A Matter of Destiny - 5


Dr Sharad Panday

The next story I wish to relate is of high educative value to parents on children born with congenital heart defects or CHDs. Some parents that they have an absolute right over their child's life and instead of allows their doctors to decide upon the suitability of operating upon such children, they try to dictate terms to the doctor. "Can we not delay surgery, till the child is a little older?” and so on and so forth, I realise that very often his is due to misplaced affection for the little one. Of course, ignorance of such a disease also plays a significant role in such matters. A mother or a father wishes to delay the child's surgery notwithstanding the fact that such a delay could lead to an irretrievable situation when no amount of surgical intervention would be of any use. The child's condition would  have deteriorated to such an extent that no doctor would risk taking the child on the operation table. No amount of coaxing and cajoling seem to work on such parents and they are satisfied that their child is alive even though the quality of life is poor. Many such children having grown up into teenagers and then undergone surgeries have asked me whether they would have grown up normally had they got operated earlier. There is an arcurrent of resentment towards their parents. Of course, parental concern is understandable but it should not be to the extent of working to the detriment of their children. They often wait till the child's conditions becomes inoperable and when they learn about this, panic grips them and they run from pillar to post, trying to get surgical help.


Recently, a mother came to see me with her young son. He was suffering from a condition called Patent Ductus Arteriosus (PDA) and had been visiting almost every doctor in the city, in what is commonly known as doctor-shopping. The mother had even shown her son, Jitendra, to some doctors who participate in charitable camps organised by social organisations.

She had the indoor papers of Bombay, Nair and K.E.M. Hospitals and prescriptions of some private city doctors. Finally she came to me and certainly not of her own will. A junior doctor had told her that Jitendra's condition was very complex and the surgery entailed would be very complicated and that she should therefore seek a senior expert's opinion. Since the son was obviously failing in health, she finally agreed, although reluctantly, to get a cardiac catheterization done on him. This investigation revealed the necessity for a surgical intervention-albeit the risk to Jitendra's life was extremely high.

I first gave a piece of my mind to the foolish mother who had insisted upon the delay in subjecting her son to surgery. Her silly, superstitious behavior had caused much physical and emotional trauma to Jitendra. I then explained to her the risk involved in operating upon Jitendra so late when so many complications had set in. I even told her that we could have a mortality (death) on the table. She gave me a firm assent for carrying out surgery, although I did not fail to notice the tears brimming in her eyes. But I had to be a little harsh while explaining, in order that she did not expect a miracle in the post-operative period.

I am describing this story at some length not to highlight any technical point but just to show that despite all eventualities, some people are fated to live-the Good Lord above just does not welcome. prematurely!

My anaesthetists and my perfusionists were mentally or serious problems during surgery. I even cancelled a social programme in advance as I was sure I was in for a real marathon session. Soon enough, surgery commenced and even before I could proceed fragile ductus ruptured. An adult ductus—the boy was not even old—when it ruptures creates a situation similar to an aortic mun life-threatening one). Without going into technical details, I can landed in a very sorry mess and to extricate ourselves from this st affair was going to be painfully difficult. But we tried our level best did manage to save Jitendra. But at what cost? Loss of sleep not only for the parents, but to the surgeon, the anaesthetist, the perfusionists and the nursing staff and even to the theater attendants—a little slip on their part could have cost Jitendra his life. But do people ever realise what doctors go through when they take upon themselves the responsibility of their patients? When we succeed, we become heroes-next only to God! But when we fail, we are most cruelly accused of "criminal negligence”.

When Jitendra came to the clinic for a follow-up visit, he seemed totally unaware of the serious situation he had been in during surgery. However, his parents knew about the grave risk to his life during surgery, in Jitendra's surgery. more so the mother, who was mainly responsible for the inordinate delay in Jitendra’s surgery.

I must admit that there was a radical change in her behaviour in the post-surgical period. One day she approached me and said: "Doctor, had something gone wrong with Jitendra on the operation table (she meant death') I would have died of remorse. I would have never forgiven myself considering that I was the one who had put my son in such a grave situation by my own ignorance and selfishness".

My only appeal to such parents is that they should allow surgery to be performed on children when the conditions are optimum for it, not to unnecessarily delay it till the child's case becomes inoperable.

About 5-6 years ago, a close friend of mine, in fact my classmate-do not wish to name him—rang me up. "Sharad, I want to bring a case to you; the child is in a pretty bad shape" he said. I tried to give him appointment but he butted in, saying: "Sharad, please give the earliest appointment, in fact, I'll bring them today itself. Money is no problem. They are very affluent people". When I saw the boy and his X-rays and other investigations like the CT scan etc., there was absolutely no doubt my mind regarding the diagnosis-it was a mediastinal tumour. The boywas coughing away and looked miserable: the symptoms obviously due to pressing upon the trachea (windpipe). After I gave my opinion, my friend urged me to take up the boy for surgery at the earliest. Now the meant Monday when I had another open-heart surgery in the morning already fixed. Reluctantly I decided to operate on the child after the first major case and asked the parents to get the child admitted in the Thu Friday so that any further investigations, if necessary, could be carried out.

Friday dawned, then Saturday and finally Sunday, but there was no trace of the patient. I told the hospital staff to make the necessary cancellation. I never heard from the parents and from my friend.

