I had just finished a grueling orthopedic residency. Yet once again, I was on the run and bearing bad news. I was sprinting from a well-known Mumbai hospital to a nearby hotel room. But this time, the bad news wasn’t for the family of one of my patients. It was for my mother. As I waded through the crowd whose constant overflow from the sidewalk onto the road left a shifting tidemark, my senses stayed dead to the incessant cacophony of the traffic and its limitless supply of inescapable exhaust fumes. Mumbai, a bedazzling beehive of unabating human activity, suddenly seemed to have gone dark and come to a standstill. But just for me. Mom looked up as I entered the room. She appeared to be praying silently with the beads of the holy rosary trembling in her otherwise rock-steady hands. “Does the hospital need more cash?” she asked, nodding towards an open briefcase on the bed stacked with high denomination rupee notes. Like most Indians in the 1990s, we had to pay an advance in cash for treatment in big-city private hospitals and replenish the account when the deposit ran out. She thought I had come to collect more money. I came to give her the bad news. The news that I carried with me followed my sudden exit from my sixty-year-old dad’s intensive care unit bedside. He had undergone a cardiac bypass the previous day in the Mumbai hospital and was feeling uneasy. Uneasy enough that the Catholic in him asked for a priest to administer the last rites. I reassured him that he would be fine, but nevertheless, I found a church nearby and a priest who was kind enough to drop everything and walk back to the hospital with me. I laughed through my nervousness as I said to the priest, “My dad is a very anxious man … so much for the steely confidence of a surgeon undergoing surgery!” Father Barbosa nodded understanding. “He will feel better after I pray with him.” We all prayed together by his bedside, and at the end, the priest anointed my dad’s forehead with holy oil. Dad and I were big fans of “famous last words quotes” trivia, and our final exchange would have been more poignant had we known what was to follow. “Dad, I am going to walk Father Barbosa to the hospital entrance and will be back soon.” He nodded. “I will be waiting,” he said. All I know is that when I returned to my dad’s hospital room, I walked into the all too familiar hell that breaks loose when a soul in hospital threatens to leave this world. Where a beep storm of monitors triggers circumferential waves of quick thinking human activity around a patient’s bed. One of the humans by my dad’s bedside was a young ICU resident who, two hours prior, had taken me aside and said, “We have run all the tests. Everything seems fine. I think your dad is a little anxious.” Now it was she who looked more than a little anxious. The surgeon in me wanted to stay, but the son in me took over, and I began my lonely run back to the hotel. I burst into the hotel room to break the news to Mom. Deep down inside, I knew that Dad had passed away, but my words came out clothed in a white coat, “Mom, Dad’s condition suddenly got critical.” Her eyes widened in shock. “Oh my God,” she gasped. I pushed on, “I hope to God he makes it.” My stricken face gave my words away. As a physician herself, she did not need a bad news translator. “What’s the use of all this?” she choked as she despairingly shoved the open briefcase filled with money from the bed onto the ground, where the notes ended up forming a bizarre-looking rug. Her hands continued to clutch the holy rosary. I didn’t say anything more and just held her close. Surgeons don’t cry, they say. We both did — not just because another surgeon died but because a husband and father did. We were both oblivious to the rupee notes scattered all over the ground. My Mom did not let go of the rosary beads. And we did not let go of each other. That moment drove home for me that when matters of sickness and health reach a point of reckoning, science and wealth may not necessarily be the highest power that the afflicted turn to. Including people of science who also possess wealth. Maybe it is because science does not always get it right, and money cannot cure every wrong. As we stood desperately holding each other, I knew what was going on in my mind was possibly going on in hers, and we will never stop playing it on a loop, forever. The events, the decisions that led to us being here. It all began with my otherwise asymptomatic dad consulting a doctor for throat burn from eating spicy food. This seemingly innocuous decision put him on a cascading investigative path where an EKG led to a stress test that led to an angiogram, a test that outlines the pipes that supply blood to the heart. This test demonstrated near blockage of the blood vessels that supplied his heart. Cardiac bypass surgery was recommended, but my dad wanted to have a balloon angioplasty, a procedure that can be performed by slipping a small tube through a poke hole in his thigh, as he did not want his “chest split open” by the surgery. The irony was not lost to me that surgeons are as afraid of surgery as everyone else. Perhaps even more so. Given his angiography findings, our cardiologist did not recommend balloon angioplasty as it had the potential to precipitate a block in the blood supply to the heart, lead to a heart attack and necessitate an emergency bypass. But one of the country’s foremost angioplasty experts who prided himself on his ability to do “cases that no one else has the ability to do” decided to give my father what he wanted. And my father ended up getting that forewarned complication and needed an emergency bypass. The interventional cardiologist possessed a hammer, and my dad asked to be the nail. The hammer-nail cliché had dealt yet another blow, this time close to home. And in a crazy way, our family full of physicians unwittingly aided the system in carving out our very own swiss cheese model of accident causation, creating perfectly aligned craters of calamity through which, holding hands, we executed a free fall. At every point, Mom and I went with the flow, blindly trusting what the system had to offer and the decisions being made and going along with what my dad wanted. Adding to the calculus, elementally, we were from a “small town” and had come to the “big city” for treatment. To frame our medical journey using American geography, we lived in idyllic Northern Maine and had traveled to a medical Mecca comparable to Boston or New York City for my dad’s treatment, where he ended up being treated by doctors of great renown who counted Heads of State and Bollywood stars among their patients. Perhaps the humanity of big-name hospitals and rock star physicians can be layered with an intimidating gloss that can make the awestruck patient reluctant to subject that gloss to the nicks of questioning. Even if the patient is a surgeon himself. I have often wondered how the cardiac surgeon mentally processed my dad’s death. I can imagine the well-meaning, yet clumsy, attempts of his colleagues to console him, akin to what well-meaning friends do to console at times of personal grief. “You did everything you could,” “If you operate enough, you are going to have complications.” “It could have happened to any of us.” All surgeons know the pain of having hurt someone we are trying to heal. We talk about our complications with our colleagues like we would talk with a close friend about a breakup or a death in the family. We are always deeply torn inside and wondering what we could have done differently and better! I think of that resident sometimes—the one who called him “anxious” two hours before he died. Just as I learned something, I hope she did too. Wisdom that she will pass on to her students and that her patients will benefit from. There is a public perception that we surgeons think we are God, and we are ridiculed for it. But when faced with a complication, that is the one time we wish that we were a deity gifted with the power to change the course of events. To our family of mortal surgeons, a well-intentioned system filled with kind and knowledgeable professionals delivered a death by a thousand cuts. We learned that when we are cut, we bleed just like everyone else. And I learned that a knife that carves your or your kin’s body could also reshape your thinking and change your process of decision-making. It certainly did mine, and made me more thoughtful whenever the opportunity arose to use a knife. The timing of this tragedy could not have been worse for my family while in a perverse way beneficial for my future patients. Having recently completed my orthopedic residency, I now sat atop the decision-making tree that controlled life and limb, where a labor of planning, precision, and love could still yield the bitter fruit of failure. Like every surgeon, my dad was no stranger to that experience in his professional life. For his surgeon son and spouse, this was further reinforced by his death. Some of us surgeons believe in the afterlife. I do. And I hope my dad is listening in when I say, “Dad, I learned a lot in medical school and residency. I learned even more about what it means to be a doctor when you were alive, but sadly I learned the most from your death. Wherever you are, I want you to know that by constantly endeavoring to do the right thing by the patient, I am doing the right thing by you.” I know I will not always get it right, but it will never stop me from trying. Source
