Saturday, November 16, 2013

Left in the lurch

Once a while, we get patients who remind us about how pathetic can healthcare in the country be. 

SSB, a 55 year old lady was wheeled into our emergency with a history of backpain followed by paralysis of her lower half of the body since the last 2 months. She had very bad bed sores . . . and that was the reason her relatives brought her. 

It was Titus who saw the patient. They had quite a lot of papers relating to some treatment SSB received at a big hospital in one of the metros. 

Titus could not believe what he read. The lady had been diagnosed to have follicular carcinoma thyroid sometime in April 2013 and she had a hemithyroidectomy done for the same. And the relatives did not have a clue that it was cancer. 

It was not difficult to come to a diagnosis about her backpain and the paralysis. Some quack had taken few X-Rays of the spine and the mets were so clearly seen and there were compression fractures of the body of couple of vertebrae. 

2 things, I could not understand. The reason why only a hemithyroidectomy was done after a diagnosis of follicular carcinoma thyroid. And the second, how come the relatives did not have a clue about what the patient had. 

Titus started to explain about what all we could do the maximum for her. It was difficult. It has been quite a  few days since we wanted to start off a formal palliative care program. I'm still not sure on how we could take on this. I still remember KD who did fantastically well under our care. There are quite a few units in EHA under the leadership of Dr. Ann Thyle who's doing fantastic work in palliative care in rural North India. 

SSB's relatives could have none of it. Titus called few of us too to put across things. The family was just not willing to understand. They just wanted some medicines to cure the bed-sores. 

This is not the first time we encountered such a case. 

We had a young man from one of our nearby villages who was diagnosed to have nasopharyngeal cancer about a year back. Unknown to us, he had gone and done surgery from one of the premier institutes in the country. The diagnosis was well written in the papers. 

However, the family had no clue about it. Until he had a recurrence and he came to us. We took a CT Scan and found out that it had spread out too much. 

He passed away within a month. 

I don't know whether the families had bluffed to me regarding their ignorance of such a serious diagnosis. However, I don't think one can find any excuse for doing only a hemithyroidectomy after a diagnosis of follicular carcinoma thyroid has been made. 

I would stand corrected if there is any change in management processes of late . . .

1 comment:

  1. Most probably hemithyroidectomy was done as the fnac can't diagnose follicular carcinoma -without showing capsular or Angio invasion , hence the surgeon will go for hemi first, then completion if m/g. By that time pt can get non compliant to a second operation