As a medical specialist, armed with voluminous knowledge of diseases, skills and several years of experience, I had started exuding a good degree of confidence, somewhat more than what my wife felt was desirable.It was around then that a frail, 83 year old lady came to see me for abdominal pain, jaundice and fever. She was as apprehensive of me as a doctor as I was of her old age. The duct through which bile flowed from her liver to the intestines was blocked and converted into a bag of pus with stones. It was not without trepidation that I offered to pass a rather thick endoscope down her throat to the intestines, pass an electric wire into the lower portion of her bile duct and cut out and clear the passage through ERCP. I did not mince words in explaining to her sons the considerable danger that the procedure carried in her vulnerable condition. The patient on her part agreed to take the chance.
With two of my juniors keeping strict vigil on her pulse and respiration, two nurses assisting me with the instruments, and innumerable beads of perspiration breaking out shamefully on my forehead, I gently manoeuvered the endoscope past her vocal cords into her foodpipe. Then it seemed to descend effortlessly down to her intestines.
I inserted the electric knife into the lower end of the clogged bile duct, pressed on the footswitch slitting the narrow opening and letting out a gush of pus and dirty bile into the gut. The procedure couldn’t have been more perfect. Several of her children, grandchildren, well-wishers and friends looked admiringly at me as I explained with pride the complicated lifesaving feat that I had accomplished.
Encouraged by her dramatic improvement at my hands, her daughter-in-law came to consult me for gallstones, one of which had slipped into her bile duct. She was around 40, young, pretty and appeared a picture of perfect health and happiness. I proposed the same ERCP to her.
This day somehow turned to be another day.The bile duct opening was sticky and blocked and wouldn’t let the electric wire-knife in. I changed the angle and tried again and again, but did not succeed. I went on trying all the tricks I had learned during my training fellowships in Japan and Germany, but failure haunted me. My clothes were soaked in sweat when I finally gave up.
I lay in bed soaked in shame and hurt, trying to rerun the events of the day in my mind, wondering where I had gone wrong. After wandering through the catacomb of logic and science without a meaningful answer, I began to realize there was perhaps something quite beyond my brains, my hands and my skills. As the thick crusts of arrogance began peeling off my heart, I could hear the words of Ambroise Pare, a 16th century French surgeon, echo in my ears:” I cleaned his wounds but God healed them”!
Valuable lessons often come from unsuspecting sources and in innovative ways.
As published in HT City( Hindustan Times) dated 2 October, 2011.
Comments
Post a Comment