Cuts like a knife

Should surgeons treat family members if they have mastered the kind of operation their loved ones need?

I was rounding on patients in the ICU on a mundane Monday afternoon when my wife called. “Khursheed was playing in the hall and fell, cutting her head on the corner of the table. It’s bleeding profusely,” she said with a sense of panicked urgency, demanding that I do something from a distance. “Just apply pressure for 5 straight minutes without lifting your hand to see if it’s under control; it’ll stop,” I replied cogently, with the experience of treating several hundred scalp wounds. I wanted to add “All bleeding stops eventually. This is the golden rule of surgery. Either you are able to control it or the patient runs out of blood,” to lighten the situation, but if you sound a little too nonchalant in front of your wife when she’s alone at home dealing with a medical emergency that involves your own child, there might be another emergency you might have to deal with later on.

Our daughter was somewhere between 3 and 4 years old when this happened, a veritable dynamo: always racing around the house at fullspeed, designing her own obstacle course, jumping on couches and off chairs, falling several times a day. Every time she’d fall and we turned around to check if she was okay, she reassured us that she was. Most often she would get up immediately, stating, “I’m fine!” and we’d get back to doing whatever we were without moving an inch. Seldom has there been a huge explosion of tears that needs some emphatic consoling, and I suspect this fall belonged to the latter category. I called back to check in on the situation. “The bleeding has more or less stopped but the gash is bone deep,” she said, this time with less panic but more wariness. I suggested that she bring Khursheed to the hospital so that we could take a look and do what needed to be done.

Within the hour, my livewire of a child walked into the hospital, bravely holding my wife’s hand, her face streaked with the imprints of her dried-up tears. Her eyes were still red from the volcanic eruption that had taken place inside them. I gave her a warm and tight embrace, the kind that says everything’s going to be okay.“Dada, blood is bleeding!” she exclaimed dabbing her scalp and showing me a pink tinge of dried blood on her index finger. I inspected the wound all the while casually talking to her about how it happened and came to the conclusion that it needed a few stitches.

I plonked her on an empty bed in the ICU, shaved a bit of hair around the laceration, cleaned the wound, and without any hesitation or anesthesia, made two quick stitches, with her bellowing till her lungs were empty. But it was over in less than half a minute, and my howling child was silent again, like a bomb that had just been diffused. The doctor standing next to me wondered how I could do this to my own child, as she gleefully kissed me goodbye, somewhat proud of her new scar.

While this was a minor cut, it got me asking a slightly larger question. Should surgeons be operating on their own family members, if someone needed the kind of operation the surgeon was a pro at performing? For instance, god forbid, if my daughter had a brain tumor, would I have the courage to open up her skull and delicately tamper within areas that defined her identity and determined her consciousness? When we make decisions for patients, we do so like we would for our own family, but would the obverse also hold true? Should we treat a loved one just like we do any other patient or hand them over to someone who is more unattached?

The answer really boils down to emotional equanimity in the presence of a complex operation. Lumps and bumps, cuts or bruises can be treated by every doctor; otherwise, our families might question our very presence in the house. “What’s the use of you being a doctor?” my mom often wonders aloud when I refrain from giving an opinion on the myriad afflictions that plague her and her friends that have nothing to do with my specialty. I try to reason that the treatment of diabetes, blood pressure, and cardiac failure have evolved so much that I have no clue how to treat any of these, but the argument is futile.

Of course, by virtue of you being in the medical profession, you are a guiding light for family and friends who value your judgment and trust you to direct them to the concerned specialist, but would I be willing to bore a hole into the skull of someone with whom I eat dinner with everyday? Some argue that nothing would be more beautiful than that, while others may feel this to be completely inappropriate when you could easily find someone just as competent to do the job who would be able to maintain objectivity and be emotionally calm while performing complex brain and spine surgery. A complication from surgery may affect personal relationships, but conversely, a successful surgical outcome of great magnitude could create an intense interpersonal bond that might strengthen a relationship in a way a minor procedure never could.

