I worry when good people with readily treatable ailments make bad decisions and end up losing health and lives, their families lose members, breadwinners, and carers. Some of the recent losses have affected me personally and forced me to write this blog.
1). 46 yrs, hypertensive, anxiety-prone individual without any other cardiovascular risk factors was investigated at employers behest as part of an annual health check. Stress ECG, where the person’s heart is stressed by exercise under close supervision showed that he had an issue with blood supply to his heart. An angiogram of his heart confirmed a critical narrowing in a coronary artery at a location cardiologists call ‘the widow maker’.
LAD is the heart’s” main artery and it supplies 40% of blood to the heart. If all this blood supply gets cut off suddenly there is a near-instantaneous collapse of circulation leading more often than not to death. So the name ‘widow maker’. Also implicit in the name is that it often affects men. A problem was found on health check, angiogram defined the problem completely and the treatment was straightforward.
His cardiologist suggested stent to this narrowing at the time; lack of faith in medics or something else that transpired in the counselling session got him home without undergoing a short swift life-saving procedure. One of his friends is my friend and the two of them landed at my place for tea. I was incredulous that an intelligent person came out of the hospital without undergoing a simple ‘life-saving’ procedure. I spent a fair time explaining the heart’s circulation and beastly nature of ‘widow maker’ and the simplicity of the particular angioplasty procedure. I recommended him to get the job done the next morning and offered to help in any which way he might need. Time passed.
My wife saw his wife and their little kids a few days later and on her insistence, I called up my friend (who in turn was friendly with Mr 46 yrs)) and again recommended that the procedure be done without delay. Some months passed,
Did I know he had an angioplasty? No.
Could I believe he wouldn’t undergo a small lifesaving procedure? No.
I would see him sometime and think that he must have undergone angioplasty as explained, why would anyone risk his survival? I had no business intruding and he might not wish to discuss health issues with unrelated people, so I didn’t. Frankly, I was unrelated as I was only a friend of his friend.
One routine day, the two friends were on their morning walk, and then there was one. The other had collapsed, gasping, and couldn’t be salvaged despite heroic roadside attempts and rushing to the hospital.
2). 51 yrs, slim, non-smoker, non-diabetic, non-hypertensive, normal cholesterol profile, energetic man develops chest discomfort. He lands up in a good hospital where he was seen by a good doctor. An ECG (electrical tracing of the heart) wasn’t normal. The good doctor tells my good friend to get admitted for suspicion of a heart attack.
A discussion between the man and his wife goes like, ‘ how can ‘MY’ ECG be wrong, how can ‘I’ develop a heart attack, I am careful with everything, my cholesterols are normal and kept under tight control?’ She: If he says so you must listen. ‘Doctors say such stuff without much reason, haven’t you seen in newspapers and TV how they conduct unnecessary procedures? You really think I’m having ‘a haaart attack’.
The good doctor wanting not to intrude suggested to them to go to another bigger hospital nearby, if they had issues with his hospital or with him. He offered to get them dropped by his hospital ambulance and in the wife’s words begged them not to go away! My good friend didn’t listen; his wife was too meek and they both went back home knowing in their own hearts something was amiss.
She called me four hours later at 3 am when my friend was no more. Certified dead by the same doctor who had been begging them a little earlier.
3). Man 52, bad heart, unable to live a life was advised a heart transplant 2 years ago. He found someone willing to say what he wanted to hear, ‘you will be fine without a heart transplant’! Well done, he returns with a worse heart, water in the lungs, kidneys failed, liver dysfunctional, and suffering from what we call cardiac cachexia or body wasting. Poor appetite, persistent fullness of the belly due to excess water in and around the abdominal organs means the patient loses a serious amount of body fat, muscle, and bone. His body doesn’t respond to drugs to bolster his heart function, the family still can’t decide if the advice being given is right and the man’s heart which has had enough beating over the years, gives up.
Why do these young breadwinners make fatal misjudgements is the question that needs an answer.
