‘Masterly Inactivity’ is at times the best treatment.
What do patients want from their doctor ? Is it that they want short and sweet treatments ? Is it that they want affordable or – if feasible, free treatments ?
Let me tell you a story from my own practice.
It was 7.30pm on that Saturday evening – 10 years ago, as I was driving home after completing my weekly satellite clinic in Margao, Goa.
Mr. Rodrigues’ son was on the phone. Mr.Rodrigues had come for a review at 4.30pm that day and looked hale and hearty. As his son’s name was displayed on my car dashboard, I wondered if something I had prescribed for his father that day had not been available at the pharmacy, and he was calling me to recommend a substitute.
But before I dwell in detail on what transpired that evening on that phone call, let me update you on the Mr. Rodrigues’ story.
Mr.Rodrigues at 80 years of age had being diagnosed with a Calcified Juxta-Renal Abdominal Aortic Aneurysm, and had been referred to me for surgery for the same – three years earlier. He weighed 50 kilos on a 5’11” frame at that time. He had uncontrolled systemic hypertension, an uncontrolled diabetes for company, and if that wasn’t enough, he was a bronchial asthmatic as well.
The family had been obviously informed about the risk of the rupture of the aneurysm and death; and they were very eager to proceed surgically at the earliest. I remembered the mantra advocated by my CVTS Prof. Subbarao’s that “a living problem was better than certain death”.
I discussed the treatment options with the family, and we came to the conclusion that getting his blood pressure and sugar levels under control was a priority while we built up his general condition to withstand a possible intervention.
At a clinical review two weeks later, Mr. Rodrigues was much better with his blood sugars and pressures under control. Feeling better and unaware of the ‘devil’ within his tummy, he started eating well, gaining weight and moving around freely.
The family was happy, and in the changed clinical scenario, very keen on a conservative approach. After all, a surgery for an aortic aneurysm at that location was not going to be a cake-walk, and with the circumferentially calcified aneurysmal wall – I knew, it was not going to rupture easily either.
So we worked on the strategy of ensuring that Mr. Rodrigues avoided any strenuous activity and had his medications and follow-up regularly.
Three years had passed for someone not given three weeks to live by the referring hospital, and I was always happy to review him once in a couple of months. Like that Saturday evening.
Now let’s get back to his son’s call on my car Bluetooth :
“Dr. Irineu, can I speak with you for a moment?”, he requested.
I said, “Please proceed Son.”
He continued, “I am just calling to inform you doctor that we drove home after going to the park for a walk after consulting you. At the park and on the drive home, my father kept on telling me that he has to thank you for the three happiest years of his life. I told him that all of us as a family had a wonderful time with him all these years. On reaching home, my father asked me to make him a cup of hot masala chai and get him some ginger cookies. I did as he had told me. He dipped the cookie in his tea, put it in his mouth, let it go down his throat.”
The son stopped speaking. He then started sobbing and then burst out crying “Dr.Irineu, Daddy then just collapsed in his chair and passed away. And I knew that I had to call you to thank you on behalf of my Daddy and our family”.
By this time, I could feel my hair standing on end as I slowed down and parked my car by the roadside. He spoke for nearly 10-odd minutes about his father and his family until he hung up. I started my car and drove home in silent homage.
That evening I missed my mother very dearly who always taught me that being a good human being is more important than being anyone else. And as a cardiovascular surgeon, being a better doctor and a better human being always came first.
No surgical heroics, no complicated procedure, but an everlasting lesson and memory to cherish for a lifetime. The fact that the family ensured that their friends and their families came to my service for treatment, was a testimony of their gratefulness.
It’s so true that ‘Being Human’ is sometimes the best remedy and the best form of marketing. After all, the patients expect their doctor to ‘walk the talk’ with them.
About the Author:
Dr.Irineu A Pereira is a leading cardio-thoracic surgeon and thought leader based in Goa.