Taking it personally

Developing clinical detachment isn’t easy. Doctors experience pain and grief in equal measure when a patient is long gone.

A few months ago, I had operated on an elderly lady for a behemoth tumour arising from her pituitary gland. We take down these tumours through the nose using an endoscope. Surgery went off immaculately. Her vision, which had been expeditiously deteriorating, improved almost instantly after the operation and she returned home within a few days of surgery. Her two sons, who worked as servers in a restaurant, were delighted with the outcome and grateful to us for doing it at a nominal cost.

A week later, I got a phone call at 7 AM from the son, indicating that the mother was refusing to wake up. “She’s breathing but appears to be semiconscious,” he said tersely, not able to make sense of the situation. I quickly ran a laundry list of possibilities in my mind for delayed deterioration after an operation of this nature: infection, sodium-water imbalance, hormonal disturbance, hydrocephalus, hypoglycaemia, stroke… the list went on. “Get her to the emergency department of the hospital immediately,” I bounced back, charging to reach there myself, making innumerable phone calls on the way to get the team geared to deal with the myriad possibilities I was considering. We put the scheduled cases for surgery on stand-by in case she needed to be taken back to the operating room.

When I saw her, she was gasping. I grabbed a breathing tube and shoved it down her throat to secure her airway and connected her to a ventilator while the others fixed an intravenous access to collect blood samples and run some fluids. A nurse put in a urinary catheter and a litre filled the bag in a whiff. I tugged on her neck to see if it was stiff. It was log-like. “Shit,” I winced, diagnosing, “She’s got meningitis.” My assistant looked at me with raised eyebrows and the unspoken question of “How the hell did this happen?”

We ran her through the CT scan machine and noted that her ventricles or fluid-filled cavities of the brain had blown up. We paced her to the operating room and placed a drain in the ventricle to release pressure as well as to test the fluid for infection. Cerebrospinal fluid, which is often chaste, was dirty and turbid in her case. The results of the analysis were ominous. The highest doses of antibiotics were administered as we shifted her to the ICU to place some more lines and tubes as she lay there tethered to a tower of infusions.

After two hours of commotion, I finally sat down with the family. “Did she have any fever or leakage of fluid from the nose?” I inquired. “No,” they said, “she was absolutely fine until she went to sleep,” they lamented. “It’s very unusual for such a dramatic presentation,” I told them, but convinced that brain fluid had been leaking from somewhere that had been infected, perhaps not coming out through the nose but probably trickling down the throat. Their eyes welled with silent tears trying to make sense of this unexpected turn of events.

Over the next few days, their mother made a steadfast recovery, her eyes opening to mild pain, her limbs making random purposeful movements. Sighting a window of opportunity, we took her back to the operating room to seal the suspicious leak. We found it and packed it with fat, sealing it with glue and a little prayer. We changed the drain in the head on two occasions over the next two weeks; leaving it long enough inside the brain risks infection as well. I spoke to the family for an hour each day, sometimes 2–3 times a day. I answered phone calls from several other relatives and from other doctors they were known to, appraising everyone involved.

After about 3 weeks and noticing only a marginal improvement, they were running out of money and hope. I helped arrange for some social workers to aid them. I organized a GoFundMe campaign through some charities. The hospital too benevolently deducted whatever they could. Later that week, her level of consciousness dropped again. An MRI showed multiple tiny strokes in the areas responsible for her consciousness. The infection had gnawed away at the tiny arteries supplying these areas. The blood pressure was labile, the urine output began to drop, the liver started giving up – all signs of a malevolent sepsis.

One month had passed since she had been admitted. The sons had exhausted their mind, spirit, and sinew. I answered every question and replied to every text message at odd hours of the day and night, surrendering my time at home to alleviate their anxiety. I offered to shift her to the public hospital where I worked so that further treatment would be cost effective. She passed on within a few days of transfer after battling for 36 days. The body was wrapped in a shroud and cremated within a few hours.

I didn’t hear from either son after that. Their names no longer showed up in my most frequently contacted section on WhatsApp. It was as if I didn’t exist for them anymore, while in my head and heart, I had felt as though I’d become a member of their family, fighting for a common cause.

“It’s hard for me to fathom how people can be so ungrateful for the things you do for them,” I despondently said to a colleague one day, wondering why they could not even say “thank you” – not at the time of death, of course, but a few months later.
“Their mother died. You have no right to be upset with them,” he pounced.
“But I do,” I said, without any guilt.

28 Comments on “Taking it personally
  • Supriya Correa says:

    Yes Mazda…even neurosurgeons are human. Very human.Thank you for being unrepentantly authentic. And bringing emotion back.