All of them were intelligent people, wealthy, health-conscious, and aware of an issue with their health. The first one had undeniable proof, second had a terrible family history. Almost no male in his clan lived beyond 54 and all died of heart disease or strokes. The third struggled with his day-to-day life, restricting his activities and exertion while keeping a brave face. Why would they not take sound advice from competent well-meaning doctors?
An easy answer would be ‘they didn’t know’. But all of them did know, and all of them knew much in advance and elected to do nothing. The other reason could be fear of medicalisation of their life, scare of hospitals, doctors, treatments, surgeries, etc. That indeed is a respectable reason, but all these people had adequate knowledge and knowledge resources available to know their illness and its damaging effects on health and life. They had all known the ways to get better and the modest risk of therapy compared to the extreme risk of not actively treating their illness.
I suggest that a narrative built over the previous two decades and left unchallenged by the medical fraternity nudges people to make bad judgments about critical elements of their lives. One wouldn’t fix a leaky tap at home, they call a plumber. No one starts fixing a car engine, but ‘feel’ competent to make judgments about the best ways to treat their hearts! They value their heart, their life, risking the destitution of their wives and kids less than a mere car engine or a leaking tap!
The media seems to be working on an agenda against the medical profession and that is making people sceptical of good advice; much to their own detriment. A Hospital was shut down last year and its doctors subjected to media cruelty beyond measure when a 22-week abortus moved its limbs. The doctors and hospital did per recommendations, but a trial by print and visual media alongside capitulation of government and administration created a firm impression in the public mind of wrongdoing. Later inquiries which exonerated the hospital and doctors never found mention in the public domain and the story of negligence is imprinted in the minds of people forever.
A child that suffered multiorgan failure was supported by artificial life support; cost escalation due to set procedures was touted as wrongdoing by the medics. TV anchors had a field day screaming hoarse that doctors had looted the family! Readers would do well to remember that in the particular case doctor’s fees was less than 3.5% of the total bill. Do remember that when you get hospitalised, it’s not just the doctor’s fee that you pay. You pay for real estate, lights, air conditioning, cleanliness, nursing, bed linen, drugs, refrigeration, syringes needles, food, water, implants and disposables, porters and ward boys, technicians, and also operating profits for the investments. If only media mandarins followed a nuanced approach, the doctors wouldn’t have been this badly wronged.
While media is in the business of raking up viewership and ad revenues, governments want to appease the mob to rake in their votes. The less one discusses the august judiciary in this regard the better, one can’t say a sentence without being hauled up for contempt. The worst performance unfortunately has been put up by the medical leadership, which faced with a sustained media onslaught and judicial overreach has capitulated and failed to protect its reputation. The image thus created, has painted our profession in an extremely negative colour; it is painful that an average Indian is harsher and more judgemental towards their medics while being ambivalent towards convicted rapists, murderers, and terrorists.
We the medics, nurses, and paramedics are in a uniquely privileged position. We look after a human at his/her most vulnerable time and tend to the injured body, heart, soul, and spirit to bring them back to life and health. Do remember that results can’t be guaranteed and costs of healthcare aren’t minuscule. And when someone is doing a story to rake in viewership, truth is likely an important casualty. Our country is failing to protect its patients, who base their judgement of valid medical advice upon a manufactured, ill-conceived malafide narrative. The three patients died because they made terrible judgments, despite having time on their side and receiving appropriate medical advice. Truth be told, we have three dead young people, with wrecked families who had no reason to make fatal health-related judgements while overturning valid well thought of advice. Imagine the media shenanigans if one of them was sent home from an emergency by a reputable doctor. The doctor’s reputation would have been torn apart, his hospital and his own face pasted across media for weeks on end, a veritable rampage. Killed by a narrative there is no one to blame, hold responsible or culpable, beat up or lynch.
Despite what’s reported in Media, your doctors are your guardians. There are few in the country that come close to the ethical and moral standards that we set ourselves and remain beholden to.