Overcoming fear of failing as a doctor

I have been practising as a pediatrician for over 22 years now, but whenever I come across a very sick child with complications and so on, I am afraid that I am going to go wrong somewhere and miss either the diagnosis or the management and lose the child for ever. I know that my fear is not irrational because every doctor, during his/her professional life, makes some errors of judgment, not all of which are going to kill his/her patient(s). This is because medicine is a very complicated science, and in some respects, it is not even a science, but an art that one learns throughout life. It is not even just an art, but also an act of faith: faith in one's own self as a doctor, faith in the abiding sea of knowledge that a doctor draws upon, faith in experience being a bigger teacher than books, and ultimately, faith in the Almighty: the most agnostic doctor will look to the skies for divine help when his patient fails to improve under his treatment.

I thought about all this for the last six days as I struggled (and am still struggling) to save the life of a newborn who is under my care. While there is a secular trend towards improvement, the child keeps having episodes of worsening which leads me to believe that, through her, the Almighty is testing my faith. I am happy to report that the baby is now showing improvement.

Such is life, and such is the tension in the mind of a clinician.

29 days on ... some News

I last wrote my blog on the 5th of February ... and now, here I am, back to write some more stuff for you all to read. There have been things that have moved on around me, and to say it in a line, I have been REALLY, REALLY busy. I mean, professionally. Mumbai has had a bad year, what with large numbers of new and old illnesses striking at least one member of almost every family, be they rich, middle-class or poor. I am grateful to Allah, that he has spared our family from any serious problems, but some of the patients' families that I have met have had even more than one family member in hospital with Dengue, Typhoid, Malaria, severe Diarrhoea or Viral Hepatitis.

All through February, I struggled with a two-and-a-half year old boy NZD. He has been with me since birth. Born in a middle-class family, he was, until his present illness, a lively, ebullient child whom his parents brought to me for every single vaccine, check-up visit and minor illness. In short, a text-book cooperative patient who did not miss any of the offered vaccines at all.

Then, all of a sudden, he was brought to me in a state of altered consciousness and body tremors on the 2nd of February 2007. From then till almost for a month, he continued to remain the same, despite all our best efforts to set him right. The family spent over 1.5 lakhs of rupees, and we had almost five to six doctors treating him ... but to no avail.

I finally sent the family home from hospital yesterday. The child continues to be in an altered state of awareness. He is rigid, has no idea where he is, and depends on the caretakers to feed him through a noe-to-stomach tube.

Seems as if God has completely forsaken that family.

Then, let me tell you about a ten-year old girl called ZTH. She was referred to me by another clinician who needed advice on how to build her up as she needed IV nourishment. Her intestines had given up completely on her on account of an illness that had crept up on her a few years ago. The illness? Ulcerative colitis (go, look it up on Google). After several medical attempts to control the recent surge in the activity of the disease, the illness continued to ravage her body, causing her to have several bloody stools each day, accompanied by dehydration, weakness, paleness and abdominal cramps that caused her to scream loudly several times a day with the pain.

When I met her, she was already in clinical depression, and on several mood-enhancing drugs in addition to the specific medicines for her actual illness. Immediately, a tear welled up in my eye as I had treated this child much earlier for another serious illness - a kidney disease. She had, mercifully, recovered from that - only to come down with this monster disease.

Twenty days after I began to see her, she went in for radical surgery. Her large intestine was completely removed, as almost all of it had been destroyed by the monster inside her.

Wait. Read on. This story has a nice ending. Within five days of the surgery, she began to have liquids, then gradually, solids too. She got discharged from hospital a few days ago. All nice and cheerful. And fully recovered from that monstrous illness. But without her large intestine. And with the last part of her small intestine brought out to the exterior in the front of her tummy. To discard the waste matter of the GI tract. This hole is called an ILEOSTOMY (Google this, my friend).

In other news, my mom has to undergo surgery for a slipped disc sometime next week. My daughter Inas has completely wrecked her mobile and is waiting for us to buy her another. My wife finally bought her first mobile phone and has actually learnt how to use it! Hannah, my younger one, completed a nicely written project on "Refrigerator" for her science (Thanks Google!).

That's all for today.