A famous Chinese academician, Lu Xun once said, “A great mind must demonstrate a great spirit – greeting tragic fate with a smiling face and summon great courage to deal with any misfortunes.” To succeed we must take risks. It is not possible to secure the support and understanding of everybody. Medical care is a complex profession which inevitably may lead to some misunderstandings or complaints. Doctors will always encounter such situations. However, once a doctor has joined the medical profession, he has opted to a career to save life, and is expected to contribute towards this end. As long as it benefits the patients, he will remain happy even if he may be wrongly blamed or accused.
I remember this incident. A young lady was admitted into our hospital with a lower abdominal mass and ascites. Before her admission she had ultrasound and CT examinations done in several hospitals in Guangzhou. The diagnosis was peritoneal metastasis of ovarian cancer. Routine examinations of mycobacterium tuberculosis and ascites cancer cells were negative; chest radiograph did not show any TB lesions. Her stomach was very much distended that she was very uncomfortable. We conducted an experimental anti-TB treatment to no effect. Later we conducted an experimental intraperitoneal chemotherapy for a total of three days, again to no effect.
Our clinical intuition told us that this patient was not having cancer. We therefore decided to perform laparotomy. After stomach incision, we discovered the abdominal cavity was covered with abdominal nodules with peritoneal thickening and hard nodular texture. Clinically, diagnosis of ovarian cancer was established. However, the gold standard of diagnosis is a pathological examination. We took a number of tissues by ablation for pathological examination. Half an hour later, the result was out: abdominal tuberculosis! All the doctors and patient’s family members were very delighted with the finding. After operation, family members of the patients insisted to give us a dinner as an appreciation to us. We acknowledged their appreciation but declined their invitation to a dinner in order not to breach the hospital’s rules.
One of the features of abdominal tuberculosis is once it has been exposed to air, the condition will improve subsequently. After the operation, we began anti-tuberculosis treatment; the patient’s ascites decreased day by day and finally disappeared altogether. Her general condition improved each day. Ten days later, the suture was removed. She was really the most fortunate of all patients. We were all very happy for her.
However, unexpectedly the patient’s family members had more and more grouses against us as her condition improved. They complained to us asking, “Why were you unable to diagnoses it was abdominal tuberculosis until after the surgery? Why did you give her chemotherapy? You are to be responsible for ….”
We do admit that our initial diagnosis was incorrect! However, doctors are not “God’, doctors can only conclude based on all the available information. In the absence of the necessary evidence, we could not conclude with definite certainty that it was abdominal tuberculosis.
Just imagine if we had not performed a surgical exploration on the patient, we would have never come out with the correct diagnosis and the patient would be assumed as suffering from ovarian cancer until she died. Her family would never have any grouses against us. Was that of any benefit to any party? Now she was saved, we were very glad though we had been wronged!