My boss (Dr Girish Bakhshi sir) at JJ used to tell us "A good surgeon also needs to be a good physician." We didn't get it back then, but as I joined practice, I understood what it meant. Here is an incident which proves that point.
Surgery residents, take note.
Surgery residents, take note.
Last year, when I was at GCRI, I had operated an advanced oral cancer case. Surgery and reconstruction done quickly. Flap was looking good post op. Then, on 2-3rd post op day, he developed severe jaundice. We got LFTs done. It was mixed hyperbilirubinemia. Liver enzymes raised.
We got a gastromed refer done but nothing came forth. Hepatitis negative. What else?
On 5th day, his kidneys started shutting down. Creatinine was rising. Hemoglobin was falling, but he wasn't bleeding from anywhere. Bilirubin was rising. He would have died in a day or two.
On 5th day, his kidneys started shutting down. Creatinine was rising. Hemoglobin was falling, but he wasn't bleeding from anywhere. Bilirubin was rising. He would have died in a day or two.
Then, we took a detailed drug history again. Initially they denied taking any medicines, then said slowly, "We are taking some herbal medicines". We asked for the list of meds.
Turns out, the patient was taking FIFTEEN different choorans for cancer.
Turns out, the patient was taking FIFTEEN different choorans for cancer.
Now the diagnosis came together - Drug induced autoimmune hemolytic anemia. I consulted gastroenterologist, nephrologist and hematologist on phone, since I didn't want to waste time getting referrals. Started him on steroids. My junior asked me why I was giving steroids to a post
op patient when it could hamper wound healing. I gave him my logic. It was our best and only shot to salvage the patient.
Three days later, the liver enzymes reversed, hemoglobin almost back to normal. Next day, we discharged him.
This incident will always be memorable!
Three days later, the liver enzymes reversed, hemoglobin almost back to normal. Next day, we discharged him.
This incident will always be memorable!
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