"Sir, we have received the histopathology report of Mrs. XXXX" my Registrar said.
"What about it??" I asked. We got such reports of all our operative cases. There had to be something unusual about it for her to say so.
"It says 'material inadequate. Do a deeper curettage'".
I remembered that patient. The material had been scanty when we had done a dilatation and curettage. But that had not been due to any lack of effort.
"I remember. The operating surgeon had done a really good curettage, despite which there was hardly any material" I said.
"So what shall we do?" the Registrar asked.
"The endometrium was atrophic. So there was no material. We cannot get any material if we repeat the curettage and curette deeper as the pathologist has suggested. We have to treat her condition appropriately, based on her symptoms. Let her see me when she comes to the outpatient clinic the next time."
The Registrar went away. This was the second time someone had erroneously told us to dig deeper into the endometrium. This time it had been an Assistant Professor of Pathology, while I was Professor and Head of my department. The first time it was the Assistant Professor of my department while I was a first year resident doctor 34 years ago. That patient was young. She had abnormal uterine bleeding.
"Admit her and do her endometrial curettage" the Assistant Professor told me.
I did that. The patient came for a follow up. Her histopathology report was 'proliferative endometrium'. She was still bleeding. Instead of treating her with appropriate medicine, like a progestin, the Assistant Professor said, "you have not done a good job. Admit her and do her endometrial curettage again."
I knew I had done a good job the first time. But there was military discipline in the civic hospital. So I followed orders and repeated the curettage. The report was still the same, and the patient continued to bleed.
"Can't you do a good curettage? I am telling you, do a GOOD curettage" the Assistant Professor said.
So I admitted the poor woman and did a good curettage a third time. The third report was ' endometrium in prolifeative phase. Bits of myometrium seen.' When the Assistant Professor saw that report, she said, "I think you have done a good job. Though she is still bleeding, don't do a curettage again. She cannot afford to lose myometrium. We will treat her medically." I don't know what treatment she gave to that patient. But I do know that she did not teach me the right management of such a patient, probably because she did not know it herself. I had to learn it from her mistake, and by reading books on my own.
"What about it??" I asked. We got such reports of all our operative cases. There had to be something unusual about it for her to say so.
"It says 'material inadequate. Do a deeper curettage'".
I remembered that patient. The material had been scanty when we had done a dilatation and curettage. But that had not been due to any lack of effort.
"I remember. The operating surgeon had done a really good curettage, despite which there was hardly any material" I said.
"So what shall we do?" the Registrar asked.
"The endometrium was atrophic. So there was no material. We cannot get any material if we repeat the curettage and curette deeper as the pathologist has suggested. We have to treat her condition appropriately, based on her symptoms. Let her see me when she comes to the outpatient clinic the next time."
The Registrar went away. This was the second time someone had erroneously told us to dig deeper into the endometrium. This time it had been an Assistant Professor of Pathology, while I was Professor and Head of my department. The first time it was the Assistant Professor of my department while I was a first year resident doctor 34 years ago. That patient was young. She had abnormal uterine bleeding.
"Admit her and do her endometrial curettage" the Assistant Professor told me.
I did that. The patient came for a follow up. Her histopathology report was 'proliferative endometrium'. She was still bleeding. Instead of treating her with appropriate medicine, like a progestin, the Assistant Professor said, "you have not done a good job. Admit her and do her endometrial curettage again."
I knew I had done a good job the first time. But there was military discipline in the civic hospital. So I followed orders and repeated the curettage. The report was still the same, and the patient continued to bleed.
"Can't you do a good curettage? I am telling you, do a GOOD curettage" the Assistant Professor said.
So I admitted the poor woman and did a good curettage a third time. The third report was ' endometrium in prolifeative phase. Bits of myometrium seen.' When the Assistant Professor saw that report, she said, "I think you have done a good job. Though she is still bleeding, don't do a curettage again. She cannot afford to lose myometrium. We will treat her medically." I don't know what treatment she gave to that patient. But I do know that she did not teach me the right management of such a patient, probably because she did not know it herself. I had to learn it from her mistake, and by reading books on my own.
