Living On Hope

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“Lately I’ve been running on faith
What else can a poor boy do?
But my world will be right
When love comes over you…..” “Running on Faith”
By Eric Clapton

It was March 2004  when I received an email out the blue to find out if I was available to head The Department of Neurosurgery at a private hospital in Bangalore. I had no plans to leave Canada again as I had  just returned from Bahrain after setting up a Neurosurgery Department there. I slept over the email  and talked to my family and then discussed the details with the hospital.

The following day, I read the mail again and decided to get more details about the hospital. It was a 250 bed multi speciality hospital catering to trauma with no Neurosurgery department.  This, I found a little odd because  trauma service is never complete without a Neurosurgeon being part of the team. I decided the opening would be a challenge worth considering. I spoke to my family and  it was agreed that I give it a try, as I  was offored the position of Chief of Neurosurgery and I could use my expertise to help needy patients. I replied, asking for more details and finally after few phone calls, it was agreed that I would travel to Bangalore in May 2004 and take up the assignment.
My practice was not busy for the first few weeks, but as I expected it was gradually turning busier. It was a Monday, I remember,  when a family came to see me with a child. His name is RG, 8 yrs of age and I could right away see he was very weak on his right side of the body and his face was asymmetrical. The boy’s mother told me – over the last few weeks, she noticed RG has been dragging his right leg and not swinging his right arm as much as left,  and his face did not appear symmetrical. The child had been complaining of headache and had vomited few times. He was also sleeping more than usual.

They lived in Mysore and had taken  their son to a local doctor who suggested he be examined by a Neurologist. The child underwent MRI examination of the brain and the parents were then told  the shocking news that their son had a brain tumor. They were advised to take their son to Bangalore for consultation with a neurosurgeon.

You can imagine the shock and anguish of the parents. They immediately hired a car and rushed to Bangalore  to a well known hospital, only to be told that they had to wait a week before he can  be  examined. They took him to another Neurosurgeon who examined RG and after reviewing the MRI scan suggested an operation to remove the tumor  The  surgeon explained to the parents that the prognosis is poor, he may not wake up after  surgery or that he could even die on the operating table. They obviously didn’t want to take that risk, and decided to wait for a week.

After what must have appeared an eternity, they managed to see the Neurosurgeon whom they wanted to see initially. He told the family, there was nothing that could be done and advised  them to take the child home and let him die peacefully. Two weeks have passed since their initial consult with the  Neurosurgeon and they were in my office looking for any option to save their child. I saw RG sleeping on my examination table, so innocent, oblivious to the fact that he had a brain tumor that could potentially take his life. His breathing appeared labored and he was not moving his right side. Examination revealed that there was increased pressure within his head.

MRI scan showed a tumor in the middle of his brain along with a cyst which was  part of the tumor, compressing and blocking free flow of fluid that normally circulates around the brain and spinal cord. The cavities in the brain were getting larger, filled with fluid and applying significant pressure on the surrounding healthy brain. It was obvious to me that if an operation was not done immediately,  RG could succumb to the tumor. I explained to the family that I agreed with the other Neurosurgeons that  the operation was necessary, but  could be performed without the risk they were warned of. I knew what RG had was a very slow growing tumor but behaving cancerous because of the location. Immediate operation on the tumor was not important but relieving  the mounting intra-cranial pressure was critical.

I spent as much time was necessary to explain to the parents what my treatment plan was and reassured them that chances of his dying were practically nil. This came as a total surprise to them. How could I be so different from other Neurosurgeons? There was nothing I could do except make them aware that time was of essence and final decision was theirs to make.

Finally they told me that they will get back to me in a day. I made a  notation in the patient’s file that his parents were made aware of the clinical condition of the child and that they had decided on their own to take the child home at their own risk. Just prior to taking him home, they asked me what the surgical fee would be for surgery. I told them my own fees would be negligible and that I would  speak to the hospital administration, as I had no control over the hospital’s charges.

The following day, the parents brought RG back to me. He looked more lethargic and apparently had vomited few times. They had decided to go ahead with my plan of treatment and told me the child’s life now was  in my hands. The boy was immediately admitted to the hospital and a CT scan of the brain was ordered in preparation for the surgery. Following CT scan RG was taken to the operating room and underwent uneventful placement of what is called Ventriculo peritoneal shunt. This procedure involves  placing  a catheter in the cavity of the brain, bringing it outside his skull and connecting to a pressure regulated valve. Then attaching  another catheter and running it under under his scalp and skin all the way to his abdomen.  The fluid that was blocked from normal circulation and was applying pressure on the normal brain was now  bypassing the tumor and was emptying into his belly. Once there, it would  get absorbed  to re-enter  circulation again.

The whole procedure took about 2 hours and in the recovery room RG was awake. The following day, he was sitting in bed drinking juice and same day he was started on soft diet and he was discharged on the 3rd day and went home walking. Instructions were given for follow up.

I saw him about a week later for suture removal and he looked bright and parents told me his walking and speech had improved significantly. The shunt I had placed appeared to be working well. Parents were advised to bring him back to me in 3 months for further follow-up.
Subsequently I went on vacation to Canada.  When I was  there, I was informed that  RG became drowsy again and his parents contacted  me  in Canada.  I suggested  an MRI scan of the brain to be done. It showed the cyst that was part of the tumor had increased in size and was applying pressure on the brain stem. I advised they take RG to a Neurosurgeon right away rather than waiting for me to return to Bangalore. He was seen by a Neurosurgeon in Mysore, who assured them that he could do the surgery using a specialized equipment called a Neuroendoscope.
The surgery went well but RG did not show any improvement. When I  returned to Bangalore, I told the family to ask the surgeon to order a CT scan of the head. By this time the surgeon realized what lay ahead  and  informed  the parents that he could not locate the cyst and that he closed the surgery. His bill was Rs 75,000 and hospital bill was for another 30,000. He refused to return the money and discharged RG home!

I saw RG in my office and once again I admitted him to hospital. The next day he underwent uneventful surgery and as earlier he improved immediately and was discharged home after 3 days.

At the time of writing this real life story, RG is doing well and is attending school and is involved in minor non contact sports. It will be 2 years this May 2006 and I am sure he will continue to do well.
May God Bless RG….

Author: Dr K.B. Mallya- Canada

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