    Reply
  • Vipul shah says:

    Dear Dr Mazda sir

    As in Life there are up & down
    Sunrise & sunset

    Similarly in professional carrier every case can be either success or Failure……

    Your word detachment in your Piece is explained very well by Lord Krishna in Gita in 18 chapters…….

    Conclusion sir is your duty is to perform best to your bestest abilities & leave results to HIM up
    Without any credit or debit of your performance

    God bless you sir

    Keep on writing your mind

    Reply
  • Megan Correa says:

    Dear Mazda, you are more than a doctor. Thank you for all you did for the family. Never have I come across such a wonderful doctor. Well done.

    Reply
  • Priyadarshan Pradhan says:

    Sad. That is the way life is.

    Reply
  • Lakshmi Nair says:

    Doc sometimes as patients we do forget that the dr who saved lives is a human too with feelings . I’m sure the non acknowledgement hurts but on with the show , calm down and carry on 😀🙏🏼

    Reply
  • Shruti says:

    I find your emotional connection rare, beautiful and deep. It is the family’s loss to not have recognised it.

    Reply
  • Elizabeth says:

    Thank you Dr for your wonderful service done to me I am full recovering from surgery

    Reply
  • Rajesh Kadam says:

    Dear Dr. Mazda,

    Thanking you for the gr8 job done; it’s a part of emotions which make us closer and it should be thr as it motivates to make our professional better.. It’s a different learning from every chapter of our life… Keep shining.. Stay blessed🙏

    Reply
  • Lois Juma says:

    I feel your pains because you connect with your patients emotionally. Merry Christmas and a Happy New Year to you Dr. Mazda. Keep up the good work.

    Reply
  • Chanda says:

    Best medicine for despair is ‘Service’
    Just 3 words ‘Make me Care’
    Some know how to express their gratitude, many keep it bottled up. Thankfulness- gratefulness – gratitude is always within you, some spell it out others remain silent.
    March on dear Doctor we need your kind.

    Reply
  • Gloria Msampha says:

    Sad reality of life. People don’t remember what you did for them. They only see what you didn’t do. Never regret being a good person to the wrong people. I’m sure their mother appreciated all your hard work. Keep up the good work.

    Reply
  • Clera Varghese says:

    Wow….it is great to read your actual experience and emotions for a patient being a Doctor .I do acknowledge your dédication and care for your patients.
    I usually used to think that only nurses are more emotional and become more closer to patients and their relatives,as they are spending more time with patients .

    Reply
  • Dr parvin desai says:

    We do get attached ito our patients n feel the loss.my passion is yoga which teaches be detached but i am still trying some time i succeed .but keep trying .Do read Bhagwat Gita it answers all questions.alsi see mahabharat the movie after every chapter Krishna gives a lesson in moral science. Think about it.helps a lot.

    Reply
  • P F Gilder says:

    To feel hurt, bitter, detached, even spur-of-the-moment-vengeful, is a human frailty so real, it can ‘become the person’. And like many physical conditions, some mental frailties may be incurable.

    Loss of faith in someone you earlier trusted, is the coin-flip of loss of hope.

    The layperson doesn’t recognise the medicine behind the mask and one can’t blame him. The victim/family
    doesn’t see (of course) the sleepless perseverance, the professional integrity and the medical limitations of a treatment – that is something only the doctor would know.

    The caregiver doesn’t have the logical faculties of the regular person. In that split second’s finality, he feels horribly betrayed that his one true saviour has himself thrown up his hands. One becomes existential.

    Thankfully Dr Turel, you have it in you to inspire trust. I have come to you, and you’ve patiently reassured me in my obstinate condition.

    My deepest gratitude.

    Your beautiful writing is only suggestive of your empathy & efficiency, and your total involvement with the patient’s condition.

    I do not think the two sons were ungrateful to you. They have just lost the first person they ever loved and they’ve, at least temporarily, given up on life.

    They will get in touch one day.

    Reply
  • Dr Rajesh M Shah says:

    Sir, appreciating your concern for the patients…. Nowadays we don’t find such selfless, honest super consultants…. Proud of you…. 👌👍👏

    Reply
  • Rustom Jasoomoney says:

    It is heartwarming to come across a compassionate and dedicated Doctor like Dr. Mazda.

    Reply
  • Gool Kotwal says:

    Just carry on doing your Best, God will take care of the rest.

    Reply
  • CHANDAN R. SANJANA says:

    I can feel you being upset over the lack of sensitivity of these family members after doing your best not only to save their mother but to also find ways to help them to get financial aid to cope with their expenses.
    Thankless people one has come across many many times during their course of life, especially when you have gone out of your way to help them and comfort them. Sad but true.

