Influenced Treatment

It was one of those busy days. I had just finished the wards and was going through the pile of paperwork, when two guys walked into my office. They were tall, stout, round around the middles, and used to walking into offices to get their work done. The stouter fellow looked like a policeman in civil clothes or a village politician in a Marathi movie. “What is it?” I asked them. “This patient’s treatment” the stouter of the two said, and shoved a case paper in front of me as explanation. I took the paper and read the clinical notes. I had seen the patient in the outpatient clinic two days ago. She had pelvic infection and adenomyosis both. I had put her on a course of an antibiotic and an anti-inflammatory drug, and called her with investigation reports after a week so that a hysterectomy could be done on her if the infection was controlled and the reports were normal. “She has been given the right treatment” I said. “Now what else do you want?” “We want her to undergo the operation now”, the guy said “we cannot wait.” “But she has an infection. It must be cured before any operation can be done on her” I said. “Otherwise the infection will get worse and her life will be in danger. I had explained that to her.” “We know additional commissioner Mr. XXX. He is a family friend”. Additional commissioners can have family friends, but they don’t land up in a hospital for poor patients. Even if they do, the fact cannot alter the course of their treatment. I knew this particular additional commissioner and liked him too. But that was not the point. “That is good. Now give her this treatment, and bring her to see me on the next outpatient day.” The guys went away, but it seemed they would return soon. They indeed did so in half an hour. “We went to see the Dean, and we have this note” the stouter guy said. I had no time to waste, but I wanted to settle this issue. “Come in. Sit down” I indicated a couple of chairs. “Let me see what the note says.” He handed me the note and sat down with a victorious look on his face. He seemed to know how to handle government and municipal employees. The note was written by assistant medical officer who sat next to the Dean’s office. I read the note. ‘This patient is known to additional commissioner Mr. XXX. Please give her appropriate treatment”. “OK!” I said. “So can she have the operation now” he seemed pleased with himself at having handled me properly. “The note says I should give her appropriate treatment. So give her the medicines I have prescribed and bring her to the outpatient clinic next week” I said quietly. He could not believe his ears. Finally he managed and got up to go away. He turned around near the door and said, “I have met many people, but not anyone like you. You stick to what you say the first time.” There was some sort of wonder in his voice. “That is because I say the right thing the first time, and it is not in my patient’s interest to change it. Please remember that everyone cannot be managed by bringing about pressure of influential persons, and it not always in your interest too.” It is more than two years since. That patient has still not come to the clinic. Perhaps she went back without treatment. Perhaps she underwent hysterectomy with someone else and had a flare up of her infection. It is just another of those loose ends that remain so.