A Matter of Destiny - 3


Dr Sharad Panday

Some 16-18 years ago I had another such experience. I had operated on a small boy-Willy Fernandes-a case of total correction for Fallot's Tetrology. Following surgery, Willy sustained a cardiac arrest and, I suspect, there was a slight delay in reviving him, for the boy did not regain consciousness. A very eminent neurosurgeon was called in for advice. His verdict was that Willy had suffered " total brain death" We had to reason to doubt the verdict. The neurosurgeon ruled out surgical intervention and all of us gave him up as a goner. We felt terribly sad but there we nothing more that we could do for the patient. He was merely put on the respirator and isolated in a corner of the room, none of knowing how long he would last in that situation,

His dear mother, God bless her, was constantly on attendance but the father who initially was always around had naturally a and soon stopped coming to the hospital. On my rounds every day visit the patient, inquire about his mother and her welfare, She wore a faint smile. There was not a trace of anger or animosity, there was only concern for her dear Willy, She hovered around him like a hawk. Some 8-10 days later, the ever-vigilant mother noticed a flicker of a on movement in Willy's right hand. I thought she was imagining- you know how mothers are, but she seemed very definite about her minute Over So I went over to examine Willy, did a thorough examination, perfomed all the neurological tests to evoke a response but there was none whatsoever from Willy. Attributing her "hallucination” to lack of sleep, I gently patted her back and left the room

Some 5-6 days later, I had a surprise. This time the resident doctors confirmed the mother's observation there has indeed been some movement in the fingers of the right hand. But these, we thought, could at best be described as involuntary movements, for wasn't Willy still on sive to pain and to our commands?

But to our delight, there was a gradual daily improvement in Will's condition and soon he started moving his right arm; then he wanted responding to pinch and after about a month, he was fully conscious had developed hemipareisis (partial paralysis of half side of the body) Perhaps some clot had got lodged in his brain to produce this situation. Gradually even his hemipareisis improved and he was discharged 2 3 months later with a slight limp.

But now he had another problem. As he was put on a respirator out to his unconsciousness, we had to perform a tracheostomy (an opening his windpipe) on him and attach the respirator to the tracheostomy be (T.T.). But since he was assisted by the respirator for a long time and to the tracheostomy on for a long time too, it now became difficult to wean him off the tracheostomy. He had become used to breathing through the tracheostomy tube and he just would not breathe if the T.T. was removed! So, perforce, the T.T. had to be kept. He was therefore, transferred to the E.N.T Department where a senior consultant looked after him. They now had to teach Willy how to take care of his tracheostomy, what sort of tube he should use and so on! He was finally discharged from the hospital with the T.T.

Even while he was in the hospital, Willy had learnt that I was going abroad and he wrote a personal letter to me to check the fact. If indeed, I was going, he wrote, he wanted a 'silver' tracheostomy tube. It was practically a 'demand’ and I could not but feel admiration for this brave boy who had suffered so much. Despite his serious problems I found him to be rather aggressive for his age, but still I could not help admiring him. I had become quite indulgent towards little Willy and he was soon making many more demands on me, as if by right!

Anyway he was discharged in due course and we lost track of him. One evening, after about 8-10 years, as I was sitting in my clinic, I heard a big commotion outside my office and suddenly a young man of about 1920 years barged into my room. I was very annoyed with my secretary but before I could say anything, the young man greeted me in a very familiar way and congratulated me on my son Chunkey's entry into the film world! I asked him who he was and was all set to have him thrown out on the assumption that he was a star-struck fan when, to my surprise, he asked me to go down memory lane and to remember a small unconscious boy in K.E.M. Hospital in Ward 23. It was only then that I recognised my little Willy who had grown up into a young, confident man. I wondered aloud whether anything was the matter with his heart. He reassured me that he was absolutely fine. He had seen my photograph with my star son in one of the film magazines and he felt it was his duty to come and personally congratulate me. Considering the demands he used to make on me as a child, I was not at all surprised that even that day he should demand of my secretary his right to greet me-So what if he did not have an appointment? The secretary, however, had made Willy wait till the end of my clinic hours but he did not seem to mind that at all!

Sitting in front of me was a young, aggressive and ambitious man, who was hardly bothered about his minor handicap at the site of his tracheostomy. There was a minute opening and hissing sound emanated from it but this did not deter him from leading a fruitful life. He concealed the opening with a muffler and to an unsuspecting onlooker, Willy was a young exuberant man full of life. His gait, too, had improved markedly and he masked his limp cleverly. He established a rapport with my secretary and would enter my clinic at all odd times. He soon found a job at Sea Rock Hotel and then inquired of me whether he could be included in the Handicap Category to avail of a telephone booth and a telephone. Later I heard that he had started a small scale business and was doing pretty well. I feel proud that he has become a useful member of oursociety. He never grudged his bad fate, never ever cursed his de did I ever hear him blame anybody for anything in life, His only was to succeed and I am confident that he will achieve his goal.

But just fancy: he had been declared as 'brain dead' and case a decade earlier. Had we accepted the verdict and to him respirator and allowed him to die, Willy would have been lying today, instead of being a useful and productive member of repeat: doctors should never give up on a patient till the very end. God has His own ways with man.

Another incident that has taught me never to give up on a patient care one MrsSumanZhaveri. A thin, emaciated lady was brought to my She had already undergone two heart surgeries prior to coming to me first, a closed mitral valvotomy, following which she had a restenosis of the mitral valve for which a city doctor had put a Shiley Valve or a be logical valve. Now, biological valve has a limited life span and get destroyed eventually.