    Reply
  • Benifer Porus Irani says:

    Mazda dikrah …. I say that you are a genuine Human Being and more than a aproh Doc !!
    You did all right and that was destined for that motherly soul.
    Go well boy and good humane work.
    Love ya and ganih duvah,
    Prosperous New Year !!

    Reply
  • Rita Singh says:

    When u do your best it’s natural to feel hurt when ur efforts r just ignored.Being a doctor does not exempt one from normal human feelings.B comforted in the thought u tried ur best.

    Reply
  • T George Koshy says:

    Hi..very honest piece of writing..I have been through the same situation more than once..difficult to stay disconnected and aloof..who knows.u might cross paths with her sons again and I am sure they will give u a big hug then

    Reply
  • Vinod Ahuja says:

    Excellent article. Such is life when doing good and one is not appreciated . It is quite common with medical profession.

    Reply
  • Anjali says:

    A very honest, straight from the heart write up , dr Mazda. And every word of it so true. Unfortunately as doctors we are classified as black= bad or white= good almost god. So truely you have pointed out that doctors are neither…we are just human beings, sensitive and emotional too, trying to do the best to cure and heal. So do continue your fabulous job, God bless. Dr Anjali Patki

    Reply
  • Khushroo Patel says:

    Dear Mazda
    Beautiful gut-wrenching piece you wrote.
    50 years of Cadio vascular Thoracic Surgery I have had the pleasure of missing a cell phone thrown at me like a missile by the son who came to the ER in Cadiac arrest due to Aotic dissection.

    Rushed her to surgery and relieved the tamponade and placed her heart lung machine.

    After 10 hrs surgey I could not save her.
    It was 6 a.m. The family waiting area was full.
    The daughters were very grateful, but the son who had least to do with family, was in a corner, shot the missile barely missing me.
    The grieving daughter, with tears flowing, slapped her brother, insisting he apologise.
    You are young. You will meet all sorts of people.
    Every human being is a combination of devil or a Saint at different times in their lives.
    Believe in goodness of all mankind until proven otherwise.
    Again a great piece

    Reply
  • Khushroo Patel says:

    The patient’s son through the cell phone like a bullet.
    Correction to reply

    Reply
  • Zarine Talati says:

    Mazda, what a heartfelt piece. You are passionate about your work and you give it your all ! It is disappointing after all that some people forget to appreciate a person who did so much for their family !
    Kudos to you!!
    Perhaps they do appreciate you but have not expressed it. Whatever the case, don’t let it change you !
    Ps: I suffered the same at work (not being appreciated) and I have started not expecting appreciation at all and that has helped me a lot ! Take care and best wishes !

    Reply
  • Hutoxi Doodhwala says:

    You fight so hard doing your best to save the patient. You put your heart and soul in helping the family on all fronts. Yet there is no acknowledgement. Completely understand your disappointment.
    Nevertheless keep up the good work !
    Wishing you super success!

    Reply
  • Zubin Bhesadia says:

    Dearest Mazda,

    This was really a heart-wrenching narrative! Each sentence quoted by you was so candid & straight from the heart that I could witness the scenes unfolded frame by frame.

    People attribute the success of any surgery/process (irrespective of the level of criticality) only to the following factors, viz., the facility at which it was carried out, the expertise & experience of the Surgeon, the technology/equipments used, the medication administered & the care given.

    The main 2 pre-dominant factors that define the surgical/procedural success/failure are however overlooked:

    i. LABOUR – the painstaking efforts & hours put in by the Surgeon & his dedicated & well-rounded Team of professionals to study the case in great detail, to brainstorm on every if & but, to ensure no aspect is missed out leading to further aggravation or complications, to ensure safety & impeccable precision & procedure from the first cut till the last stitch, the follow-ups round the clock, a safe & complete recovery & last but not the least…a happy, pain-free & relieved patient exiting the hospital with peaced-out loved ones.

    ii. LUCK – a radical factor not within the control of the human realm & having its remote-control in the hands of God Almighty Himself…a factor so strong that it can completely turn tables on the best LABOUR (ref. previous point i.) put into the surgery/process.

    And where Luck come into play, its the Will of God…so at that threshold, there is no questioning, doubting or bad-naming Labour…and it would be absolutely unjust to do so…period!

    As long as one is satisfied that one has put in complete Labour, then the play of Luck should not make one doubtful on one’s capability & experience…albeit there may be a temporary set-back.

    The best introspection that one can do at such an awry juncture is to reflect on the past successes & Jump Start – jet, set & go to the next ailing case & once again, take the journey to make a world of difference for the new person. Luck surely is an elusive factor, but not at all times.

    May Luck & Labour go hand in hand & always favour you & the Team…go ahead Doc…craft more happy stories. God be with you all.

    Reply

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