Wrong Diagnosis
“Doctor, I get stomach upset repeatedly, gas trouble, sometimes diarrhea,
sometimes constipation, loss of appetite, bitter taste in the mouth------,‘ one
of my patients was narrating.
I interrupted and asked him,
“Since when do you get these symptoms?”
“About five or six months.”
“How old are you?”
“Forty seven.”
“What is your occupation?”
I interrupted and asked him,
“Since when do you get these symptoms?”
“About five or six months.”
“How old are you?”
“Forty seven.”
“What is your occupation?”
“We own an orchard of grape vines”
“Do you yourself do manual work? Or-----“
“Very rarely. We have employed peasants.”
“Have you lost weight?”
“Yes!”
“How much and in how many days?”
“Eight kilos in six months”
“Tell me about your family?”
“WE are four of us; myself, my wife, a daughter and a son.”
“Please lie on the examination couch. I will examine you”
“Do you yourself do manual work? Or-----“
“Very rarely. We have employed peasants.”
“Have you lost weight?”
“Yes!”
“How much and in how many days?”
“Eight kilos in six months”
“Tell me about your family?”
“WE are four of us; myself, my wife, a daughter and a son.”
“Please lie on the examination couch. I will examine you”
In proportion to the weight loss, he was not emaciated and
malnourished. His vitals were normal. He had a firm mass in the right lower
quadrant of his abdomen, at the junction of the large and small bowel.
“Some times I get water brash, retching, sour taste----,“He started narrating some more symptoms as I was examining him.
“Okay,” I said.
After the examination, I explained to him my findings and said,
“Let us get barium films of the intestines (Ultrasound and CT Imaging were not around at that time), a chest x-ray and other basic investigations done. After that, I shall be able to decide further line of treatment”
“OK”
Four days later, he brought the reports. His chest x-ray and lab reports were normal. His barium study was abnormal. I mounted the x-rays on the viewing box and started explaining -----
“Some times I get water brash, retching, sour taste----,“He started narrating some more symptoms as I was examining him.
“Okay,” I said.
After the examination, I explained to him my findings and said,
“Let us get barium films of the intestines (Ultrasound and CT Imaging were not around at that time), a chest x-ray and other basic investigations done. After that, I shall be able to decide further line of treatment”
“OK”
Four days later, he brought the reports. His chest x-ray and lab reports were normal. His barium study was abnormal. I mounted the x-rays on the viewing box and started explaining -----
“This is the small intestine and this is the large intestine. This
is the junction of the two. We call this as the ileo-cecal junction. This
ghastly looking shadow at this junction is ominous. This requires to be removed
by an operation. After that, I shall send this for a pathological examination
called as ‘biopsy’. On the basis of the report, I shall decide the plan of
further treatment.”
“Doctor, how much time it will take for the operation?”
“About two to three hours”
“Is this a major operation?”
“It is!”
“Doctor is this ‘cancer’?” He asked anxiously
“How can I say? The ‘biopsy’ report will tell the tale.”
“What if it is ‘cancer’?”
“Let the ‘biopsy’ report prove it first. Why fret about a non existent danger??”
“About two to three hours”
“Is this a major operation?”
“It is!”
“Doctor is this ‘cancer’?” He asked anxiously
“How can I say? The ‘biopsy’ report will tell the tale.”
“What if it is ‘cancer’?”
“Let the ‘biopsy’ report prove it first. Why fret about a non existent danger??”
He did not report for a week. When he came to decide for the
surgery, he had ‘stomach upset’, gas trouble and diarrhea.
“We cannot perform surgery during an acute attack of dysentery.” I said. “You take the medicines which I prescribe now, let the attack abate, and then we shall plan the operation. OK?”
“OK!” He said. “How long should I take these medicines?”
“You report to me after three days. I shall assess the progress and then decide.”
Three days later, he came to report. He was improving
“You continue these medicines seven more days. So totally take them for ten days; and see me there after.”
“We cannot perform surgery during an acute attack of dysentery.” I said. “You take the medicines which I prescribe now, let the attack abate, and then we shall plan the operation. OK?”
“OK!” He said. “How long should I take these medicines?”
“You report to me after three days. I shall assess the progress and then decide.”
Three days later, he came to report. He was improving
“You continue these medicines seven more days. So totally take them for ten days; and see me there after.”
“OK! Doctor, may I go to my native place and come back?”
“Sure!”
“Thanks a lot”
“You’re welcome!”
He went to his native place only to return after seven months.
“How are you?” I asked.
“Much much better! My appetite has improved, the bitter taste in my mouth has disappeared, my stomach upset is almost non existent now-----“
“Wonderful!” I said.
“Let me examine you.” I said.
“Sure!”
“Thanks a lot”
“You’re welcome!”
He went to his native place only to return after seven months.
“How are you?” I asked.
“Much much better! My appetite has improved, the bitter taste in my mouth has disappeared, my stomach upset is almost non existent now-----“
“Wonderful!” I said.
“Let me examine you.” I said.
His face had a sheen now. His expression was cheerful. Obviously he
was in pink of health. His abdominal lump had disappeared now! I was
surprised!!
“Let us get your follow up barium study done” I said.
“Ok”
Three days later, he brought his barium x-rays. That ghastly looking lesion had disappeared.
“Cheers!” I said. “You are perfectly normal now. You do not need any treatment”
Saying, “Thank you doctor” he went away.
Weird thoughts set my mind in a tumult!
“Let us get your follow up barium study done” I said.
“Ok”
Three days later, he brought his barium x-rays. That ghastly looking lesion had disappeared.
“Cheers!” I said. “You are perfectly normal now. You do not need any treatment”
Saying, “Thank you doctor” he went away.
Weird thoughts set my mind in a tumult!
“Was my diagnosis wrong then?”
“Indeed it was!!”
“What if he were to develop an acute attack of dysentery immediately after the operation??”
“It would have been a disaster!! The result would have been horrendous!! He would have developed a very bad sepsis! And may be I would have lost him-----“
“What if this really was a ‘cancer’ and still I had still not advised surgery??”
“His condition would have been worse! He would have died a miserable death!! The medical fraternity would have ridiculed me. I would have my neck in shame. There would have been a storm of criticism against me!!”
“Indeed it was!!”
“What if he were to develop an acute attack of dysentery immediately after the operation??”
“It would have been a disaster!! The result would have been horrendous!! He would have developed a very bad sepsis! And may be I would have lost him-----“
“What if this really was a ‘cancer’ and still I had still not advised surgery??”
“His condition would have been worse! He would have died a miserable death!! The medical fraternity would have ridiculed me. I would have my neck in shame. There would have been a storm of criticism against me!!”
The acute attack of dysentery not only averted a debacle but saved
his life too!!
There is an unwritten dictum in medicine:
“ERR ON SAFER SIDE!!” (It is better to err on the side of caution.)
“Did I not err on safer side then?”
Most certainly I did!!
There is an unwritten dictum in medicine:
“ERR ON SAFER SIDE!!” (It is better to err on the side of caution.)
“Did I not err on safer side then?”
Most certainly I did!!
A TRUE STORY IN REAL LIFE!
A DRAMA IN MY LIFE!!
DR. HEMANT VINZE
