The Cloth Tourniquet

CONQUEST OF DEATH 6

As a corollary to the anecdote of “The Swollen Leg,” it would not be totally out of context to narrate an incident that happened in my family. My wife is from Pune, a city about three hours away from Mumbai in the State of Maharashtra, India. Her father became stable after having sustained a heart attack. He started his routine. To meet him and relax during the vacation, she went to Pune.

One day while on a routine walk, he suddenly developed cramps in his calf. He limped, somehow managed to come home. Anticipating a clot, but not knowing whether in the artery of the leg or in the vein, she fastened a cloth tourniquet above the level of the calf. The physician treating her father was called. 

Soon he came.

Seeing the tourniquet he asked, “Who fastened this?”

“I” Replied my wife.

Not knowing her relation to the patient in question, he asked, “What is your name doctor?”

“I am his daughter. I am not a doctor, my husband is! He is a surgeon. I have heard him teach his students: ‘sudden pain in the calf muscles while walking is claudication.  It can be due to a clot. The clot can be in the artery or in the vein. If the clot slips and enters into general circulation, the complications can be horrendous.’ So to avert a debacle, I fastened it!” she replied.

“Brilliant prudence! By giving important first aid, you have certainly averted a life threatening debacle. Not all house wives of surgeons are curious enough and possess a sense of presence of mind! Kudos to you!!,” the attending physician lauded my wife. 

“Let us shift you to a well equipped hospital and take a vascular surgeon’s opinion” said the physician, to my father in law.

“Well, we will be guided by your advice.” He replied.

My father in law was shifted to a hospital. Soon a vascular surgeon was consulted. He assessed the case and came to the conclusion that the clot was in the important artery of the leg.

So he advised an operation for removal of the clot. He and all the relatives around agreed.

The operation was successful. My father in law’s recovery was uneventful.

There is a well-known saying: “Behind every successful man there is a woman”

I beg to modify it and say, juxtaposition to a man, however successful, there is a woman!!

A True Story in Real Life!!

A Drama in My Life!!         

  

The swollen leg

CONQUEST OF DEATH 5

“Do you perform fibrin degradation products or D-Dimer test?,” I asked a pathologist friend of mine.

“Not in my laboratory, but I can get it done” He replied.

“In which laboratory can I get it done urgently?”

“I can arrange to get it done urgently for you! What is the problem?”

“A middle aged lady, traveled from the U.S. to Mumbai. She was sitting in the plane for a long time. Now she has developed ‘white leg’. I suspect deep vein thrombosis. I got her Doppler sonography done. It is not very conclusive. So I thought of laboratory evidence to prove----”

“Searching for proof, you are wasting a valuable time,” he interrupted me, “No laboratory test is a cent percent proof. There are some false positives and some false negatives. Clinical evidence is also an evidence. In some quasi emergency situations like the one you have encountered now, it is better to depend on your clinical judgment.

“When you were a house surgeon, you used to advise such a patient ‘bed rest with elevation of his leg’, give perfunctory treatment with antibiotics and some so called clot dissolving drugs and wait for  nature to heal. Many patients would improve. But remember you have witnessed ‘white leg’ (phlegmesia alba dolens) turn ‘black leg’ (phlegmesia cerulea dolens), venous gangrene??

“As a surgical registrar, you had better drugs to treat such patients. But those measures had an intrinsic threat of embolization, rarely though patients have died!

“Time has changed now! Today intensive care units can manage such patients better. Instead of wasting time in proving your diagnosis, admitting the patient thereafter into a comparatively under equipped hospital and managing her, better admit her right away into a hospital with a well equipped ICU attached!”

“Thanks for your genuine, honest advice for the well being of the patient,” I said.

I admitted the patient into an ICU. The doctors in charge managed the patient very well. Her recovery was uneventful. A debacle was averted! 

Was it not prudent on my part then to shun my ego and boast of managing a life threatening case and take the credit of saving a life than to obey my friend’s genuine, patient friendly advice?

May I modify a well known Sanskrit saying ‘शिष्यात् इच्छेत पराजयं’ (wish your disciple or pupil to defeat you!), and say ‘मित्रात् इच्छेत पराजयं’!! (wish your friend to defeat you!!)

A True Story in Real Life

A Drama in my Life!