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Monthly Archives: May 2008



Playing God comes easy for doctors. It is all too common for a cardiologist to think that the life saved was due to his/her own effort. In any case such a happy ending to a sick patient’s sojourn in the ICCU always gives a great feeling. But today my dilemma was a different one.


A seventy year old man is in my hospital as we speak. He has a hole in his heart from birth & that’s troubling him now. He’s better after receiving some medicines but my problem is whether to go the whole hog & send him up for surgery. The basic pro-con question is, whether to take a five or six percent risk of death during surgery on a seventy year old gentleman who has seen it all, or let him live on medications for an indeterminate time period without putting him into an immediate man-made risk. Remember, average lifespan in India is 65 years for men & this man has seen his great-grand child.


The family looks up to me to take a decision. “We trust you. Do whatever is best for him. But please make sure that he’s alright”. The last line is a killer!


I took this problem to a very senior colleague of mine. He asked me to perform some more tests & see if the old man merits surgery. My problem is not that. Intuitively I know that the man will qualify for surgery after the tests. But before running those expensive tests (he has no insurance – has to pay from his pocket), what I need to know is, if he does merit surgery, should I send him to the surgeon?


I think the question is not of mathematics: Five or 6% risk is small so should we try to beat the odds?


The real question is: If I send him for surgery, and if he dies, can I shrug my shoulders & walk off from the family?


The real question is: What are the true odds that he will do as well without surgery?


Who will ever know the real answers?