anonymous
20th September 2018
DOCTOR'S DILEMMA (8)
DOCTOR'S DILEMMA(8)
DR RAVI BAPAT
It is a common observation that an apprehensive, unwilling patient creates problems after surgery. There is scientific proof to show that the psyche does affect the soma, particularly during stress such as anaesthesia and surgery.
Dr M, was a case specially referred to me for pancreatic surgery. His symptoms were highly exaggerated in relation to the signs and structural changes in the pancreas. In fact, he was also given psychiatric treatment. I postponed his operation twice and advised him to continue conservative management. However, due to persuasion by one of my colleagues operated on him. The surgery was uneventful; post-operatively he was complaining all the time but recovery was good till the fifth day. Suddenly he developed fever and pain and was found to have an abscess around the anastomosis. He was toxic and for the next two weeks it was a nightmare for me. Everything possible by way of treatment was being done but he continued to worsen. Though normally I am cool and collected, this time I called in my senior colleagues to guide me for I felt that had I left him alone, he would not have gone into this. My anxiety was writ large on my face. We tried our best, but, in the end, we lost the battle. He succumbed on the 21st day. I have often asked myself why I allowed myself to be pushed into doing the operation.
Once bitten twice shy. I have now become cautious. However, sometimes a patient's psyche plays an important role. Mr K was a case of ulcerative colitis - a known psychosomatic disease. He was referred to me as I was the first one to do ileoanal anastomosis in India. Judging him well, I decided to do a two-stage procedure. First he was assessed by psychiatrists. He did well after the first stage and put on six kgs of weight. He was an intelligent scholar and hence was more inquisitive and apprehensive. After the second stage, however, his progress was retarded as he went into depression. He developed various complications one after the other and succumbed. I feel the patient's own courage, faith and logical status play an important role in the management of disease the healing process.Compilation of professional reminiscences of specialists - edited by M.V.Kamath and Dr.Rekha Karmarkar.