Some patients are persistent. He was one such. He was a bank manager who had intestinal tuberculosis 5 years before he contacted me( in 1988) and was treated at AIIMS for the same. The diagnosis then was confirmed at AIIMS using a barium meal which was then a standard procedure for evaluating esophagus, stomach and small intestine. He had all records with him running into well over 100 pages and later he was successfully cured. 5 years later, some of the symptoms like abdominal pain returned and he consulted me for the same. The clinical examination was completely normal and the picture did not suggest intestinal tuberculosis. So I tried to convince him that we shall get an abdominal ultrasound instead and think of the barium meal. He was not willing. He insisted on a barium meal saying that it was that investigation that had picked up the right diagnosis at AIIMS. I wrote out some blood tests and a barium meat and forgot about it.
A weak later, I had a strange phone call from the radiology centre telling me that a patient of mine had devoloped intense abdominal pain after a barium meal and was very uncomfortable. They wanted to know whether I wanted to see him or he could go home instead as somebody else from his town was willing to take him. I insisted on my examining him and on examination found that he was very ill and having abdominal tenderness and rebound tenderness suggesting peritonitis. A peritonitis due to leakage of barium is a serious matter as 9 out of 10 patients are likely to die despite an attempt to treat them well. The puzzle was if he had indeed devoloped a leakage of the barium from the intestines, how did this happen as the intestinal wall is quite thick.
I admitted him and involved a surgeon to help the patient. The surgeon was the best I saw in my career but due to some health issues, his career was seriously cut short. He also was equally curious and took the bold step of exploring the abdomen to know the truth. On exploration, a sizable amount of barium was found in the peritoneal cavity. The surgeon did the detective job and found a small hole in the intestines from where the barium had leaked. On a careful scrutiny he found that there was a small abnormal looking spot on the liver. He was intelligent enough to take biopsy from both the sites (intestines and the liver). He went an extra mile in that he stayed 3 nights in the hospital in the patient's bedside to take care. The relatives were highly appreciative. They understood the predicament and the cremation was over in a few hours.
The next week, I had an unexpected visitor - a "cousin" of the patient from Bombay. He told me just 2 things. One that I was responsible for the death of the patient which he called a "Medical Murder" - he was referring to the fact that we had got a barium meal without indication when abdominal ultrasound was available! The other thing he told me was that he had called a press conference the next day so that he can appraise the press and the public of this human interest story and successfully ruin my career. It was then the seriousness of the whole thing struck me. I was speechless! I had to think and act fast. I tried telling him that I had ordered a barium meal at his request and that depended on the fact that the intestinal tuberculosis was picked up at AIIMS with that investigation. He flatly denied that the patient was treated for any disease earlier. He had destroyed the records!
I understood what he wanted. He wanted money. He spelt out the amount. I could not even think of paying it - I felt there was no fault on my side.Nor could I afford to pay it. But I had to have some concrete proof.. I did the best possible thing under the circumstances - I asked for time and he gave me 1 day!
I went home, sat alone and thought about the whole thing. Was I responsible for the "medical murder" directly or indirectly? If not, how could I get out of the mess? Suddenly I realised that there was indeed a way out - to get the histopathology reports of biopsies from the 2 sites - intestines and the liver. I personally went to the place to have a look at the slides. What I saw was something unbelievable - Intestinal malignancy with secondaries in the liver!
It did many things - It gave us the truth; It explained the hole in the intestines ( the cause of the peritonitis), It saved my practice and reputation. I did not have to worry about the threats. I could fully justify my actions ethically.
The remaining story is indeed short. The "cousin" could not believe his bad luck and I could not believe my good luck! When he came the next day as he had said he would, I congratulated him for solving the "Mystery of the Medical Murder"!
A weak later, I had a strange phone call from the radiology centre telling me that a patient of mine had devoloped intense abdominal pain after a barium meal and was very uncomfortable. They wanted to know whether I wanted to see him or he could go home instead as somebody else from his town was willing to take him. I insisted on my examining him and on examination found that he was very ill and having abdominal tenderness and rebound tenderness suggesting peritonitis. A peritonitis due to leakage of barium is a serious matter as 9 out of 10 patients are likely to die despite an attempt to treat them well. The puzzle was if he had indeed devoloped a leakage of the barium from the intestines, how did this happen as the intestinal wall is quite thick.
I admitted him and involved a surgeon to help the patient. The surgeon was the best I saw in my career but due to some health issues, his career was seriously cut short. He also was equally curious and took the bold step of exploring the abdomen to know the truth. On exploration, a sizable amount of barium was found in the peritoneal cavity. The surgeon did the detective job and found a small hole in the intestines from where the barium had leaked. On a careful scrutiny he found that there was a small abnormal looking spot on the liver. He was intelligent enough to take biopsy from both the sites (intestines and the liver). He went an extra mile in that he stayed 3 nights in the hospital in the patient's bedside to take care. The relatives were highly appreciative. They understood the predicament and the cremation was over in a few hours.
The next week, I had an unexpected visitor - a "cousin" of the patient from Bombay. He told me just 2 things. One that I was responsible for the death of the patient which he called a "Medical Murder" - he was referring to the fact that we had got a barium meal without indication when abdominal ultrasound was available! The other thing he told me was that he had called a press conference the next day so that he can appraise the press and the public of this human interest story and successfully ruin my career. It was then the seriousness of the whole thing struck me. I was speechless! I had to think and act fast. I tried telling him that I had ordered a barium meal at his request and that depended on the fact that the intestinal tuberculosis was picked up at AIIMS with that investigation. He flatly denied that the patient was treated for any disease earlier. He had destroyed the records!
I understood what he wanted. He wanted money. He spelt out the amount. I could not even think of paying it - I felt there was no fault on my side.Nor could I afford to pay it. But I had to have some concrete proof.. I did the best possible thing under the circumstances - I asked for time and he gave me 1 day!
I went home, sat alone and thought about the whole thing. Was I responsible for the "medical murder" directly or indirectly? If not, how could I get out of the mess? Suddenly I realised that there was indeed a way out - to get the histopathology reports of biopsies from the 2 sites - intestines and the liver. I personally went to the place to have a look at the slides. What I saw was something unbelievable - Intestinal malignancy with secondaries in the liver!
It did many things - It gave us the truth; It explained the hole in the intestines ( the cause of the peritonitis), It saved my practice and reputation. I did not have to worry about the threats. I could fully justify my actions ethically.
The remaining story is indeed short. The "cousin" could not believe his bad luck and I could not believe my good luck! When he came the next day as he had said he would, I congratulated him for solving the "Mystery of the Medical Murder"!
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