Falling crossCan we avoid medical disasters? Some say, “Jump high, jump low; when you die, it was your time to go.”

Others declare that “some deaths are preventable and we should do all in our power to give citizens the chance of long, fruitful lives.” It would be interesting to know what you think…

A young lady came to my office one Saturday morning for a routine medical certificate. Afterward, her accompanying 30- year-old boyfriend asked if I could review some test results for him. The scan for kidney stones ordered by Accident & Emergency turned out normal.

“What’s the price of a visit?” he asked.

I pointed to the poster showing the standard first visit price along with the lower second visit price.

“Well hers is the first visit, mine is the second, right?” he observed.

“Not a problem.” We all laughed.

The young man’s right lower abdominal pain had been getting worse. I suspected appendicitis. I requested urgent blood tests and ultrasound of the appendix. By the time the new results confirmed the diagnosis, the young man could scarcely walk. I administered a pain shot in the right hip.

“You’re going to need surgery as soon as possible – today,” I informed him.

“How long will I be in hospital?” he blurted out, mindful of his considerable college and church music leadership responsibilities.

“Four to five days if the appendix is not ruptured; maybe a couple weeks if it is. But don’t worry about it,” I reassured, “…you’ll do just fine.”

“Thanks Doc,” he managed bravely.

I left patients in my office and rushed the young man to A & E. I registered him, handed over his test results to the staff and personally situated in him in the back treatment area. I patted him on the back and told him to feel free to call and update me on how he was doing.

He never did.

Five days later, I got a call I will never forget. The exact moment my mind flashed on him, a senior consultant rang with a short, direct and compelling message, “The patient you brought to the hospital, they operated on him three times. He is in ICU. The family is there crying. You might want to go visit them.”

My blood turned cold.

Was he operated on the day I brought him?

It pains me immensely to discuss these matters in public. But trust me, failure to do so only guarantees that it will simply be swept under the bed.

At the funeral, his colleague and parish priest Fr. Peter Hill pleaded with mourners, “If you promise me you won’t cry, then I promise you I won’t cry.” It was an amazing celebration of this young man’s life. Remarkably, it appeared that family and friends had already exhausted their supply of tears – only to be refilled in the days ahead.

A young man, otherwise in perfect health; a young man so full of grace, talent and promise – it is as if he was snatched from us in slow motion, right before our very eyes. His family and friends, his church and college are racked with grief, shock, and helpless anger. As a surgeon who has performed hundreds of appendectomies without ever losing a patient, this experience was particularly galling.

Family and friends have warned me about writing this article. They cautioned me against saying anything that would offend high officials and portray my professional colleagues in a bad light. They say if I did, I would be sure to just stay and ‘cani’ in Dominica or forced to run away as the others do.

Oh please! I bend over backward to be fair and balanced. In defense of my surgical colleagues, in is important to understand that the appendix is not always in the typical position (in red) at the belt level, in a straight line connecting the navel to the right hipbone. In darker populations the appendix is more likely to be in a retrocecal location .

This can make it more difficult at first to diagnosis and operate. Anywhere in the world, A & E doctors would be forgiven for making that first decision.

appendix

There are many dedicated professionals at the Princess Margaret Hospital who make do with little as they diligently perform their appointed tasks. I never miss an opportunity to commend and encourage them. Yet, given the litany of complaints, an increasing number of people express fear of ending up there.

Those who can, at the earliest opportunity, go overseas to give birth or for even the most basic surgeries. Not everyone can hop on a helicopter at a drop of a hat. Their lives matter too. Now returnees are returning back to the developed countries. And it is not necessarily because they believe they will live longer or better. They return primarily because in those countries, their medical questions are answered promptly and courteously. They return because there is a culture of using the best-trained doctors. They return because there are strict systems that address mistakes openly, and take timely steps to correct them.

Having said that, one of the strange things I discovered upon my return to Dominica was the extent that intelligent, grown men and women will go to dodge speaking up about glaring issues that affect us all. They would look around, lower their voices and use disclaimers like “Don’t say I said that, but…” or “You didn’t hear that from me, but…”

There is a reason why I turned down job-offers to practice surgery in Tortola and Cayman Islands. I was born at Princess Margaret Hospital and by the grace of God I will operate there as a consultant surgeon. In a sense I already have. Shortly after my certification with the American Board of Surgery in 1991, I had the privilege of bringing down sophisticated laparoscopic equipment and training Dr. Paul on advanced gallbladder surgery techniques.

I trained at St. Barnabas Medical Hospital, the most advanced hospital in New Jersey. There we performed countless dialysis catheters and fistulas as well as kidney transplants. I even arranged and helped operate on Dominica’s first ever sister-brother kidney transplant Francis Philbert originally from LaPlaine. Today, their flourishing Florida church, Garden of Grace Ministries, is one of those in the forefront of Erika relief/ Rebuild Dominica effort. I am now working with Carlton Stoute, an evacuee from Petite Savanne. With the help of Dominicans in the Diaspora and friends of Dominica, I am confident that we will find a way for him too.

kidney recipients

Kidney recipient Francis with his wife Rev. Norma Fountaine-Philbert

I have repeatedly, patiently and respectfully discussed my application to operate with the Hospital Medical Director, the Chief Medical Officer, Permanent Secretary, Minister of Health and even the Prime Minister. Did I ever get a single written response? Nevertheless, I have stayed busy, blessed and enjoying God’s favour.

But there’s more: I volunteered at the Cancer Clinic for 5 months while waiting for my Dominica license. Dr. Malaker of Ross University volunteers as head of that department. Arising from our discussion, he organized a special overseas refresher course for me (not funded by government). He then mentioned that higher-ups insisted that if Dr. Christian was to attend, a current hospital surgeon should go as well. “The more, the merrier,” I responded enthusiastically.

Months later, Dr. Malaker and I greeted each other in the hallway.

“How was the course?” he asked.

“Still waiting,” I answered.

He was stunned. He revealed that hospital surgeon had gone on the course that we had arranged! This experience is not unique to me. Just ask any of the doctors trained in the UK, US or Canada.

Do some die before their time? You decide. Can you imagine how far we will go when we truly begin to put our country first? Openness, fairness and appreciation of the gifts that others bring to the table will help prevent such senseless tragedies. May our faith comfort those of us who bear this incredible loss. But let it not be in vain. Stay focused on the promise that all things work together for good. Stay calm and carry on.

Dr. Sam Christian is surgeon who runs the Urgent Care on 137 Bath Road, near the Windsor Park Stadium in Roseau. For more on Dr. Christian, please log on to http://urgentcareda.weebly.com/dr-sam-christians-bio.html