"Yes, I've seen several doctors. They've all given me medication. It gets better when I take the medicine, but the fever returns. I keep changing doctors because the fever doesn't stop."
She and her husband were living in Tamil Nadu. Due to the approaching delivery, she had returned to her home town. Initially, I suspected that malnutrition and fatigue due to poor nutrition could be contributing to the issue. When I examined her during the OP, she didn't have a fever. I began to doubt whether the fever was more of a feeling than an actual symptom. However, I still had to investigate the cause of her fatigue and any possible skin rashes.
On examination, I didn't find anything significant apart from the rash. I couldn't examine her abdomen thoroughly due to the pregnancy, but I noticed some red spots on her hands. When I asked her about them, she said they had been there for a while and hurt when pressed. I decided to examine her more thoroughly later and consult a skin specialist.
Fever, fatigue, and anemia—any doctor would immediately consider these symptoms. I ordered some tests to check the cause of the anemia and asked the nurses to monitor the fever more carefully. It was essential to be sure about the fever before proceeding.
In the meantime, she delivered a premature baby. The baby was severely underweight, so naturally, I admitted the baby to the Newborn ICU.
Later that night, during rounds, I saw her again. She was now running a high fever. She seemed to be struggling to speak.
"Are you having difficulty breathing?" I asked. "Yes." "Is it worse when you're lying down?" "Yes."
I asked more questions, then rechecked her condition. I noticed that some previously unnoticed murmurs in her heart were now audible. I suspected an infection in the heart valves—Infective Endocarditis. The infection was causing leaks in the heart valves, which in turn disrupted the heart's function. Small blood clots, containing bacteria and other particles, were likely traveling through her bloodstream to other parts of the body, causing blockages in blood vessels. I suspected that the spots on her hands were small emboli that had traveled from the valves. If the clots reached the brain, they could cause paralysis. The earlier observations had missed this critical condition.
The initial blood tests confirmed my suspicions—low hemoglobin and platelet count, and elevated ESR levels. These results pointed to an infection.
I consulted with a cardiologist and started her on antibiotics to control the infection and medications to support her heart's function.
An echocardiogram confirmed the infection. The valve was leaking, and if her condition worsened, surgery would be required to replace the valve. However, this was a major surgery, and her health was already compromised. The risk of death during surgery was high.
After rounds, I went to see her again. Within a short time, her condition had worsened. She could barely speak due to breathlessness, and her arm was showing signs of a blocked artery, turning blue.
We had all the facilities for heart surgery in the hospital. There was a full-time surgeon and an on-call surgeon. I discussed the situation with the surgeon.
"Jamal, there's no barrier to performing the surgery, but we need to consider other factors. In an unstable patient, emergency surgery carries a high risk of death. In a large corporate hospital, people might accept such a death, but in our hospital, they might react differently. There could be protests, attacks on doctors—it's something we need to avoid."
The surgeon's concerns were valid. In today's world, doctors often have to weigh their professional risks, given how society sometimes turns against them. The same situation was clear in this case.
As her condition worsened, we considered referring her to another hospital. However, I realized that if no other hospital was willing to treat her, we had to take a risk. After discussions, we decided to transfer her to a hospital in Kochi.
I reached out to a well-known cardiac surgeon in Kochi, and after a brief consultation, we decided that she could undergo surgery there.
The next morning, while checking the OP, I received a message from the Kochi hospital with an image of the damaged valve. The surgery had been successful, and I was overjoyed to hear the good news.
A few months later, I saw the woman walking with her child in another hospital. She didn't recognize me, but seeing her healthy and walking with her child was a moment of great joy for me.
This case teaches some important lessons. Infective endocarditis is a rare condition, which is why doctors may not immediately recognize it. This woman visited multiple doctors for the same condition, but if she had stuck with one doctor, the issue might have been diagnosed sooner, and she wouldn't have reached such a critical stage. The importance of having a clear diagnosis and following through with the same physician cannot be overstated.
In this case, the patient survived, but she will need to take blood-thinning medication for the rest of her life to prevent further clotting. The surgery could have been done at our hospital for less cost, but due to the prevailing unsafe conditions for doctors in society, the patient was referred to a bigger hospital.
The mental pressure and effort that doctors face in such cases often go unnoticed by others, and this story highlights how people often misunderstand the complexities of medical practice. When a patient dies, it's seen as a medical failure, but the public needs to understand that death doesn't always mean medical error. If this understanding grows, the pressure on doctors will reduce, and they can continue to do their work with less fear of unjust blame.