Suicide / Homicide of Patients.

Tuesday 3 pm. OPD

“She needs urgent admission and treatment.. she may be developing a stroke.” I told the relatives of this 70 some year old lady who was having recurrent episodes of tingling / numbness all over her body, with slurred speech. Otherwise healthy.

The disturbed family was displeased: a mom (patient), her son and daughter (very polished but obviously cut off from each other because they avoid talking to each other) who stay in different cities away from the patient. “You can suggest us the treatment and tests, doctor,” the US based son said, “but it is difficult to admit her as there is no one to stay with her in the hospital… I am in India only for three days, and I reached Pune only yesterday: I am very worried about Mom, so got her here today.. but I have to return as we have an important project going on, that depends upon me ”..
“I am not sure if she will agree for admission, doc,” said the daughter “she is very independent, never liked hospitals… Do you want to stay in the hospital mom?” the question had anxiety, reluctance, formality and suggestion for a negative answer, all at the same time.
The mom looked at me, embarrassed smile, confused. “Well, if it is necessary..” she started, only to be cut off by her daughter.. “Let the doctor write the treatment and tests, Ma, then we will decide outside..”

I suggested an urgent MRI and few other tests, and gave a prescription. “Do we have to do the tests here only doc? Because we know that ‘xxxxxxxx’ trust, and it’s chairman is very close friend of mine.”
This trust is known for free MRIs, average quality, meant to serve the poor. It takes time to get the apptts there, and some poor patient’s apptt will be cancelled because the “Chairman’s friend from US” will request an urgent MRI.
“It is your choice” I have to answer legally correct, even if I may not like this decision.
I write notes, suggest urgent admission, and start treatment.

4 days. No follow up. Then on Saturday at 6 PM, the casualty CMO calls: “Sir you had seen this patient in OPD on Tuesday, she has come here, she is comatose, we are planning to intubate” .
I went there, anguished to the core but trained to shut up well when dealing with patients. The daughter rushed to provide details: “Doc she was not willing for admission: we did the MRI at the trust hospital yesterday morning, but she was very ‘sleepy’ since prior night. We got the report last evening..We thought she must be tired, so we waited till now.. but she is not waking up…. Then we thought that you advised admission, so we brought her here..”.

Patient had a brainstem stroke, one of the worst forms of stroke.
“When did she become unconscious exactly?” I asked
(This is how the court wants answers, ain’t it?).. but our intention was to see if she was in the “window period” for clot-busting treatment of stroke.
“The servant says about two days, but I saw her day before yest, and she said she was ok… I stay nearby only, and am in constant touch with her and the servant on phone.”
There was no point in discussion, they had all explanations about all decisions, and why things were delayed.
She required ventilator. The “busy” son kept on calling from US, and had their “Doctor Uncle in US” talk with us, conducting an accented cross-examination on phone, and telling us what we already knew.

On the third day, the family gathered its socio-financio-politico-legal experts in clever talk, and asked for a meeting. This discussion ensued, summarily:

“When exactly will she regain consciousness?”
“Can’t say”
How many more days in ICU?… Can’t say
Will she ever talk or walk again?…. Can’t say
Will she be a ‘vegetable’? …. Can’t say
One smartypants (well, smarty halfpants) asks with dismay “But Doctor, medical science has made such great advances in the USA, they say stroke patients can be treated completely, they have even done stem cell transplants etc.. and you are saying we can’t do anything”

I know a hundred hurtfully true answers that can wet the questioner. But again, my teachers shout in my mind “Shut Up”.

“At this stage, after the stroke has happened, we cannot do much”.. the technical answer.
“Doc please understand the family’s situation: how long can we continue this?”
“What can I do to help? Ask I.

The family exchanges meaningful glances . Smartyhalfpants conjures up the big courage: “We are ready to accept the inevitable. It is ok if you tell us she is not going to survive. We are prepared”.
I offend my teachers once in my mind, to answer that one. “But you all already had dumped her, killed her by delaying her treatment”. I can’t say it openly.

They waited another two days.
Then requested not to resuscitate the patient. Besides the question “When” they were not interested in anything else. The more we tried, the more that family started hating us, alleging us, questioning us. If we advised any new medicine, the first question was “ Will it definitely make any difference?”
I will not mention when the family was seen smiling last.

So many patients die / develop disabilities because the family denies them medical care in time. Superprecious time is wasted in second opinions, finding cheaper options to everything, and idiotic presumptions and self medication. Add to this alternative medicines that are cheaper and available at home.
Many parents don’t ensure the important drugs like epilepsy medications of their own children, do not stock in advance, and take huge risks by trying on their own to stop these medicines.
Most elderly population is, to state honestly “Killed by neglect masked by beautiful sweet language and excuses”, only few exceptions are seen in real life.
Wives are taken for granted for the treatment of husbands / men / earning member in the family, however serious their health problems be.
Critical / crucial surgeries are avoided, admission notes are neglected because the patient / relatives keep on searching for the cheapest options.
Patients continue to neglect doctor’s instructions, eat sweet, not exercise, drink alcohol and smoke, drive risky quoting “It’s my life”… then why is the doctor held responsible when one develops complications of such a life?
All these delays (these are also medical negligence, dumbly ignored by the Indian legal systems) cause more deaths than medical negligence by doctors. There must be a law to record and punish these too. Hospitals must also have a registry of admissions advised, investigations suggested and in case of not being followed, report such cases for medical negligence.

They admit patients at the last moment, and want the system to be responsible for a guaranteed good outcome!

In a country where the court decides the punishment amount for doctor’s negligence by calculating how much the dead/disabled person would have earned, what else do we expect from the population? This is like open statement: if a doctor neglects the health of a non-earning, an elderly, or when the parents have many sons, it deserves lesser compensation, but if an earning member / only child is affected by negligence, the hospital / doctor pays up huge! Genius!

In hope of a good outcome.