When is good news really good news? When do you feel the need to tell the truth regardless of consequences? Is it better to tell some good news and immediately follow it up with bad news?
I was in the canteen today having a cup of coffee when I got the callthat I was needed in the labour room (on a emergency callover) for an eclampsia patient -that’s the condition when a woman in labour ends up havingconvulsions(fits) and starts bleeding from excessively high blood pressure and can die of bleeding.
Well, I rushed over there and took over the case and startedthe necessary treatment. Meanwhile I couldn’t help glancing over (occasionally)to the next bed where a delivery of a child was going on. The person doing the delivery was a postgraduate student of the gynecology&obstetrics department and she soon pulled out the baby (naturally) and then without bothering to check whether the baby was breathing or not- she handedit over to the two house-surgeons who were assisting the birth (tryingto learn hands-on) and she went away.
The two house-surgeons, both of them just passed out graduates with only theory knowledge and no practical experience -were trying to make the baby breathe for the first time- and this has to happen withing the first 5-6 mins after birth to prevent any brain damage due to lack of oxygen
Unfortunately this baby was not responding even after 7-8 mins, at which point normally the doctors usually give up their efforts and declare that the baby was born dead. Meanwhile I was also so busy with the patient i was treating-that Ionly had time to glance over occasionally. By now 8-9mins had passed andboth the house-surgeons (and me) knew that the baby was gone by now- almost tenminutes without oxygen to the brain? What chance had the kid?…the house-surgeonsas per procedure should have called for expert help- if they realized that acase had gone beyond their capacity to treat. But stubbornly they kept tryingthe same old thing without asking for help- which is the highest crime you can do according to me.
Till finally, the staff nurse in the ward (prompted by me) went and calledthe on-duty pediatrician who came up and spent a few more minutes trying thesame things already tried unsuccessfully by the two house-surgeons. He then asone final effort inserted a suction tube up the baby’s throat and vacuumed outthe thick mucus plug which was obstructing the lungs. Suddenly, the baby tookher first breathe and started crying . Thepediatrician handed over the baby to the two house-surgeons to complete theformalities and went away to wash. The two students consulted between themselves anddecided to put the time of birth on the case sheet – as just a few minutes ago asthey didn’t want to get into any trouble in the future..they were giggling thatthis was the time they would even use for drafting the horoscope for the kid. Theythen placed the crying baby beside the unconscious mother and went away.
As no one told the mother that her baby had been withoutoxygen for almost 12-14mins and had died first and then come back- she would bevery happy if she learnt the news. But will she be as happy if she learnt thatbecause of the oxygen deprivation during the crucial period- her kid would bemost probably a retard…oops a special-needs kid in the future? Will she behappy then- being saddled with a child who will never be normal her life-longbut be a burden? Was this good news or bad news? that their kid had first died and then miraculously come back to life (getti-ayasu, as they call it)…or that because the kid was late in breathing the parents would have to suffer with the kid all their lives (especially financially) and it would have even been better to let the child die after the first 10mins when it didnt breathe ? who can decide that? thank god it wasnt my case and i didnt have to make that decision..
And this episode proves the entirely stupid idea of postinguntrained doctors to rural areas as compulsory rural service- it would be anutter disaster for the rural people if that happens. Till junior doctors getenough experience they should never be allowed to treat patients by themselves-there are so many things which can go wrong and peoples health is not the placeto gain political points. Those politicians who support this idea should behanged.