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On Being a Doctor |

When My Father Died

Harriette Gillian Christine Van Spall, MD
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From the University of Toronto, Toronto, Ontario M5T 258, Canada.

Current Author Address: Harriette Gillian Christine Van Spall, MD, Postgraduate Cardiology Office, University of Toronto, 399 Bathurst Street, East Wing 5-559, Toronto, Ontario M5T 2S8, Canada; e-mail, h.vanspall@utoronto.ca.

Ann Intern Med. 2007;146(12):893-894. doi:10.7326/0003-4819-146-12-200706190-00013
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I had never known failure, sorrow, loss, or despair, until all of them descended upon me when my father died.





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When My Mother Died !
Posted on June 29, 2007
Matiram Pun
Maharajgunj Campus, Institute of Medicine, Tribhuvan University Teaching Hospital (TUTH), Nepal
Conflict of Interest: None Declared

Dear Sir,

Though I was not medic when mom died but I was determined to be in and was following the sequence. I was equally curious on diseases, their pathophysiology and management. Obviously, I was too young to learn all and it was to early to understand everything but that doesn't mean I observed wrong things that too with something that happened with the demise of my mother.

Few years ago, my mother was referred and admitted in the best treatment center of Nepal with the complaint of severe anaemia, progressive weight loss and weakness. I had just completed my High School then. She had received two pints of blood already from me and my elder brother. On the second day of her admission, Associate Professor came in the round and discussed. What I could understand is all they talked about Leukaemia. In the afternoon, a nurse told me my mother needs blood. I didn't know what to do. I even didn't know that the blood must be arranged by the patient parties. I went blood bank and asked about it and they said I have to seek donors. I was lost since it was my first visit to the larger cities like this and there was none whom I knew. On the third day, the nurse asked whether I brought blood. I said I did not know where to bring from. On the round, the nurse told the Doctor, patient party could not bring the blood. The doctor simply escaped and handed the case over another doctor who is currently in Europe. On the fourth day round, the new doctor just taught the students and planned for Bone Marrow.

At an around 2.00PM, two people in white apron came. They were talking in their ethnic language. One was teaching another on how to handle the needle. The next one was little nervous. The later pushed the needle into my mother sternum spinning it as other guy told. The needle pierced about an inch deep to the sternum. He pulled the piston of the syringe up and he aspirated a full syringe of blood. My mother was in quite agony. She stretched her limbs and closed her eyes. He again pierced the sternum and aspirated a little white fluid which they put in the slides. As my mother became unconscious, they did cardiopulmonary resuscitation (CPR), called nurse and then did overhead paging for senior doctor. The drip was running fast and my mother seemed almost in vegetative state. The doctors and nurses asked us to go out of the ward and told if anything happens they would call. One hour later we were called and told the result-She is dead. There she was again NURSE! I was further shocked when I asked nurse whether I could talk to the doctors. She tried hard to convince me that my mother was in debilitated condition and it can happen. My father buried his head in both of his hands and uttered they killed your mom! They discharged late evening. I read the discharge sheet, the cause of death was written- Asystole. I took my mother straight to crematorium site of Bagmati River where there is holiest temple of Hindu-Pashupatinath.

It is almost twelve years since my mother passed. Fortunately or unfortunately, I am on the verge of completing my undergraduate course in the same Institute (Doing one year internship/apprenticeship)! While writing this response, I have been posted in the ward with the similar sort of responsibility and status as those "white apron wearing guys". I have been doing my clinical works there under supervision in the ward including, of course, in and around the same bed. It always haunts when we put five or more stethoscopes over a patient's chest to ascultate, when teachers discuss hours around the patient with a dozen of students and do the haphazard clinical procedures. I know what went wrong at that time and it always makes me to think twice and prepare well myself before doing any procedure.

Thank You !

Matiram Pun,

Maharajgunj Campus, Institute of Medicine, Kathmandu, Nepal

Post Office Box No. 1524

Conflict of Interest:

None declared

Being a doctor in 2007
Posted on July 2, 2007
Francisco Olazabal
Auxilio Mutuo Hospital
Conflict of Interest: None Declared

I was deeply touched by the piece of On Being A Doctor "When My Father Died" by Dr/ Harriette Gilliam Christine Van Spall. Having been a doctor for over 48 years and a cardiologist for 41 I thought I was immune from the vicissitudes of the practice of medicine, having seen stupidity, arrogance, callousness, patronizing attitudes, dogmatism and abuse of authority too often. I must admit, however, that I had never seen it all in evidence simultaneously as was shown in this tragic case. Politicians are again talking about universal health care. They talk with awe about the wonderful Canadian model. I hope the management of this case is not representative of the care patients get in Canada. We are not talking about an unfortunate result. In this case the evidence was clear, the therapy was indisputable, the wait was inexcusable. In 18th century Canada, when bloodletting was an accepted practice I am sure the physicians were wise enough not to use it in patients with unstable angina. This patient would have fared better then. Too bad he did not cross the border to Cleveland. Or hopped a plane to Puerto Rico. We may be "Third World" in some things but he would have been treated appropriately and promptly, no matter what his financial status. To have done otherwise would not only have been malpractice, it would have been criminal.

Conflict of Interest:

None declared

No Title
Posted on July 5, 2007
Frank E. Schmidt, M. D., F.A.C.S.
LSU Health Sciences Center
Conflict of Interest: None Declared

This tragic and poignant article typifies what state-controlled, "socialized" medicine delivers. The bureauocracy demands timidity and mediocrity, and the system, controlled centrally, complies. The result is that patients suffer. How sad that the liberal element in the United States is now trying to throw over the best medical care ever known to place this failing system in its stead.

Conflict of Interest:

None declared

colossal blunder in a land with dread of malpractice
Posted on July 11, 2007
Ramesh R Rau
SAL hospital,AHmedabad ,India
Conflict of Interest: None Declared

I am pained to read the way a Left main with triple vessel disease patient was not advised urgent surgery and the mistake was compounded by advising blood donation- a contraindication here.In a land of malpractice cases and with physicians doing numerous tests to be clear of any malpractice points, it is surprising that this sort of mistakes occur and go unpunished.The loss to the authour is double as she lost her father from a very preventable cause and being a medical person she knows it painfully well. Is the teaching system flawed? Should the cardiologist and surgeon not be held responsible for criminal negligence? Will the authour ever sleep with a clear conscience that all was done properly? These are queries the medical profession as a whole should try to answer so that no father with left main disease dies before undergoing bypass operation.

Conflict of Interest:

None declared

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