In my conversations with several surgeons, most are willing to operate on family but very few are willing to have a family member (obviously a surgeon) operate on them. You are free to comprehend for yourself the dichotomy of this thought process.

The American Medical Association provides a code of ethics disallowing the treatment of one’s relatives, raising a concern that “professional objectivity may be compromised” and the “physician’s personal feelings may unduly influence professional medical judgment.” India, to my knowledge has no such regulation. With that in mind, my father, a neurosurgeon of great repute, has performed 20 successful surgeries on 16 family members, including one on me. His conviction is that the family could not get anyone better to do the job.

Fifteen years ago, I was admitted for the removal of a benign bone tumour in my foot, and he insisted that the primary orthopaedic surgeon allow him to take a bone graft from my iliac crest to harvest in the defect created by the removal of the tumour. The scar reminds me of him daily.

A few months after my daughter’s head had healed completely, my wife fell from her bicycle while on one of her evening rides. Thanks to a helmet, her head escaped unharmed, but she gashed her chin badly, it threatening to disconnect itself from the rest of the face. I could have easily sutured it up, but prudently requested my plastic surgeon to do the honours instead. Sometimes, discretion really is the better part of valour.

 

 

22 Comments on “Cuts like a knife
  • Debashree Turel says:

    🤍🤍You have all of our permissions 🤍🤍 but we hope you never have to use it. Nice write.

    Reply
  • Dr Ketan Desai says:

    Really nice write up Mazda. You have created your own niche and i am sure can go ahead in this field in a big way. Your writing connects with the reader. Congrats and sincere best wishes. Ketan Desai

    Reply
  • Chandan Sanjana says:

    I think the family AND close friends would look to the surgeon in the family. Their level of confidence would be so much. Like what you mentioned about Debashree, plastic surgery on her chin would be a must so that is the way to go..off to a plastic surgeon so that she has no scar for life.
    Well written as always Mazda. Congrats

    Reply
  • Krishna Shroff says:

    Very well written Sir
    It definitely is difficult to remain objective, when it comes to major health issues of one’s own family members!

    Reply
  • Supriya says:

    Its lovely to read about the Turels through your stories…I cannot imagine anyone wanting any other surgeon but you to handle the case…hope your sweet family is always blessed with good health and you can take your gifts elsewhere

    Reply
  • Kalp says:

    As u have mentioned

    Minor bruises or ailment are fine

    but I usually don’t operate or treat family members

    Nice write sir

    Reply
  • Anjali says:

    Hi dr Mazda, always love your write ups because they raise pertinent questions, delve into genuine life experiences, always with a touch of humour and tongue in cheek. Besides Brian Adams is my all time fav…so cut like a knife doctor…

    Reply
  • Karthik Malepathi says:

    Hi Mazda , Karthik here . Had to do L3-S1 TLIF on my mother a year ago. Same emotions in my mind , but we treat every patient as our family member and operate. I just remembered those days, hmmm. Hope ur doing extremely good and happy for you.

    Reply
  • Dr Rajesh M Shah says:

    Sir, as far as a family physician is concerned, all family members would like to be treated by their own physician only. But as you rightly mentioned for a condition in which a special physician is required it’s all to gather a different ball game. Enjoyed reading it as always.

    Reply
  • Rita singh says:

    For me I think it’s better for some other specialist to perform serious cases because am an emotional person.difficult to remain unmoved seeing ur own blood. Very interesting to read about ur family.So even ecperts have health issues!

    Reply
  • Donna Reen says:

    Dr.Mazda personally i would want the surgeon who is a family member, if not operate, be there at the operation. It gives us more than courage… a feeling that the family member cares. He ceases to be a doctor then but a family member providing care and support. My mother was operated by my brother who is an orthopaedic surgeon on the spine at the age of 84 years. I remember it was a relief thàt he was doing it. Though it might have been a great strain for him. Then again when my son had a broken nose..he got the plastic surgeon to do it but was there throughout. So I suppose a doctor ceases to be a professional when it is a family member. The family member looks upto her/him as a knowledgeable experienced support.

