Blink and a Lucky Save

That patient came to our outpatient clinic like any other patient two weeks ago. She was 50 years old. She had had abnormal uterine bleeding, and had undergone a D & C operation in a private center. She came to us with a report of severe hyperplasia of the endometrium. I found that she had a six weeks’ size uterus and no other abnormality. “Shall we post her for a hysterectomy, sir?” asked my resident doctor. It seemed a reasonable question. The treatment for severe hyperplasia of the endometrium in a woman above 50 would be hysterectomy. But I had a thought without conscious thinking, like that fellow Malcolm Gladwell had written in his famous book ‘Blink’. “She will need hysterectomy” I said. “But let us be sure that we don’t make a mistake.” “Mistake?” “Let us ask for the slides and paraffin block from her pathologist, and request our pathologists to report the slides.” The resident doctor arranged for that. The patient came back to see me today morning. She had the report given by our pathologists. It was ‘endometrial adenocarcinoma’. “If we had believed that first report, we would have performed a total abdominal hysterectomy and bilateral salpingo-oophorectomy on her. That would have been grossly inadequate treatment for her. Now she can undergo extrafascial total abdominal hysterectomy and bilateral salpingo-oophorectomy and pelvic and paraaortic lymph node dissection.” I told my wife about this and said “was the woman lucky to have a correct diagnosis made before undergoing surgical treatment!” “She was lucky she landed up in your cabin at the first visit” she responded. “Umm…” I said and I think I blushed (at the age of 53!). “Don’t look uncomfortable” she said. “My patients going to public hospitals tell me about their experiences there. What I said was correct, not something said just to please you.” I knew she would never say something just to please me, not after 23 years of married life.