A Patient that I Lost

     Our life as doctors spanning over perhaps half a century would have touched thousands of lives, most of them in a positive way and a few with bitter endings. We may have processed the encounters as casual routine in our line of work; but there will be many who will ever remain grateful to what we have offered and how we had made a difference.
     As my specialty dealt with treating asthmatics and ones with a variety of allergy problems, I can claim to have kept a few of them alive, being able to breathe and leading a normal life. To many, allergy is just a nuisance or inconvenience, but to the few, it is a matter of life and breath.
    To pick the most memorable ones is not easy, out of the many who have left indelible impressions that will never fade from my memory. I want to share such an episode from my professional life.
     It was a routine evening on a moderate Houston spring, about twenty or so years ago. Had my dinner and was about to go to bed. Since I was not on call, I was expecting a good night’s rest.
     Then the phone rang. Surprised, I picked it up expecting to caution my answering service to contact my associate on duty that night. To my surprise, the call was not from my answering service. It was from the father of one of my patients, one of the few who had my residential telephone number. His voice was quietly stern, intense with fear and anxiety, yet, almost cold with a grim assumption.
     He spoke “ I just got a call from the ambulance people, Pradeep has been taken to Texas Children’s hospital from the Summit”. Then hurriedly, he added. “It doesn’t sound good”.
     I pulled my thoughts together in a hurry. Pradeep is not yet eighteen, a precocious freshman at the prestigious Rice university and would still be eligible to be treated at the Children’s. And Summit being a sports arena where professional basketball was being played, he must have been attending such a game.
    The father apprised me in short, gasping, agonizing bursts: He must have been exposed to a lot of smoke (this was before all the facilities were ruled by no smoking ordnance); his Proventil may have been old and expired, or even empty. I assured the father that I would rush to the hospital and meet him at the Emergency room of TCH. He was also on his way to the hospital.
    It took me about fifteen minutes to drive, park and get to the Emergency room. I made a quick glance at the parents in the waiting area, but I walked straight into the patient room. But it was all over. Pradeep was gone. He was on the rigid, steel ER cot, a white sheet covering his entire length, save his face. And his face! His face was still, staring straight up, cold, blue, bare, and vacant, with no life. He was gone, and nothing else mattered anymore.
    The reality was beyond bearable. The parents lost their only brilliant child. They lost all their hope, their life, and their future. I lost one of my pet patients, my satisfaction of having kept him well for many years, had suddenly become my professional letdown. But such failures teach you to be humble; it is the warning, a caveat that you are human.
    I stayed with the parents for a while. We did not speak. They were not even crying. They were stunned, stoned, and unable to think. …I did not go to the funeral. I could not.
    After a break of about three months, I received a subpoena from a couple of attorneys: Das vs. the Summit; Das vs. the ambulance company; Das vs. the insurance companies. I have never been more scared in my life. Only relief was that I was asked to report as the witness. I do not recall whose witness!
    The anticipation before giving the ‘deposition’ was torturous. I could not function without thinking of it even for a second.
Finally, the day came.
    The process was arranged in our elaborate conference room. I will never forget the clutter as I walked in. There were about twelve people in the room, but not the parents. All total strangers, with no smile on their faces. And absolutely no expression of friendliness. There were about three huge cameras with professionals handling them. There were many microphones set up to mop up all that I spilled. But I felt my mouth as dry as a rock, as if a blotting paper had wiped up all my saliva.
    I sat at the end of our huge table. The vultures circled around me. Eventually, the grilling began; and it continued for about three hours. They asked every imaginable question about my taking Pradeep as a patient, my qualifications, my background, where I learned Medicine, when I came to the US, if I could speak English, my training and my Board certifications, and then, what was the diagnosis, treatment, response, office visits, hospitalizations, his co-operation, his performance as a student, as a patient etc, etc.
    Fortunately, after the initial lump in my throat, and the nervous stammering, I grew comfortable, then confident, and eventually I was in charge. I felt, I am the doctor and the one who knew about Pradeep. I had given everything within my ability to help him as a patient, seen him as often as was needed, explained to him and his parents everything about asthma, instructed them about the various medications, their actions, technique of usage, the possible side effects; and the danger if he did not follow those instructions. I knew what I had done for him; and I wouldn’t let these lawyers intimidate me.
    I saw Pradeep initially as an eight-year-old, undernourished and diminutive with scaly eczematous skin, dry parched lips and an unoccupied, almost belligerent look. Slowly we became friends, the family remained very concerned about the proud, only possession in life. They followed the prescribed therapy with all the nuances. Pradeep was an exceptionally bright child, performing at the top of his class, and a gifted piano player who was invited to perform at the White House in front of the President of the United States. He was only 9 years old.
    I was wrong. He was rebelling, refusing to get treatment and to get refill of his inhalers and other medications. He thought visiting the doctor was not important.
    It turned out to be, that on that fatalistic day, the inhaler in his possession was too old or empty. He choked with the smoke filling that huge sports arena. By the time his friends realized and called the ambulance, the game was over, the basketball game and Pradeep’s game of life. The crowd of 16,000 was rushing through the many doors to get home or to their girlfriends or boyfriends. The ambulance people had a tough time to get in and navigate their way to Pradeep, who ran out of breathing, access to his little bronchioles totally tightened up, dry with mucus and swollen membranes. And finally, when they got to him, all that remained was mechanical routines. The epinephrine, the oxygen, the beta stimulants, the steroids, the Ambu bag, was all of no avail.
    But the verdict had to wait until they diagnosed it in the fully mechanized Emergency Room of Texas Children’s, equipped and ready to handle any emergency.

But this was a case, they couldn’t.
Pradeep was pronounced dead. Dead on arrival?
A young, promising life was extinguished before it started.
But the attorneys wanted to keep the story going.

Author: Dr. Venugopal Menon

Was born and raised in a loving family in pre-independent India, became a doctor, served Indian army, got married, then came over to America with wife and a daughter, established as a successful Allergist, raised a family of three children, was involved in many social establishments, retired, and wrote memoirs, 'My Mother Called Me Unni, A Doctor's Tale of Migration'.

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