Influential Brother

She was a girl in her early twenties. She came to us with vague abdominal pain, probably related to bowel upset, but during the check-up we found she also had an ovarian cyst about 7-8 cm in diameter. We performed ultrasonography and a CT scan, and confirmed she had probably a benign cystic tumor. All was going OK for her. But unfortunately she had a brother who was politically connected. So he went to the first citizen of the city and brought a reference note. I had not seen her till then. He met me during my antenatal clinic, and showed me the reference note. “My sister has this condition for which she has been advised an operation.” “That is correct” I said, seeing her examination findings and reports. “But now the anesthetists are saying she must have this X-ray and this blood test.” “That is correct” I said. “Without those tests, we won’t know if it will be safe to give her anesthesia for that operation.” “But those tests should have been done before. Now she will have to wait for another week.” “What has happened cannot be undone” I said. “She must have those tests done. If you want her to undergo further treatment, get those done. If you want disciplinary action taken against whoever who did not advise these tests before, put up a written complaint in my office. I will investigate the matter and take necessary action if required.” He seemed to understand that and went away peacefully. She came again after a week. I saw all her reports and advised a laparoscopic surgery, with readiness to perform a laparoscopy if required. She went away with an appointment for hospital admission. Her brother turned up the same afternoon during my antenatal clinic time and demanded to see me. I could not leave the pregnant women who had queued up for being examined. So I sent a message that he should wait and I would see him after the clinic was over. He sent his visiting card as reply. It said he was a lawyer. I suspected those were intimidation tactics. I told my Registrar to talk to him and ask him to wait for the clinic to get over if he desired to see me personally. She came back in five minutes. “Sir, he said he is connected to a political party which is the ruling party in this city. He said his sister is not married yet and how can she be subjected to an operation by opening her abdomen. He said he has come from the first citizen of the city. So I told him to get the operation done by the first citizen if she knew better.” “You said that?” I asked in amazement. “No sir. I said that part in my mind.” I smiled. That girl would do well in life. I finished the clinic work and called him in. “Doctor, my sister is not married. How can she have an operation by opening her abdomen?” he said. “If that is necessary, it has to be done.” I explained. “She has an illness, and whatever treatment has to be given must be given. We will try to get the cyst removed by laparoscopy, but if it cannot be done, we will open her abdomen.” “But doctor, open her abdomen through a small incision” he said. It had probably to do with her prospects of marriage. “We always make the smallest possible incision” I assured him. “If we make bigger incisions, we have to work more and spend longer time suturing it.” He did not seem to be totally reassured. “You are a lawyer, are you not?” I said. “”Yes.” “Surgery is not like law. In legal practice, longer the case drags on, more the money the lawyer makes.” “No, no!” he protested “I usually try and get quick decisions.” “I know about legal practice. Every time a lawyer appears in the court, he charges the client” I said. “A doctor does not make more money by prolonging the operation. So rest assured, we will make the smallest incision compatible with successful outcome. But if you want some surgeon who will guarantee that the cyst will be removed by laparoscopy alone, I will recommend another doctor. That one makes that promise.” I mentioned a name of a doctor in another hospital of the corporation. I did not say that doctor always kept that promise. He was probably shrewd enough to understand what I was saying. “No doctor. We want her to be treated by you,“ he said. “I will get her admitted in the hospital tomorrow.” He went away, but did not come back. His sister did not get admitted as scheduled, and the OT time slot reserved for her was wasted. Perhaps they went in search of that doctor who would give the guarantee I would not give. I wish her luck.