Yakeen Ka Safar

A surgery gone wrong

Asfandyar sat on the bed engrossed in reading some medical reports and diagnosis history of a patient. He studied them carefully that maybe classifying the reports may help to clarify the recent issue going on in the hospital. The issue that aggravated him badly, that had kept him restless the whole day back at work and even he was committed that night too. That certain issue was the largest and most controversial subject he had ever faced in his career. A treatment error had occurred in his hospital.

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Earlier that morning, an urgent surgery was called off, as a patient with muscle-invasive disease was brought in the ER. It  was a Bladder Cystectomy. Asfandyar was immediately required in the operation theatre. Hours passed and he was still occupied performing the surgery meanwhile another serious case arrived. This patient was having aortic stenosis and was between the mean age of 65 to 70. His left ventricle of heart had narrowed, resulting in some acute signs of heart failure,  severe breathing difficulty and was previously suffering from fever and multiple painful joints.

Dr Farhan Ahmed was a Cardiothoracic Surgeon in the hospital. The elderly patient was referred to him as soon as he was pushed in the hospital by the pediatrics. The condition from which the patient was suffering was not beyond the scope of the doctor's knowledge or training ofcourse. He hurriedly studied the patient's medical history, the fact-sheet and the chronology of the diseases the patient, Salman, had faced in the past.

Asfandyar had taken his training in Cardiovascular diseases in America too, hence he was required to attend the patient immediately. But because he, himself was preoccupied in performing a surgery that came prior to this one, he couldn't make it on time.

While Dr Farhan was going through the patient's medical file his attention never left little details. He vigilantly acknowledged the patient's medical past through the fact-sheet that was given to him. But one should never forget that medical records are not inviolate. They could be inaccurate or incomplete (for eg, mislaid hospital reports or visits to alternative practitioners or different prescriptions for different medicines) or it could be simply, not fit for purpose. That was it.

Due to the shortage of time and a critical patient hanging right above Dr Farhan's head, he was unable to validate whether the information mentioned in the given fact-sheet was incorrect or misleading. He should have taken reasonable steps to verify the information in the report and must not deliberately left any relevant information, unchecked. But unfortunately, he completed the consent forms quickly and sent the medical report without an unreasonable delay.

The treatment error occurred because of a diagnostic error – the patient's condition went undiagnosed. The doctor misdiagnosed it and ordered an ineffective treatment. That was because, the patient was already in his ripe age. He was 68 years old. Timely, the surgical aortic valve replacement was not considered because symptoms were mistakenly attributed to comorbid conditions. The severity of underlying aortic stenosis was underestimated by an rheumatic fever, mistakenly.

In the absence of any specific or effective disease-modifying medical therapies, surgical aortic valve replacement has been and continues to be the cornerstone of management of severe aortic stenosis. That is exactly the same disease Mr Salman was facing. But as his disease was mistakenly considered as rheumatic fever and not aortic stenosis,  the doctor performed a valve repair instead.

Within some hours, Salman's condition worsened. His surgery went complicated minute per minute and nearly ended up causing a heart failure. Dr Farhan knowing that things were slipping real fast from his hands, arranged an urgent surgery for him in Cardiac centre PIMS, Islamabad. A well equipped ambulance was on-call for transferring the critical patient to the Federal Capital of the country.