate on him seeing the MRI report and he would be legally justified in doing so.
Next morning, Mr H and his family flew to Srinagar to spend the rest of their vacation.
I was caught in a similar situation 3 years back when Mr Z came to my office with his father from Srinagar. Mr Z is an editor of a leading weekly magazine in J &K (Jammu & Kashmir). His father was suffering from a Recurrent anal fistula and was advised an immediate operation after a MRI showed a fistula tract.
On detailed consultation, the 70 yr old gentleman (Mr Z's father) had no discharge or symptom for the last 16 months. As mentioned in the above case, I advised them to sit back and observe and not to go for an operation. The patient looked at his son in a disapproving manner as if saying " where have you brought me, my lad?". Without any effort, I could read them with ease. It took me about 20 minutes to explain them the risks of operation especially when it is not needed and the chances (more than 75%) of his getting alright without surgery. Mr Z asked " Agreed that my father is alright, what about the MRI which shows a fistula tract?". "I operate only on humans, not on X-ray Films !" was my candid reply. While departing, the old gentleman tried to touch my feet acknowledging his gratitute. I escaped this embarrassing situation by jumping back and folding my hands in respect.
Mr Z sends his magazine regulalry to me by post which I accept with great happiness and pride.
No comments:
Post a Comment