The Moment of Truth - 2



Each plastic surgical problem has something that makes it unique and demands a specific 'tailor-made' correction. This makes work very interesting. It also makes putting a price tag on one's operation more difficult. Many years ago, the phone rang. A well-modulated male voice asked Dr.M, do you correct drooping eye lids?”. I said: "Yes". "How much do you charge for this operation?” He was obviously worried about the expenses. I gave the usual answer: "I have to examine you. I have to advise you to  undergo the operation only after checking that you are physically fit. I have to explain to you what the operation involves, e.g. the risk, pain, discomfort, time off from work, care required after operation, result expected and the scars resulting from the operation. Then follows your acceptance of my advice and indication that you would like me to operate.  After all this, the fees will be mentioned”. I could have added that the real price paid by the patient was in the pain, discomfort, scars etc. that he would have to bear which cannot be measured in terms of rupees.

He came to see me. He had severe drooping of both eyelids. This was a marked disfigurement and a disability in his work as a Professor. He had his problem for many years. He had thought of getting it corrected now as he had an offer for work in Canada as an Exchange Professor. He was an intelligent man, a real 'doctor' with Ph.D to his credit.

I found something unusual on examination. (The muscle concerned with lifting the eyelid has normal or near normal power usually. Also, the other muscles of the eyeball and of the face are normal). Many muscles of the eyeball and some of the face muscles were weak and had been so for many years. The professor's condition had been stable for the past 10 to 12 years. The face muscle concerned with closing the eyelid was very weak on both sides. Therefore, the surgical correction of the position of the eyelids (a fairly common and gratifying procedure which I have performed many times) was unthinkable. The adjusted eyelid may not be closed properly by the weak muscles. This could cause damage to or even loss of the eyes.

I advised him against operation and recommended the use of a device to hold the eyelids up whilst working. This was to be used only intermittently. I also referred him to a neurologist for further investigation and treatment in this problem of 'Occulofacial Myopathy” for which there was no cure. The support for the eyelids however worked well. He went Canada. Months later he wrote to me that my advice was repeated and firmly supported by a panel of doctors in Canada.

Compilation of professional reminiscences of specialists - edited by M.V.Kamath and Dr.Rekha Karmarkar