An elderly 67 year old female, diagnosed case of a metastatic cancer was a regular patient coming to my emergency department. She would often present with complaints of pain, constipation, low blood sugars, low blood pressure, neutropenic sepsis, and all sorts of post chemo therapy complications. She used to regularly call for our Ambulance services to bring her to the hospital, and also had a caretaker with her 24×7.
Since her husband was a retired army officer, her treatment was free of cost at the designated Army Hospital in Mumbai. Hence she never got admitted to my hospital, but would always prefer to be shifted to the Army hospital for further management, after taking primary treatment in my emergency.
There were also instances when there were requests made for a hospital ambulance to be sent and when my team would reach her home, her husband would request the ambulance to be taken directly to the army hospital 40 kilometers away, a service which most corporate hospital ambulances do not provide with their own ambulance, but provide outsourced ambulances with whom they have a tie up.
I had myself attended to & treated her on multiple occasions and could palpate the agony and frustration on the face of the elderly, frail husband. Children had settled abroad leaving the elderly couple to fend for themselves, grappling with struggle every single day.
Citing her chronic pain management, the husband had many times requested me for a prescription of inject-able sedatives, which I always turned down, and told him that she will need to be under monitoring in the hospital if administered the same (overdose of sedatives can cause respiratory depression, circulatory collapse and death). Such prescriptions are always given by a registered medical practitioner with their stamp and registration number.
It so happened that on one of night duties, the husband came to my Emergency department, alone, and was attended to by a young, freshly passed MBBS graduate doctor, who was unaware of the background history of his patient, and the possible complications of such drugs. The senior doctor with her on duty had gone to shift a patient to the ICU, and got busy there after the patient crashed in the ICU and needed resuscitation.
Sensing an opportunity, the old husband started crying and begging the young doctor for the prescription of the injectable sedative, saying his wife could not sleep due to the pain. Initially she refused, but subsequently gave in to her emotions seeing an elderly man crying like that. Call it immaturity, or lack of experience & far farsightedness, she wrote him the prescription for a vial of the sedative.
Within 2 hours, the patient was brought dead to my Emergency! And one need not be a doctor to guess the probable cause of death.
I refused to issue a death certificate, knowing that it was MOST LIKELY due to the sedative overdose, which the patient might have been administered, by the husband, or by the attending caretaker at the insistence or instigation by the husband (you don’t have to be a healthcare worker to know how to load drugs in a syringe and press its plunger), which would count as a murder in a court of law. At the same time, knowing her case, I did not initiate medico-legal formalities. There was neither any visible evidence for me to do that, nor did I see a point in making the old man suffer any further.
She was then taken to the same Army hospital, where her treating doctor, unaware of the entire plot, issued a death certificate which read – Metastatic Cancer, as the cause of death.
Till date, I don’t have an answer: Who was right and who was wrong? The husband or me?
But whether I find out or not, I continue walking the tightrope of medical ethics every day.