As a doctor, what is the most dangerous lie a patient has told you?
It was not exactly a lie per se. Just a social fact that was taken for granted.
This is not my story, this is the story of my senior whom I worked under. Let's name him Dr. K. After retelling me this tale, he looked me dead in the eye and told me never to take people's words and their actions in face value. Because people lie, they may have their own reasons, nobel reasons even, but they do lie.
So he got called in for a severe abdominal pain in a middle aged lady, the pain not subsiding with normal pain medications. Only the doctors in the hospital are allowed to prescribe for opioids and as per the paramedics, she seemed to need one. He came to the ER and saw her lying on the bed, all pale faced and sweating. He took her vitals, her pulse seemed to be increasing and her Blood pressure seemed to be decreasing from her previous recording. The look on her face gave away how severe the pain she was in. On examination, her abdomen was cardboard like, seemed like there was pain almost everywhere. He gave her fluids to resuscitate her.
In the meantime, he began taking her history, she told him that the pain started from her left lower quadrant of the abdomen and started shifting to whole of her abdomen. When asked about her last menses, she looked positively scandalised and told him that she was a widow and she had just started her menses that morning.
She never had any tests or imaging done throughout her life because she had been healthy previously. Even her kids were born at home and not hospitals. We didn't have a good enough Ultrasound machine there but there was one which was functional enough. On Ultrasound that he did, he saw a lot of fluid in the pelvic cavity in the female. It could be a ovarian cyst that had ruptured.
A ruptured ovarian cyst was his provisional diagnosis when he rushed her to the OT and opened her up. He gave her an option of going to a higher centre but since she didn't have enough money to afford it and the fact that ruptured ovarian cysts are a gynaecological emergency, plus her vitals were unstable, under high risk consent, he performed an exploratory laparotomy.
This is what an incision for exploratory laparotomy looks like. Picture taken from Google.
And therein, in the pool of the blood in her pelvic cavity, was the proof of her indiscretion, a floating barely formed fetus. It was a ruptured ectopic pregnancy, not a cyst. He had assisted on just two of these surgeries beforehand, and now he had to do it on his own. He just calmed his nerves and did whatever he could to clean the blood, removed the fallopian tube and the ovary of the left side, made sure she wasn't bleeding from anywhere and closed her up.
In the post operative room, he told her about what he had found. He then asked her why she lied about her menstrual history, a lie that had cost her, almost her life.
Dr. K is a very daring doctor, the most daring I've ever seen. I've seen him take risks and perform procedures without ever doing it beforehand by studying about them extensively, he would call his seniors while performing any operations when he got confused and ask for opinion, inside the theatre. And he did it all for those who couldn't seek medical help elsewhere. I've never met any GP as of yet who has ever matched upto him in knowledge, skill and attitude.
And even he got duped by dismissing one of the most important differential diagnosis in a fertile female with lower abdominal pain, a ruptured ectopic pregnancy just because she said she was widowed. And in a conservative society like ours, when your husband is dead, there is no more sexual activity, or that's what is preached.
After the surgery she got better but she asked him to lie about her diagnosis to her children and her family because she didn't want to be a social pariah amongst her village. So everyone was told that it was an ovarian cyst that had ruptured.
This event occurred in a rural hospital run by a single GP, some medical officers, some paramedics and not in a big city hospital gynaecological procedures happen routinely.
So the moral of the story is please please please be straightforward with your doctors. No matter how shameful your secret is, trust us, we've seen worse. We try our hardest not to judge. We have been trained for it.
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