Recently I read news A doctor was brutally killed by a person who alleged the doctors negligence killed his nephew (http://www.telegraphindia.com/1140924/jsp/odisha/story_18866076.jsp#.VDN72_mSySp) Few episode in renowned TV shows also condemned doctors for negligence and malpractices. I was deeply hurt and decided to share an incident which happened recently. I would like to tell everyone Doctors try to save the life till the end and no doctor can ever kill a patient.
The weekend Call:
It was night 11PM on a Saturday when I got a call from a friend. He informed me there is a patient 23yr old lady who is 33 week pregnant and has been diagnosed with AML( Acute Myeloid leukemia). No one in the city hospitals is ready to accept the case “sensing the seriousness and bad prognosis”. Unfortunately the medical oncologists in the city were also out of town in the fateful night for a conference. I initially thought I need to take care of the patient in the night and tomorrow morning will send the patient to Hyderabad. Only one thing that was disturbing me was patient was 33week pregnant and having a premature baby.
I got a call from casualty at 12Am in the night the patient reached the casualty. I immediately reached the casualty to see the patient. A young female sleeping on the casualty bed with oxygen mask on face. She was breathing heavy and was looking very sick. On seeing the patient I realized that if I send the patient to Hyderabad she is going to die on the way and the baby will also die with her. I flipped through the reports and was shocked. The platelet count was 12000 (Normal is more than 1.5lakh), Hemoglobin was 4(Normal is more than 10 at least), Total leukocyte count was 1, 37,000(Normal4000 to 11000). As usual with patients there were no earlier reports and I found that she was diagnosed to have acute leukemia (A type of Blood cancer) today only. After the diagnosis she was abandoned asking her to go to higher center.
Challenges ahead of me:
1: To correct the hemoglobin and platelet count. The leukemia cannot be treated in this condition with the baby of 33weeks. We needed to wait for delivery of the baby and then only plan for any treatment.
2: To save the baby who is supposed to be pre term.
3: Whether the Obstetrician will agree to take up the case with such low platelet count. (Platelet count is important for blood clotting. in low platelet count is there is possibility of bleeding during labor or Cesarean section.
4: The patient belonged to low socioeconomic status and would be a challenge to them financially.
5: To deal with the emotions of the family members as they have just heard the diagnosis of cancer and there is possibility that the patient may die.
I decided to take up the challenge. I called up the obstetrician and explained the situation to her and to my luck she was also very enthusiastic and said don’t worry we will do the best. I then counseled the patient attainders and explained about the present situation and also the challenges ahead. They also understood the situation and gave their consent for the further treatment. I then shifted the patient to ICU for better monitoring and advised the attainders to arrange blood and platelets. The next day (Sunday) was uneventful and patient was stable but the platelet was not much improved.
The fateful day:
On Monday it was early morning 6 O’ Clock I got a call from the Obstetrician that the patient has progressed to labor. I rushed to the hospital. I could feel the pain the patient had with the hope to see her baby. We immediately sent for latest blood counts and were shocked to see the platelet count has not increased much in spite of transfusions from previous day. We advised the attainders to get the platelets etc and counseled them about the latest development.
Patient was shifted to OT and we planned for labor in the OT with back up of anesthesia so that if required we will go for C/S. It was 5 hrs of stress for every one of us. I also decided to be in the OT and be present during the procedure. Ultimately a baby girl was born at 11 30Am. The mother saw the baby and smiled (In spite of the pain). My colleague had real tough time in controlling bleeding but with help of fresh frozen plasma, platelet transfusions etc we could control bleeding at that time. The baby was though premature was healthy her all blood tests were normal and also taking feed properly. After shifting out of the OT the lady wanted the baby to by her side and wanted to spend time with her. we all had tears at that situation.
We were happy that we could successfully complete one task and baby was healthy but still needed to be kept under observation. The mother was fine with bleeding controlled but still we had to be cautious and needed to replenish the platelets etc so as to avoid any further bleeding. In spite of repeated transfusions of platelet there was no improvement in her platelet and in the evening she started to signs of restlessness. In spite of all measures taken the mother could not be saved and died due to internal bleeding. The baby was asked to be kept under the guidance of the pediatrician for 2 days as she was born premature but next day I was informed the attainder had family issues and decided to take the child. I really wanted to see the baby whom we had saved and wanted her to live at any cost.
End of the day Analysis:
Next day I was thinking about the whole incident and many questions came in my mind
- If the patient had done regular check up during her pregnancy and may be the disease would have been diagnosed earlier?
- What would have happened if I also would have washed my hand and said “Go to a higher center”?
- What if my colleague the obstetrician wouldn’t have agreed to take up the case as it was risky?
- What if it was a boy instead of a girl would they have kept the child under the pediatrician as she was preterm and was at risk of many complications especially in first few days?
I felt god wanted the baby to see the world hence he had sent the patient to us. I was happy that we worked as a team and took up the challenge. As a doctor our aim is to try to save the life till the end, many a time the patient come in situation where nothing can be done but still we try to do our best.
