Subashbhai was worried…..He had noticed that he felt full after eating one “rotla”….Earlier, he would a dozen rotlas and ask his wife Hansaba to make more…Was it due to the fact that Hansaba had passed away last year after 40 years of marriage? He also felt weak….He had noticed that his stools were black in color….
When I saw him, he was emaciated and abnormally pale…..Abdominal examination revealed a vague mass in the upper abdomen….I knew I was dealing with a possible carcinoma of the stomach…..These were days before endoscopy and the diagnosis depended on a barium meal, which I dutifully ordered…..I also asked for a x-ray chest…. I asked him to come back the next week so that we could discuss treatment options…..On his first visit, he was accompanied by his eldest son who seemed to be very concerned about his health…..
The next day, I went down to Radiology to take a look at the x-rays….My worst fears were confirmed…..The barium was suggestive of a very aggressive form of cancer called “linitis plastica” making the stomach look like a contracted leather bottle….Worse, both his lungs were full of metastasis indicating that it was incurable….I reckoned that he had around six months to live…..How was I going to break the news to Subashbhai? It was like pronouncing a death sentence….
In the evening, I had visitors…..his two younger sons and their sister…..They were hesitant and uncertain about how to broach the subject of their father’ illness….On their asking, I told them that their father had incurable cancer and had less than a year to live….
“Have you discussed this with Bapu?” asked the second son. No, I replied, he was to see me two days when I would discuss his condition with him….The sons and daughter looked relieved at this. “Doctor” said the second son, “please do not tell my father about the cancer…He is a very sensitive person and will take it badly…After the death of our mother, he has been receiving treatment for depression. He may decide to commit suicide on hearing the news. Please let one of us break the news to him at an appropriate time”
I was in a quandary…. I had a doctor’s duty to inform my patient…but should I do it and take a chance of a disastrous outcome? I told the son that I would give his request a serious thought….I could not sleep that night….Remember that the seventies was the time when nearly 90% of physicians felt that news of incurable cancer was to be hidden from the patient, or at best gloss over the details……Something was not right…..
The next day, I decided to seek advice from my Professor, a crusty chain smoking man who was thought to be an “old pete”……He listened to me gravely, puffing on his charminar…..” Have you spoken to the patient himself?” he asked….He was to see me the next day, but I did not know what to do……”There is an article in the BJS about the ethical dilemma….You can read it later….You have no right to withhold information from him..It has been seen that patients are grateful if full information is provided and assisted making further choices….My advice is to tell him the whole truth…” he concluded….
I dreaded the meeting with Subashbhai….I was not sure whether I was doing the right thing….But the meeting went very well… Subashbhai thanked me profusely for not hiding the truth….He died three months later…..
The old Professor sent for me after his funeral…..”Did you know that Subashbhai’s first son is adopted?” he asked….I did not, I admitted….He owned three shops in Zaveri Bazaar, known for diamond merchants….He also owned land in Valsad……His other children did not want the eldest son to inherit anything after their father’ death…After Subashbhai realized that he had a very short time to live, he made a will, leaving one shop and some land to his eldest son……
I use this case when talking to my students about Medical Ethics…..Even now, 90% of students feel that the old man should not be told…..