I remember my days as an assistant to a well known orthopaedic surgeon. I had joined his clinic just after the completion of my internship. His clinic has OPD and IPD sections along with an operation theatre. I was in charge of the IPD patients. It was the third week of May 2005. In that week two operations were scheduled – one was a hip replacement surgery and the other was a prolapsed disc surgery. Hip replacement surgery was successfully conducted early Monday morning on a 92 year old lady, who was admitted for another 7 days to recover completely. The other surgery for the prolapsed disc patient was scheduled on Saturday. She was admitted since a week, and as her complaint was not getting better via medications and physiotherapy, she was advised surgery. She had immense pain, so much that she could not move with out using a lumbo-sacral belt. This operation was a necessity to relieve her from the pain that the depressed disc was causing by compressing her herniated spinal cord.
This patient was a simple, calm lady with a family comprising of herself, her husband and their two sons. She was a middle aged lady with short hair, some of which were grey indicating the aging process. Fair complexion, large eyes with puffy skin below them, and weighing a little more than average, this lady spoke excellent English. Whenever I took her BP, I always admired how beautiful hands she had with perfectly manicured nails. The hospital staff liked her as she was unlike the other patients who always threw tantrums. Her family visited her twice a day and her children were very concerned about her ill health.
It is a routine to get some blood tests done before an operation. ELISA (test for HIV) is one of them. A technician from the pathology lab had come to collect her blood for the tests on Thursday morning around 7 am. The reports came in the evening. Most of her test results were normal or close to normal but unfortunately the ELISA showed positive results. This test is a very sensitive method to detect antibodies against HIV but requires another test, a Western Blot, to confirm the results because false positive result can occur. Yes, a positive ELISA test does put the person in the category that he or she may be HIV positive but the next test has to be done for confirmation.
The surgeon had disclosed the results to her and explained the importance of conducting the confirmation test. But her results had caused her immense aggravation, and she refused to go for any further tests. “Please doctor, give me discharge. I want to go back to my home. Please.” These were her words on asking her to go for HIV confirmation test. There was some talk between the surgeon and the patient of which I or any other hospital staff were not a part of. The entire hospital staff (nurse, physiotherapist, interns, maid servants and myself) was called by the surgeon, and was asked not to discus this case in front of other patients (IPD and OPD). Also, we were asked to take some safety precautions ourselves while dealing with this patient. Since I was the in charge, it was my duty to look into this matter. I made sure that my staff is following all the instructions sincerely. Eventually, the patient was counselled, operated, had recovered and was happily discharged.
Before the arrival of reports, the entire hospital staff was treating her like a normal patient, but this report made us take care of her in a little different way. Initially we did not use gloves while administering her injectables or taking a note of her blood glucose levels. But once we were summoned, then the entire staff was very particular of wearing gloves while examining her or while injecting her with fluids or medicines. We were all cautious for some reason. That reason was fear of AIDS. But the fear was not a reason enough for the surgeon to not operate her. He performed the operation very confidently as he does on every other patient. My staff and I tried our level best to fulfil our obliged duties towards her as normally as we could. There was a radiant smile on the lady’s face on the day of discharge as she was relieved from the pain that she was suffering for so long.
Sometimes, when alone, I did speculate the reasons for her acquiring HIV. I could not believe by her looks that she was an HIV positive. I, being a doctor, had read a lot about HIV and AIDS. I knew well about the modes of transmission. I knew that those results are yet to be confirmed. I knew that being HIV positive does not mean that she has AIDS. But I was still very cautious. Being cautious is sensible but to isolate an affected person is insensate. These patients are already in pain by learning this bitter truth of life. Our isolating or behaving abnormally with them will only add to their pain. If the doctors get scared and isolate such patient’s then there will be no one to treat HIV patients.
Every time we wore gloves and examined her, there used to be a slight uneasiness in her behaviour. It made her nervous. May be it reminded her of her positive results. There are few rules which should be made universal in all hospitals like wearing of gloves while examining or administering injectables to all the patients, irrespective of the diseases they are suffering from. This will not just reduce the rate of occupational transmission of infections but it will also relieve an infected person from the mental soreness that the feeling of being inferior brings in.
Sometimes, even healthcare professionals do the mistake of making a sick realize the ghastliness of his or her illness. Then, as a common man any one can do this mistake. It is important to treat a human as a human irrespective of what disease he or she is suffering from, and this fact stands same for everyone. I always keep reminding myself of the bold surgeon, who cured the affected lady, bought a smile on her face, and took all her blessings. This lessens my fear and gives me the determination to reduce the sufferings of all those who are sick and unwell. It also reminds me of some lines from the Hippocratic Oath I chanted confidently along with my peers on my convocation day – the day when I was considered as a medical fraternity.
“I swear by Apollo, Asclepius, Hygieia and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath…
I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone…
I will preserve the purity of my life and my arts…
All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal…
If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.”