Respected surgeon gives docs rap on the knuckles

Much respected retired Professor of Surgery A. H. Sheriffdeen has questioned the failure on the part of the Lady Ridgeway to promptly treat a 10-year-old, boy with a ruptured appendix due to the non-availability of a senior surgeon at the premier paediatric hospital in the country.

The incident took place on Aug 22. Dr Sheriffdeen has brought the incident to the notice of the President, College of Surgeons of Sri Lanka, requesting the outfit to inquire into the incident.

The following is the text of the letter addressed to the CSSL President: “I write this letter following a bout of acute depression and a sense of hopelessness following an incident that occurred on Saturday 22nd August 2020.

I saw a 10-year-old boy at Ratnam’s Private Hospital around 11 am with an obvious clinical diagnosis of acute obstructive Appendicitis. The mother said that she could not afford treatment at a private hospital, so I gave her a letter to the Lady Ridgeway Hospital, assuring her that the boy would get the best possible care. The grandmother was screaming that she would pawn all her jewellery and take prefer treatment at a private hospital, but I again reassured her that I had faith in our trainees and doctors.

On the same day, at about 8.30 pm, I got a call from the boy’s father to say that the junior doctors had told the family that the appendix had ruptured, that the boy needed major surgery by a Consultant and there was no Consultant available. No solution was offered. They were desperate and agitated.

I told them that I did not do emergency surgery at night and suggested a few names and Private Hospitals they could go to.

That was when the depression hit me. Why, I asked myself repeatedly, why am I wasting my time? Why am I wasting my time talking about professionalism and ethics? Why did I waste my time chairing the Committee that produced the Book “Professionalism and Ethics in Surgical Practice” where in Chapter 2 on “Total Patient Care” this scenario is dealt with? Do not these doctors or their near relatives have 10-year-old sons whom they care about? How would they feel if this incident occurs to them?

Why are we wasting time talking about modern techniques, recent advances, updates, laparoscopic and robotic surgery, mentoring programmes, Scientific Sessions, workshops and so on when a 10 year old is left to die from a ruptured appendix due to non-availability of a senior surgeon at the premier Paediatric Hospital in the Country – in the whole of Sri Lanka?.

Professor Milroy Paul was my Professor of Surgery. This was in the early 1960s. He had a surgical Ward in the Lady Ridgeway Hospital. I have seen him driving his old Riley car in black trousers and white dinner jacket with a black bow tie arriving at the hospital at 10 pm to do a tracheostomy in a child with Diphtheria and stridor. He obviously had been at a dinner dance. Mind you, there were no pagers, mobile phones. He always left a contact land line number in the ward and if this method failed to contact him, the registrar was expected to go to the hotel by car or taxi to summon him. He always came promptly. The patient mattered more to him than that dinner, than that dance.

The government gives duty free cars to our doctors just for this purpose. Mobile phones are freely available. Contactability is not an issue. But something is lacking, is it not? All the fancy cars, all the fancy mobile phones did not help this child in an hour of need.

That is because we lack commitment- a commitment to care, treat and cure regardless of day or time-a commitment not to betray the trust – betray the trust that mothers, fathers, grandparents, brothers, sisters, children place in you.

There will be the usual explanations but they will only serve to compound the issue as trying to get explanations or hold an enquiry is usually an attempt at cover up. It needs a change of culture, a paradigm shift.

The child may have survived, but that is totally irrelevant to the issue at hand.

More ruptured appendices, acute abdomens, general, orthopedic, neurosurgical, urological, cardiothoracic, vascular etc. emergencies – more excuses; will they not end?

I am writing this as therapy for my depression. The foul taste will not go away. As a Medical administrator once said, “Patients will die, it cannot be helped!”