She was brought to me in an absolute moribund state in congestive cardiac failure (heart failure). I was upset on two counts:

In such a state, the relatives should not have brought her to a doctor's clinic. She should have been immediately hospitalised by the ‘literate' relatives.

Instead of seeing their original doctor, they had brought her to me when the case had worsened. I thought it was their duty to notify their own doctor and not go around shopping for a new one,

The relatives told me that their doctor was not being cooperative but was rude and that the patient simply did not wish to see him again. The patient then requested that I should take over her case as she had full faith in me and did not wish to see any other doctor.

Having said this in a very feeble voice she asked me what my fees were! Not wishing to add to her anxieties, I replied: "We shall see to that later, first get admitted immediately in the hospital".

My first impression was that she would not survive the night. She was that bad. I called up my residents and asked them to get her admin immediately in the Intensive Cardiac Care Unit. Unfortunately for me, she soon improved markedly-unfortunately because she was a very high-risk patient, operated twice before and no surgeon likes to have a mortality on his hands. However, better sense prevailed and I soon got over my negative emotions and took her up for surgery. But prior to that, I explained to her relatives that she carried a very high risk and she could eve die on the operation table, as a third heart surgery is not simple and valve had been totally destroyed. Apprehensive and anxious as they were,they assumed that my elaborate explanation was a covert demand for high Fees but they assured me in plain Gujarati that they were willing and ready to pay whatever was charged. How I wish money can buy everything! The affluent class always thinks in terms of money.

My pleas not to compel the patient to undergo yet one more surgery fell on deaf ears. The relatives wanted me to operate on her, come what may.

Finally I did operate and to my good fortune, surgery and anaesthesia were uneventful. Fortunately for her, she too came off the bypass with very minimal support and was all right for the next two days.

Suddenly, on the third post-operative day, my telephone rang in my clinic and my resident, Dr.Kubal was on the line. In an urgent tone he informed me that MrsZhaveri on bed No 5 had sustained a cardiac arrest and that they (the resident doctors and nurses) had been giving her external cardiac massage for the past twenty minutes and wanted me to rush down to the hospital.

That Mrs.Zhaveri had suffered a cardiac arrest did surprise me; only half an hour earlier before returning to my clinic, I had visited her and she then seemed fine. But what astonished me more was that this frail woman was giving a tough fight to the God of Death, for twenty long minutes. Her pupils as yet were not fixed and were still reacting to light, I was told. That meant that her brain at least was not yet dead. It also meant that my residents were giving very effective cardiac massage. After giving me this information, DrKubal immediately put the phone down and rushed to his patient. I called him up again from the clinic telling him about the futility of my trying to reach the hospital fast. It would have taken me at least fifteen to thirty minutes to reach my destination in Bombay's traffic at the very earliest. I dreaded the thought of going to the hospital. I knew it would all be in vain. By the time I reach, I presumed, 45 minutes would have elapsed with the cardiac massage still in progress. I dreaded the thought of 45 relatives pouncing on me and asking me 45 difficult questions.

Most reluctantly, I decided to go and reached the hospital and took over the massaging from my tired junior doctors, gave the patient a new heart-supporting drug, made some minor changes in the drug regimen and to my utter surprise, MrsZhaveri now started rallying round. It was certainly not due to my efforts as much as to the collective efforts of my hard-worked resident doctors. To them goes the entire credit for persevering and not giving up the lessons which I had taught them in their early residency days were now being put to use very effectively. MrsZhaveri was revived, but immediately went into a condition called 'heart block”. Continuing the massage again, we shifted her to the Cath-Lab where apacemaker was introduced in her body.

In order not to take any more chances with this fragile lady. w Mrs.Zhaveri on a respirator and she continued to have the the pacemaker over the next 3-4 days after which she recovered fully and in due course discharged from the hospital. Being a very thin and en emaciated lady, during the vigorous thumping on her chest whilst the external cardiac massage was going on, we did manage to fracture several of ribs but she soon recovered from the 'assault'!

When she came to my clinic for a follow-up, she complained about nothing more serious than a small scar on her chest which was beautifully hidden by her blouse. I was not sure whether to laugh or cry. Here was a woman who had been virtually snatched from the jaws of death-at one time she did not seem to have the slightest chance of living for the next 24 hours!—and now she was complaining of a trivial scar. That she had had about an hour's vigorous cardiac massage did not seem to have upset her one bit. That she had been 'clinically dead' and was now playing her perhaps third or fourth innings was of absolute no significance to her! Shall I say with the cynic: Vanity, Thy Name is Woman!

Every now and then, I keep giving a fresh dose of advice to my Residents. Never give up easily, I tell them. Day after day, I feel convinced that there is a Destiny that rules our lives and that the Universe is one big computer. Our births and deaths are fixed by some Force and the data is fed to some computer and we make our entry and exit to and from this world at the specific time fixed for us. We, the doctors, cannot and do not know who is the one marked to live and who is to die. With the best of efforts and in the best of hands, a patient may die and, on the other hand, despite all odds, a patient may live. I tell my Residents that all hearts may not revive but some may, and will, for they are destined to. Out of curiosity, at her subsequent visit to my clinic, I asked MrsZhaveri whether she had any strange feeling during the time she was clinically dead—that is, for about an hour, the period of her cardiac arrest. Some patients have described some wonderful feelings during the time of their cardiac arrest and subsequent revival. But not our dear MrsZhaveri. She remembers nothing except the small scar on her chest!

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