Saturday, March 7, 2015

Not A Medicine At All !!

Mr Venkateshan came to the clinic to get his tooth removed. He is around eighty. Whenever he comes, he invariably mentions his son, whom he says is the best ‘Heart Transplant Surgeon’ in Melbourne. And he also mentions the fact that his son has kept an old pair of his (Mr Venkareshan’s) footwear with him and that he goes to work only after paying respects to them every morning. Mr Venkateshan is obviously very proud of his son and justifiably so. “I told my son that I am getting my tooth removed today. He wanted to know whom I am going to. I told him that I have one of the best dentists right here in Ponda and not to worry”. Needless to say my ego leaped up three steps. I examined the tooth, thought that it might not be very difficult to pull it out and prepared for the extraction. Then I asked him the usual set of questions.

“How is your general health sir?”
“I am fine doctor. See I am eighty but I don’t have any trouble. I drive the  car myself”
“So, you do not have any of the common ailments? Diabetes, blood pressure, heart conditions?”
“Nothing doctor. I am fine. My son arranged for a detailed check up when I went to Australia six months back. They certified me perfect.”
“Oh, that’s very good to hear. Did they suggest any preventive medications?”
“No doctor”
“So, you don’t take any medicines on a daily basis?”
“Nothing doctor. I told you. Why do you want me to take medicines? God has kept me in good health and please let me remain like that”
“I hope you remain so for ever sir, I just wanted to make sure. That’s all”

I did the extraction. It was a bit difficult. The tooth was very long and very firm. But it was OK. I made him sit in the clinic for nearly half an hour, checked for bleeding, confirmed that he was fine and sent him off with few painkillers.

Around five in the evening I received a call from him.

“Doctor I am sorry to disturb you but you see there was some trouble”
“What happened?”
“There was no bleeding when I left your clinic but it started bleeding afterwards. I had a very difficult time”

My heart missed a beat. It always does. Whenever a patient complaints of bleeding after extraction. I have removed may be seventy or eighty thousand teeth and have handled hundreds of bleeding cases but this complaint always makes me anxious and nervous. And if a close relative is a doctor, I am likely to face a court martial for even minor complications.

Once it so happened that a lady who had a heart condition fainted after injection of the local anaesthetic. It was a case of ‘Vaso vagal syncope’, meaning a short spell of fainting triggered by fear (of injection or extraction), or a stimulus like an injection pain or such other ‘trigger’. It had nothing to do with the heart condition and I had taken all the precautions. She recovered and the tooth was removed. But the next day I had to face an inquiry from her brother who called from US.

“Doctor did you check her blood pressure before injecting?”
“What Local anaesthetic was used? Did it contain adrenaline?”
“Had you prescribed antibiotics before extraction?”
“Do you use disposable syringes?”
So on and so forth. So, I was concerned on hearing about the bleeding. About Mr Venkateshan and also about myself. I enquired anxiously,

“How are you now sir?”
“Now it is better” He drawled “I called you just to inform about it.” My heart slowed down a bit. “You see it was my fault. I should have told you that I am taking Warfarin tablets every day” (‘blood thinners’ - medicines which prevent clotting of blood)
“But sir, I did ask you if you take any medicines on a daily basis”
“Of course you did doctor. I told you it was my fault. You see I am taking this tablet for more than twenty years and it has become natural for me like my morning cup of tea. I don’t consider that to be a medicine at all” !!!

This time I was lucky. There was no complication and no court martial. I have come across this tendency a few times in the past. One tablet for cholesterol or half a tablet for blood pressure taken daily is not considered ‘Medicine’. I will have to learn to rephrase my questions in future. 

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