Mitral stenosis is a form of rheumatic heart disease that seems to plague patients even today. It happens to be the most common form of such illnesses. It is also the subject of a number of stories that I have yet to tell. This post is the first one in the series.
In my early days after qualification, I was posted as a Lecturer at a peripheral hospital briefly. There used to be a great shortage of anesthesiologists then, which has only increased manifold over the years. We had to give local anesthesia and sedation to our patients scheduled to undergo minor procedures. I used to do that regularly. We had a complex of operation theaters, in which there were tables for Obstetrics and Gynecology, General Surgery and ENT. The other specialty Resident Doctors had heard of me giving local anesthesia and sedation to my patients. One day the House Officer from the General Surgery department came to me in the OT and said,
"Will you please give spinal anesthesia to my patient? He is a young fellow with a hydrocele."
"Let me have a look" I said. He took me to the patient who was lying down on the operation table in the surgical OT. I asked his history and auscultated his heart and lungs.
"Hey, he has got a mitral stenosis" I said. "Did you not know about it?"
"No" he said and gave me a look.
"Auscultate his heart" I said. "He has a classical middiastolic murmur with presystolic accentuation."
"So will you anesthetize him or not?" he asked me. I was aghast.
"Sorry, no" I said. Get him checked up by a cardiologist and anesthesiologist. He requires proper anesthesia by a specialist. You should examine your patients before posting them for surgery, or one day you will lose a patient. That will also get you into deep trouble."
He did not seem to like my advise. He took the patient out of the OT anyway. I was worried that he would not improve. So I warned his Lecturer about this. He also gave me a look, but at least promised to talk to the House Officer. I don't know what happened to either of them, and what they are doing today. I only hope their patients and they are OK. This happened thirty years ago. There are new players, but mitral stenosis continues to be ignored. We shall see different aspects of this in the subsequent posts.
In my early days after qualification, I was posted as a Lecturer at a peripheral hospital briefly. There used to be a great shortage of anesthesiologists then, which has only increased manifold over the years. We had to give local anesthesia and sedation to our patients scheduled to undergo minor procedures. I used to do that regularly. We had a complex of operation theaters, in which there were tables for Obstetrics and Gynecology, General Surgery and ENT. The other specialty Resident Doctors had heard of me giving local anesthesia and sedation to my patients. One day the House Officer from the General Surgery department came to me in the OT and said,
"Will you please give spinal anesthesia to my patient? He is a young fellow with a hydrocele."
"Let me have a look" I said. He took me to the patient who was lying down on the operation table in the surgical OT. I asked his history and auscultated his heart and lungs.
"Hey, he has got a mitral stenosis" I said. "Did you not know about it?"
"No" he said and gave me a look.
"Auscultate his heart" I said. "He has a classical middiastolic murmur with presystolic accentuation."
"So will you anesthetize him or not?" he asked me. I was aghast.
"Sorry, no" I said. Get him checked up by a cardiologist and anesthesiologist. He requires proper anesthesia by a specialist. You should examine your patients before posting them for surgery, or one day you will lose a patient. That will also get you into deep trouble."
He did not seem to like my advise. He took the patient out of the OT anyway. I was worried that he would not improve. So I warned his Lecturer about this. He also gave me a look, but at least promised to talk to the House Officer. I don't know what happened to either of them, and what they are doing today. I only hope their patients and they are OK. This happened thirty years ago. There are new players, but mitral stenosis continues to be ignored. We shall see different aspects of this in the subsequent posts.