Six months later, the same friend called up again. "Sharad, I have a problem. Do you remember the kid I had brought to you—the child you diagnosed as having a mediastinal tumour?” I was so upset that I almost fumed. "Don't speak a word to me about that case!” and was about to put the receiver down. I was upset not because they were disinclined to let me operate on the child, but because they lacked the basic decency to inform me that they did not wish their son to undergo surgery at my hands.

But my friend pleaded with me and said: "Sharad, these rich people think the panacea for all their ills is in America; they went to the States and got their child operated by an American surgeon".

By now my mercury had registered an all-time high and I exploded: "Look, I am certainly not going to take up a second hand case messed up by a foreign doctor. Tell them to take the child back to the Amercian surgeon".

Apparently, the parents while in the United States itself had told the surgeon that there was no improvement in the child's cough and the latter had replied that the cough would persist for a few days and eventually would subside, that they should not get unduly perturbed about it and should return to India.

After returning to India, they met my dear friend and told him about their harrowing experience in the United States. My friend obviously did not have the guts to inform me and so he ordered an X-ray of the chest and repeated the child's CAT scan. The X-ray again showed the same mediastinal shadow and the CAT scan was no different from the preoperative one. They were identical. My doctor friend was puzzled and I suspect it was sheer desperation that brought him back to me to seek my advice.

After examining the boy and after seeing the reports, I said to the parents: "I don't know where you have got your child operated, whether in India or in America. But I can tell you one thing with 100 percent certainty. Your son's tumour has not been removed at all!"

They were shocked and when reality finally dawned on them, they said: "Then what did the American doctor remove?”

I explained to them that he may have removed the thymus gland which in children is pretty large; that this particular surgeon may have been an inexperienced one and may have not realised that he had left the tumour intact. In any case, I said to them, the "What should we do now?" was the next question they should go back to the same surgeon and ask him to redo the surgery. , At that they responded with vigour, "We will certainly not go back to him. We want you to operate on our son",

We had a lot of arguments and ultimately the doctor in leaving all my negative emotions behind me, I finally agreed to their son. Then came the rather impertinent and unwanted advice since the tumour is on the left side, please operate from the left side.”

Before the situation could get out of control, my friend pleaded with me to maintain my calm and I replied: "I will operate from the same mid-sternotomy incision through the same scar,"

My assistant opened the chest and I took over. We took some important clinical photographs of the boy's mediastinal tumour, Believe me, I could extricate the egg-sized tumour with my finger it was simple as that. Even my juniormost resident would have removed it as efficiently as I had done since there was no problem at all. I do not wish to give any technical details, but I am truly amazed that such a tumour could have been missed by any surgeon whether in America or anywhere else. We took more clinical photographs and then closed up the child's chest cough etc. soon disappeared. His subsequent recovery was uneventful and the boy's symptoms of cough etc. soon disappeared. 

The parents then requested me to give them copies of the photographs that I had taken during surgery as they wished to show these to the American surgeon. They went to America, sued the surgeon and the hospital and I was called to the States as an expert witness. I had to fly twice to the United States during the pre-trial days. The surgeon did acknowledge his mistake and finally an out-of-court settlement was arrived at and the parents were awarded a hefty compensation.

This was a reverse case where a foreign doctor was the 'culprit' and an Indian doctor the saviour'. Yes, most of our people believe that everything foreign has to be the best and everything Indian is not quite up to standard. So many patients come to me for my opinion and then say: will go to America and have our operation done there!"

Let it be understood that I am not trying to denigrate the American or any other surgeon from other countries. This particular patient, to his bad luck, landed up with a wrong surgeon-that was all there was to it. But what I do wish to state here is that when we have here in India the Facilities, the infrastructure etc., why should Indians clamour for a distant, foreign and unknown medical service and the impersonalism with it? I can understand this happening about 20-30 years ago, when we were  not so well advanced in our techniques, and in our operative facilities. But not today. Do you know that one of our former presidents was re-opened in an emergency situation and this in the best of hands in America? If complications have to occur, they will occur in India or abroad and even in most expert hands. Had this patient not returned to me, I would perhaps not even have known about the case. Such a situation may have happened many more times we are not even aware of.

One thing really amuses me. I don't know whether I look like a surgeon or not. But many a time, especially when I was working as a Cardiothoracic Surgeon in the K.E.M. Hospital, people would often approach me, seek my advice and then wonder who I could be! I still remember the young girl in her late teens who came to me with a reference letter from one of my colleagues in the hospital. Sitting in front of me, she told me all her complaints and showed me her neatly arranged file of investigations. I asked her to lie on the examination couch and loosen her upper clothes, for examination of her heart. When I had finished, I told her that she had a hole in the heart for which she needed an open-heart procedure. She agreed, thanked me profusely for seeing her without an appointment and walked off. Soon enough there was a knock on my office door and the same girl reappeared. I asked her: "Yes, what is it again? Are you wavering from your decision?” Promptly came the query: "But are you Dr Sharad Panday?" Highly amused I asked her: "You mean you got yourself examined by somebody you thought was Sharad Panday and not really Sharad Panday? Supposing I say: No, I am not Sharad Panday, then what would you have done?”

I leave the reader with that thought!

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