It was the first day of the new academic term and our batch was bubbling with excitement. Our surgery posting had finally dawned. Now was our chance to step into the operation theatre and watch first hand as surgeons washed up and dutifully, saved lives. When most medical students envision medicine as a career, prior to entering medical school, they more often than not dream about wearing scrubs and operating to the rhythmic beats of all the life support and monitoring machines. Without doubt, the first visit to the operation theatre is one of the most cherished memories of any medical student.
We were assigned to our units and were very warmly received by our senior consultants. Cases were allotted for observation and by rotation, we were even allowed to wash up and assist in the procedures. It was a thrilling experience as we got to take incisions and operate laparoscopic instruments under expert supervision and this led to the birth of an unextinguishable spark that caused many of my colleagues to decide upon surgery as a future career choice.
At the end of the session, we assembled as our senior consultants explained to us the various procedures and why surgical intervention had proved necessary in each case. We learnt a few golden lessons that day and this proved to be the first of them: though we are doctors, we must always treat the patient and not the case and thus, non-pharmacological treatment options always superseded medical therapy and surgical interventions were only the last resort.
As the small group discussion neared its end, the chief surgeon opened the floor for any questions that the students possibly had, irrespective of their relevance to any discussion that had taken place before. Curious and fascinated by all I had witnessed, I enquired that what was the most difficult and longest operation they had ever undertaken. The chief surgeon smiled and glanced at his fellow surgeons.
“It had been an unusually rainy day when I first met him. The cold winds gushed, accompanied by the persistent patter of raindrops on the tin sheets lining the windows. The crackling thunder humbled all by reminding us who wielded the most power,” Sir began.
Recalling the day, he continued, “Having just finished the morning OPD (Outpatient department), I instructed my residents on the work up of emergency cases and was about to depart for home when Vikas* rushed in. It had been a tiring night with continuous operations and after 30 hours at work, I longed nothing more than to see my wife and kids.”
“Tearing through the doors, Vikas was gasping for breath as he pushed the wheelchair carrying his mother through. He requested me to examine his mother before leaving and having been moulded by fantastic mentors early in my career, I sat down to take his case,” he smiled nostalgically perhaps paying his respects to all his teachers.
“It turned out that his 76-year-old mother had been having pruritus and severe jaundice since the last month, making routine life very difficult for her. With severe weight loss and fatigue, she had been investigated. The reports had come positive for a cholangiocarcinoma in situ. The oncosurgeon had advised a Whipple’s procedure to be performed and owing to the lower cost at government hospitals, Vikas had brought his mother here. On further enquiry, I learnt that Vikas intended to sell his ancestral property and take loans to fund the treatment,” Sir completed the case history.
“I paused briefly to review the entire case. A Whipple’s procedure only had a 2% success rate. It would give the patient a maximum of 6 months to live. It was that familiar situation again where I was presented with the chance to be Superman. I clearly remembered my mentor’s words of wisdom. ‘Never try to play God. Accept with grace when cases have gone beyond control.’ Those were the days where there had been a high incidence of violence against medical personnel. While there was a high risk of assault as Vikas had brought all his well-wishers along, I did not hesitate long before I decided to explain the complete scenario to Vikas,” he reminisced.
“Adhering to the SPIKES (Setting, Perception, Invitation, Knowledge, Empathy, Summarize and Strategize) protocol, I gave Vikas two options. I could go ahead and do the procedure as he desired, leaving Vikas bankrupt and his mother with a high risk for complications from the procedure in the half year period till her death or I could instead do an ERCP and stent the bile duct. The jaundice and itching would be resolved and his mother would be symptom free till her death 6 months later. Vikas cried. I could see his quandary. As a dutiful son, he did not want to be guilty of having not done everything possible for his lovely mother. I patiently waited as Vikas requested for some time to contemplate,” he continued even as there was pin drop silence in the room. All the students were listening with complete focus.
“The hour passed and Vikas returned with a calm courage, the kind that shines through when all hell breaks loose. He had decided to go in for the free ERCP (Endoscopic Retrograde Cholangio-pancreatography). I promptly posted his mother for the same. The operation was a success and Vikas came regularly for follow-ups. 5 months later his mother passed away.” A single tear made its way down his cheek.
“Vikas visited me again at the end of the next OPD and broke down. He was by now a friend to all my staff and his endearing mother had won many fans with her vast wisdom and cheerful anecdotes about life. Those tears were not those of sorrow but of gratitude. Vikas fondly recollected how in the past 5 months the entire family had been together and along with his mother, they had managed to accomplish a range of activities which made up her bucket list. He had seen his mother beam with joy and radiance as she had experienced togetherness and bonding like never before. He thanked me for the beautiful moments which my frankness had enabled them to enjoy.” The graceful smile had once again returned to adorn his wise features.
“Vikas kept in touch with me and every year on Doctor’s Day, I would get a card from him thanking me from saving his family by ensuring that he did not go bankrupt for a lost cause, thus enabling him to provide his daughter with a sterling education,” Sir paused before continuing,
“Last year, a smart resident joined my unit. She had great clinical acumen and a resilience beyond her years. As she handed me a card on Doctor’s day, it was to my utter surprise that I discovered that she was Vikas’s daughter. She narrated to me how learning from and working under me had been her long-cherished dream and how her father had supported her throughout to ensure this came true. Vikas had passed away a couple of years back but in that moment, we both knew that he would be a proud and happy father,” and thus, Sir completed his answer to my question.
Though it has been many days since I first heard this story, every word rings in my head as clearly as if it were spoken yesterday. The power this story had on me, and possibly all those who heard it, was enormous. I had learned another golden rule: the importance of interpersonal relationships as a healthcare professional. Though we may focus only on a life saved or lost, the repercussions of our every action always spans across multiple generations. This is a truly noble profession and each one of us who are privileged to have been given this opportunity to be of service must strive to be our best and ensure that we live up to the standards set by all the legends that preceded us.
*: Name changed to protect identity
- The Surrender of the Medical Superhero – by Vishnu Unnithan - October 14, 2020