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Too good is bad…

I was operating upon a case of Calculus pyonephrosis. It is due to outlet obstruction of the kidney due to a huge stone. The kidney gradually enlarged in size, went into a condition called hydronephrosis and ultimately because of the attacks of infection, the fluid was converted into pus. It had practically become a bag of pus with one big and many small stones floating in it.

When we opened it, there was a rim of functionless tissue, which once was the cortex of the kidney. It was useless to preserve that gone kidney. In these patients if you rather try to preserve it, it spoils the other healthy kidney also due to infection and some unknown reasons. The other kidney had already taken over the body function. Many persons with congenital single kidney or the donors with remaining kidney lead a normal life.

Patient was my friend and had come to me with full faith in me..

I called his brother inside the OT and explained him about the necessity to remove that 'bag of pus' - the gone kidney.

"I know you will do whatever is good for him doctor" was his reaction.

He knew about my relation with his brother.

I took one over smart step (for which I am repenting till date), and an immature decision, out of sheer sentiments.

"Let us not tell this to Bhabhiji. That will disturb her unnecessarily."

"True, how nice of you to think so far."

I was no more a surgeon. Had suddenly become patients relative. One should not cross the limits. Not even of goodness. It is not acceptable. Too much of sweet gives bitter taste, like saccharine. I did not mention about the removal of his kidney in discharge ticket. I did not send the specimen for biopsy as there was no possibility of any malignancy in this case. It indeed became saccharine. I was unaware at that time about the future consequence.

Patient went home well. He made a wonderful recovery. His body responded very well as the load of infection was out. He was happy, so was his wife and brother. He came few times in post operative period and the chapter was closed. He joined his duties, gained lot of weight in the coming months.

Urolithiasis is a metabolic disease. Taking out of the stone does not cure the patient. He is susceptible for the development of another calculus any time in future. with little favorable conditions for the nidus to form and the deposition of stone over it, like simple dehydration or infection or faulty diet. After 4 years or so he again had a bout of pain on the opposite loin this time. He was in Mumbai at that time. His friend took him to a nearby nursing home. Routine X Ray revealed a small stone in the left ureter. Treating surgeon advised an ultrasonography. It is done now a days as an alternative of IVP, to see for the dilatation of ureter due to obstruction. Though the function cannot be seem precisely, but it is safe and gives lot of information. The sonologist also reported about the absence of right kidney. Patient was shocked to see that report. He could not digest it. Meanwhile his brother was transferred to some place far away and was not with him.

I knew all this when I overheard through one of my common friend that they were preparing to sue me. The hot rumors spread against me. It was not expected at least from me, people were saying. Now days it has become a trade to sell the organs. These doctors can go to any extent. I tried to tell him about what had happed through our friend but it did not work as I had also not told his wife. His brother was my only hope, but he also backed off, as he could not face them. He did not want the blame on him about why did he take the decision to allow Dr D.U to take out the kidney. He should have asked his Bhabhi. The topic had become very hot.

My reputation is some how making them reluctant. I am trying to convince them that kidneys cannot be preserved for selling. It is a long tedious process of selection of the donor. Both donor and recipient are operated at the same time in two adjacent operation theaters by two different teams. The kidney is taken out after the patient is ready with his abdomen open to transplant the donor's kidney.

They are confused and say only one thing "But doctor you should have asked us before you took such a drastic decision of taking out my kidney".

When I look back, I was at fault. I should have behaved in a traditional way. You must inform and seek the permission for whatever you do with his body.

When I look back, I was at fault. I should have behaved in a traditional way. You must inform and seek the permission for whatever you do with his body. Most of the times he will say "As you feel better doctor" but that formality is a must.