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!