Bypass Doctors At Home
Summary:
My father had 4 blockages and was operated by Dr Jahangir Kabir of United Hospital.
1. Beating heart surgery was done but it should have been an open-heart surgery.
2. All 4 grafts made during the surgery malfunctioned. This was revealed 1.5 years later when the patient suffered another severe heart attack.
3.The surgeon in charge Dr Jahangir Kabir denied to attend to patient's post-operation complications.
4. Duty doctors and nurses in step down CCU could not handle any post operative problems.
In 2007, my father was diagnosed with multiple coronary blockages requiring urgent bypass surgery. This is the process of stitching up a new vessel (obtained from another part of the body) to create an additional route that “bypasses” the damaged vessel to reestablish normal blood flow for the particular channel of the heart. We got him admitted to United Hospital under Dr Jahagir Kabir, reputed to be the most successful heart surgeon in Bangladesh.
We were grateful that Dr Kabir agreed to do the operation on urgent basis where his normal schedule allowed dates after at least a month. He did charge double his usual fee though, as solution for solvent patients, as he put it. This was the last time we had anything to be grateful to the doctor for.
No one knows what goes on in the confines of the Operation Theater. After 6 hours in there, the doctor just said "it was a good operation" and walked away before we knew what else to ask. We learned later that Dr Kabir had (probably still has) a full schedule with 6 bypass surgeries per day – 3 in the morning, 3 in the evening. If this is the case, it only makes sense that the doctor does not himself attend to the patients during the surgery.
Abba was then shifted to step-down CCU and he soon gained consciousness. This would be the start of a long phase of suffering. CCU staff insisted on force-feeding the patient as the only treatment plan while he couldn't breathe. It did not make sense to me to accept this breathlessness as part of the normal recovery process as the nurses did. I chased around the duty doctor who checked the eyes and said it was potassium deficiency. Now I know how ridiculous that diagnosis was as heart patients commonly had breathing difficulties due to accumulation of fluid in lungs. But I was desperate for abba to get some relief and was hopeless when the nurse spent an hour to get the potassium tablet from their pharmacy. Nothing was improving and by the end of the day I was sure that this breathlessness could not be neglected any more. After such a major feat on the body where the rib cage is opened and joined back, a patient needed to be able to rest and eat to recover. So my husband Ryan went to the main doctor. Dr Kabir refused to see the patient saying "my work is done, patient had successful surgery".
It had to be an acquaintance at the United Board of Directors to personally request Dr Kabir to attend to the patient which eventually identified the fluid in the lungs and brought him some relief. A day later, we were told he had a rare unheard-of infection identified as “candiditis”. The doctors in charge admitted they had no idea what it was and how to cure it. The mind boggling “candiditis” was solved the next day by a CMH doctor prescribing drugs for this common hospital borne yeast infection. After 18 mayhem days, abba returned home. That was more or less the suffering for the time being. Little did we know that the seed for much more future distress and anguish were already sown. All the events described below would not have occurred otherwise.
One and half years later, almost out of the blue, abba suffered a most severe cardiac arrest and went into coma for 4 days. We had done the regular follow-ups 1 month and 6 months after the operation and no anomaly was detected by the doctors. Also, after a bypass surgery, the patient’s heart is as good as new and risk for an attack is minimal in next 15 years or so. So I was not concerned with abba's initial discomfort thinking it may be gastric problem. Luckily my sister Mihi who was with him at the moment took him to Apollo emergency where Dr Shams Munwar (Cardiologist) did his best to successfully revive him. Abba spent about a month in ICU, fighting his vital signs on a daily basis. My mother had to sign a fatal-risk-absolving bond to have angiogram done on him. An anxious wait finally revealed that the test was successful and result is: all four grafts placed during the previous bypass had collapsed and the patient requires a very sensitive re-operation with low odds of survival.
After much advice seeking, we decided to take him abroad. As luck would have it, India just had the 2008 Mumbai attacks and Thailand Suvarnabhumi airport was under the yellow shirt seize. So we had no option other than Singapore which was a financial stretch for us. In addition to logistics, taking a patient, an unstable one at that, out of our country is an experience only one who has been through it can empathize. Abba was not at all fit to travel by air; at least the doctors here would not give any such certificate which would have enabled me to arrange for a stretcher and a doctor to accompany him dring the flight. The general medication (NG inhaler) to revive heart function temporarily was not having any effect on him and it was not legal to buy/ carry morphine which was the only substitute. Desperate times called for desperate measures. So I too risked my father’s life - I just put him on a wheelchair and made him travel as a regular passenger.
Thanks to Parkway Healthcare Dhaka office for their sincere support, we successfully set up the critical re-bypass under Dr Saw Huat Seong at Mt. Elizabeth Hospital, Singapore within a few days. After a series of stabilization procedures and high-tech medical support for several days, he was ready for the surgery. During this time at one point his failing heart had to be revived on an urgent decision of installing a “balloon pump” inside the heart – and it was done in 30 minutes that included decision-making, having the doctors and staff coming in from a weekend holiday, setting up the OT and the procedure itself. Surprisingly no one asked to sign a bond, deposit a fee, get blood donors or wait while blood pressure and diabetics is under control. Finally it was an 8-hour long surgery ending with Dr Saw’s remark "What a mess inside, but we were able to fix it".
After the surgery, Ryan met with the doctor to learn more about the whole situation. Inside the OT Dr Saw had taken pictures of the heart vessels and previous grafts and cordially invited Ryan to a 1-hour long session describing what went wrong and what was fixed. It should be mentioned here that Dr Saw performs on average one bypass surgery per week and uses most of the time for teaching and research in his field.
It turned out that the previous operation was done using beating heart surgery method although the condition required an open heart surgery. In beating heart surgery, the grafting is done while the heart is beating and still in its place. This cheaper and faster method is used when one or two vessels need grafting and all are on the front part of the heart. The open-heart surgery, on the other hand, requires shutting off all heart functions by replacing them with a “heart-lung machine” which is operated by a highly skilled technician. It takes time to set up this “artificial heart” and costs a significant amount of the total procedure charge – often more than the surgery itself. Once the heart is immobile, it is raised from the rib cage to free up access to the vessels that need grafting. These are less profitable, consume more time and resource and occupy star surgeons for fewer projects.
Now two of the four blockages Abba had were at the back of the heart and still he underwent beating heart surgery. Scuffling, groping and tugging for vessels in a hurry underneath and around a moving heart had left all grafts damaged and in a 'mess'. The methodology applied for the first bypass at United is not mentioned in any of the reports we have been given; so we only have Dr Saw’s word for it.
Just for the contrast, let me state briefly the scenario at the ICU in Mt. Elizabeth where abba was put for 3 days for post-operative recovery. I was allowed to go in at any time and stay as long as I wanted. Doctor advised us to bring him some home cooked meal that would help his appetite.
It was sheer fate that pulled abba through the second heart attack. This attack had ceased oxygen supply to his brain causing the coma; it damaged major parts of his heart tissue reducing heart functions significantly (down to 30%) which remain so till today. Many patients in his situation do not survive and onlookers are left thinking about the divine force deciding life and death.
Much as I wanted then to sue the people who caused my father and my family such suffering, such a long harrowing experience had left me exhausted and I was only thankful that abba was alive. I did discuss with a few friends (journalist, lawyer) but no one was able to direct me to any constructive course of action. I resorted to only advising acquaintances not to go to United Hospital when their family member had a heart problem. The Facebook group Blacklist Doctors: Share your complains against doctors inspired me to recollect it and put it down in black and white, for whatever it is worth.
Also posted in my Facebook Notes.
No comments:
Post a Comment