Dr. Zeba Hisam
October 27, 1995 (Published in Dawn Magazine)

I have seen many patients suffering from terminal diseases. But I have noticed, no matter how crippling the disease, the patients look very different than they do during the course of their illness.

I remember one such occasion when I was doing my house job in a medical unit of Civil Hospital. I was called in for an emergency with my senior RMO. We went to attend the patient in the casualty ward. We saw a poor and miserable man of about 60 with gangrene of the left foot extending up to his shin. The wound was so decomposed that the maggots had gotten into it. The old man was in a terrible state. He was disoriented and could not communicate in Urdu as he was from the interior. His son told us that a small scratch had given rise to the evil wound. We immediately checked his blood sugar, which came out to be 395 mg%. The poor man never knew he was diabetic.

My senior RMO refused to admit him as he said the case should be referred to the surgical unit. The casualty in charge called the doctor from the surgical unit, who also refused to admit him on the grounds that his diabetes was not under control. We tried doctors from the orthopedic unit who suggested that we refer him to the vascular surgery department. The vascular surgery doctors suggested the opposite. I felt that we doctors were a useless bunch. The family of the patient looked on helplessly as we ran from department to department. I begged my RMO to admit him in our medical ward to control his blood sugar and to prepare him for an early amputation. I thought that once we had brought his blood sugar under control, the surgical unit doctors would not be able to refuse.

So we admitted him and put him on sliding scale insulin and appropriate antibiotics. I convinced the patient’s attendants that his foot had to be amputated. After that I went to the surgical nit to get him admitted but they said that since it was not their duty to operate I should ask another unit. I kept on running from unit to unit, begging for his amputation. Needless to say, his situation was getting worse. Finally, I convinced the orthopedic unit to put him on the operation list for the following day. I did not leave the ward until operation list was finalized. I was so happy to see my patient’s name on the list.

I went to the ward to inform his family about the operation. I wrote the pre-operative orders on his file, which were to be carried out in our ward and informed the staff. That day when I went to see my patient I was shocked to see someone else on his bed. “Where has my patient gone?” I shouted. The nurse said, “Doctor! What’s wrong with you? This is the same patient.” I looked at him in dis belief. What I saw was not the miserable unhygienic man who had come in, but rather, a very neat looking man with a luminous face, lying calmly on the bed. I immediately removed the sheet from his leg to confirm his identity. Oh yes, the gangrene was still there. The old man was far more coherent and for the very time called me and put his hand over my head and prayed for me. I could not stop my tears as I left the ward.

The next day, I went earlier to shift the patient to the orthopedic theatre myself. I was so happy that day. I ran to his bed- and saw an empty bed with a folded mattress. There was no familiar attendant around. I ran to the doctors’ duty room and inquired about my patient. The night shift doctor told me that he had died shortly after I had left the ward the previous day.

I stood still wondering how many of us were responsible for his death…