    Reply
  • Vineeta says:

    I agree with the AMA in this, it is better if surgeons get themselves or their close family members operated by their equally competent colleagues, especially in complicated surgeries. It’s all about trust, faith and judgement.

    Reply
  • Lakshmi Nair says:

    I tend to agree with your dad , if qualified the father would be best doctor to administer to child . Yet I understand the dilemma of dealing with emotions too .

    Reply
  • Constance Matabiswana says:

    A difficult decision when confronted with the dire situation. When my twins were at infancy level and were running those threatening high temperatures my nursing went out through the window. It was my friend Sheila who then took over as their nurse. I just kept the mothers station. But of course I trusted my friend to be the best in my moments of panic.

    Reply
  • Suresh Awate says:

    This was an amazing story.Very well written, by reading this we are able to connect that situation and imagine.That must be a very difficult judgement.keep writing new stories.My both children have also read this story and they have liked it very much.😊

    Reply
  • Zubin Bhesadia says:

    Dear Mazda, your articles one after another are a pleasure to read!!! And, the noteworthy part is that even the simplest to the most complex of medical terminologies & cases/surgeries are explained by you in such smooth a flow of story-telling, that even the non-medical fraternity would be able to grasp the topic/s effortlessly. There are many cases that I know wherein surgeons have themselves operated upon family members & there is absolutely nothing wrong with that. Infact, the family members are at complete rest that they are in the hands of their loved ones. But, it all boils down to the temprament of the surgeon to realise the task at hand, the risks involved (if any) & will he/she be able to cooly perform the process in a calm & composed manner on the loved one. And as far as the legacies of your Dad & you go, having performed the most complex of surgeries & at times back to back from dawn till dusk & the years spent at the operation table, I’m sure that your hands will be steady as a rock even if it were family, God forbid. I’m super-sure many of the patients & their families can vouch for this. More power to you & your team. Take care, stay safe & be well. Warm regards.

    Reply
  • Khushroo Patel says:

    Years ago a very close elderly friend of mine insisted that I perform the much needed quadruple bypass on him. Due to age, and comorbidities he was a very high risk.
    He made me promise that I and I only will do the surgery and not one of my partners.
    This implicit faith is a big plus.
    Thank God that the surgery went very well he didn’t turn a hair.
    Went home on the 4th day and lived upto 93 dying from greater trochanteric fracture within four weeks of conserative treatment.
    FAITH IS A VERY POWERFUL HEALING FORCE
    Again a story book episode you wrote

    4

    Reply
  • Sheila Gazdar says:

    Love reading your articles Mazda. The personal family stories, make it all the more interesting and relatable.
    Can’t wait for next weeks article!

    Reply
  • Marzin says:

    Well written as always, Mazda.
    Not everyone is lucky to have a doctor in the family. Those that do, would unhesitatingly want one of their own to operate on them (I think)
    But then, we always say that a Doctor is God! So why would one not trust God anyway
    Look forward to reading your article next Sunday
    Cheers,

    Reply
  • Altaf Ladak says:

    Dear Doctor.. another masterpiece.. you write so well! Would agree with your father, better a qualified family member if possible.. rather than create room for guilt of not being involved/ around if God forbid something goes awry.

    Reply
  • Lois Juma says:

    Your mastery of the English language is amazing. You write do beautifully. More ink to your pen 👍🏽

    Reply
  • Dr. Feroza Unwala says:

    Look forward to reading your article every Sunday.
    Love the way the personal and professional blend.
    Shows how it comes straight from the heart and from who you are as a person. Great sense of humour too! Wish you and your family the very best always and may your mind, heart, hands and pen perform miracles everyday.

    Reply

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