With Due Respects.
I silenced it once, twice and then a third time ; as I again returned back to my sleep. I am expected in the operation theatre at 4:30a.m. the following morning for a very major surgery.
At 74 years of age, the patient is a diabetic and hypertensive who has been referred to me for right upper lobectomy for a post tubercular bronchiectasis and aspergilloma of the lung.
He has been having recurrent bouts of massive hemoptysis over the last one month. He has been stabilized over the last couple of days in hospital, and is now scheduled for the surgery the following morning.
Indeed ! Let's get back to his son's phone call.
The son tells me in Hindi, "Maaf karna sir, lekin ek jaruri baat karni hain." He apologizes while stressing on the need to have an urgent word with me
."Bolo Beta", I reply. I ask him to proceed. He proceeds to tell me that his uncle - that's the patients brother, had gone to seek the blessings of their family religious priest for a successful surgery. And as things turned out , the religious man had opined that the scheduled day and the time of the surgery were not auspicious for a great outcome. In fact, he mentioned that if we went ahead with the surgery as planned, the outcome was going to be poor.
The family wanted the surgery to be postponed to a more "auspicious" time.
I was now sitting up - wide awake, in my bed. While my support staff were probably getting ready for the big case in the next few hours, I was expected to make a decision purely on non-medical grounds about the road ahead for the patient.
I am curious to know what your reaction would have been in such a scenario, and your reply to the patient's son on the other end of the phone call.
My response was simple. "Teek hain. Kaal baat karenge. Goodnight." I agree to the family request.
I dialed my anesthesiology and surgery team, inform them about the cancellation of the case and give them the good news that they have a day off !
I return to my sleep.
Religion is an important aspect of our lives - especially in South East Asia. I personally firmly believe in the power above and around us but sadly sometimes our faith tends to border into the domain of fanaticism and superstition.
You may have been personally a witness or a victim of such incidents when the patients even dictate the day and the time of surgery. At times even the time of a childbirth at a precise time such as 11.32am. Returning to the scenario confronting me that night, I obviously had no option but to give-in but that was obviously not the end of the story.
The next morning, I went into the hospital and politely discharged the patient. I left the patient's bedside with the advice to the family to let us know a week in advance about their decision of proceeding with the procedure - at an auspicious time.
More importantly, I needed to safeguard my team from the responsibility for any serious complications arising from the family decision of the postponement and a fresh bout of hemoptysis. A due note was made and signed in the medical records. The patient went home.
Three days later, the patient had a bout of massive hemoptysis at home and was again admitted to their neighborhood hospital. The hemoptysis obviously had it's own auspicious time to spring into action.
The family called me in panic but this time they were willing to have the procedure done at any time of my choosing.
Here's my take away message for you from this story : The timing of a hospitalization, any intervention or any surgery ; is ideally decided by the medical or surgical factors concerning the patient and the possibility of safe execution of the process by all concerned care providers. It's a multi-factorial decision. It's not a decision to be based primarily only on one set of factors either related to patients or care providers alone.
Let's take an example : Let's take a case wherein the auspicious time for delivery of a baby is 11.32am, but there are signs of fetal distress at 9:30 am. The Obstetrician needs to proceed with a Cesarean Section at 9:30 am, or else there is not going to be much to celebrate at 11.32am.
Returning back to my case of aspergilloma lung, the patient was admitted for the surgery a week later, had an uneventful surgery and post-operative recovery. He went home hale and hearty on the eight post-operative day.
Religion is an important aspect of our lives - especially in South East Asia. I personally firmly believe in the power above and around us, but sadly - at times, our faith tends to border into the domain of fanaticism and superstition.
It takes 'Two to Tango' for a successful patient outcome. And a successful result is not only decided by patient factors but the entire team the surgeons, the physicians, the intensivists, the nurses. It's not only about the faiths and beliefs of the patients but the of the skills, efforts, faiths and beliefs of all the care-givers as well.
I pray that the blessings of The Almighty be with you always.
All the very best. Cheers !
Originally published August 2, 2021