“Et tu, Brutus?” “Oh, et tu, Brutus.”

Written By- Dr. Geeta Sundar

“She is the patient? “the consultant asks me, pointing to Mrs. A. “Is the Clopidogrel stopped? When can we plan the surgery?”

I look to him, confused to say the least. As far as I know, the patient is not on the said medication. “Uh…”

“You really don’t know?” Anger flares his nostrils. I can see the signs of the combustion initiating. I can feel the tension building. But I know, I am not in the wrong. I know the history of Mrs. A – I had sat with her for an hour, noting everything, getting her ready for the surgery, and surely if such a drug made its way onto any of the charts, I would have made a strong note. “How can you not know? You are supposed to be responsible for the pre-op preparation.” He adds a few more words on how disappointing it is that I don’t care about patients enough to know and work up their history.

I want to give an explanation. I shake my head. I am ready to speak.

But before I can say anything, a senior colleague cuts in. “We can operate 2 days from now sir. Clopidogrel was stopped 3 days ago.”

The consultant nods, agrees, and talks to the patient and family about planning the surgery. But he shoots me a bad glare, one that says how irritated he is with my presentation of this patient.

My mind, and my conscience, clean, I try to take a step towards him to clear the air, but I am stopped by the same senior colleague, who holds me back as the rounds proceed to the next patient.

He looks at me. “I told boss about the Clopidogrel. It was a slip of the tongue. I know Mrs. A is not on it, but I didn’t have time to retract that information.” No remorse coats his face. Just blatant, the lie or whatever it represents rolls, off his tongue. And he expects me to continue the lie and lie to the consultant, as he walks to the next patient.

I am not someone who lies easily. I have found myself exaggerating the impact of a few things every once in a while, like calling a 90 or 99 as a 100, but not where the patient care or treatment of an individual comes into play. I usually am very upfront of the mistakes I make, or the ones I will make, even if that is a sign of under confidence, or shows that I am not competent enough, in the eyes of anyone else. For me, telling the truth is a sign of my confidence. I’ll call a duck, a duck if it acts as one. But for many of my seniors, past, and present, lying is as easy as breathing. And I have fallen prey to the after effects of their lying. The very effect of telling such a lie makes my conscience burn and my principles rot.

What of then, I wonder, once Mrs. A is done with surgery? Wont the consultant remember to put her back on Clopidogrel? And would we end up over-treating her with Clopidogrel, and cause side effects of that? Anticoagulant associated bleeding risk? See? One idiotic man’s lie can create havoc!

Each one, is a Brutus. Back stabbing, selfish and not caring for the ripples that they will cause by their actions.

I keep hoping to meet better individuals and seniors who can prove me wrong, but I haven’t yet been blessed to meet one.

I had a mentor who gave preferential special, immediate treatment to those who spoke his language. He did it so openly that everyone noticed, but no one could do anything about it. Those patients were always seen first, irrespective of the call number they present to the out-patient clinic in, their surgeries were always performed faster than others who might have presented earlier.

Everything worked in their favour. Rounds were done with them in mind, they got the best of the facilities in what was available, whilst the rest were treated as mediocre.

I understand that sometimes, some patients require a higher level of care and follow up than others, but just because they were of a particular religion, spoke a specific language and had connections, shouldn’t change how they were spoken to, or cared for.

The basis of the Hippocratic Oath was that, after all, right? Not distinguishing on creed, race, color, religion, language, gender?

Yet another Brutus. Yet another political play where those with bigger pockets can demand preferential care, and those who have taken the oath agree to play the game, despite knowing better.

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It is said, all is fair in war, love and surgery. But to treat every patient that presents with a surgery reference as a potential case for operating, is a mind-set I can’t get behind. I love to operate as much as the next enthusiastic surgeon, but to try to influence and convince a patient/his family for surgery when medical management or a trial of medical management is better, is cheating in my books.

But there are senior colleagues I have met who just do that. They try to search and scourge imaging just to find a possible loophole, some possible finding, the most unlikely of supportive evidence to prove and justify the need to operate. And so they operate, make mistakes and learn. All in the name of improving their skill set.

I wonder if their conscience is clear, or do they all see things in grey? Just who are they fooling? And if that a bit of induced fear in the relatives’ minds might be enough to give them the consent needed for surgery? How would it feel on the other side of the spectrum, the other side of the table? If they were receiving the same counselling for their close family?

Maybe it will pinch then? Maybe they will reflect back on all their misgivings? Maybe karma will play the upper hand and give them what they deserve?

Maybe.

Brutus shows up again, claiming the unwarranted surgeries, no guilt or shame exuded.