A news report was published in this paper titled “SMHS and  SKIMS failed to treat a native doctor” , I initially just skipped it but later on my conscience did not allow me to let the mews item go uncontested. For two reasons. The said doctor was a dear colleague of mine and secondly the message that was being conveyed to the common man of the state was that the heath infrastructure  ( especially  neurological sciences) here is useless. The report has raised many questions which I will try to answer.
What was the diagnosis and does it have any bearing on the treatment?
The diagnosis as per ‘some colleagues’ was massive intracerebral hemorrhage but unfortunately this is absolutely incorrect, he had small hypertensive putaminal hemorrhage not causing any mass effect. The treatment in the former entity can be surgical or medical depending on the case, but in the latter case( as in  our case) is purely non surgical.
Why airlift him to a private hospital in Delhi ?

The reasons can be multiple, I will go into them one by one. One possibility is that the decision of treating  the patient without surgery which was made by the   neurologists and neurosurgeons (about ten in number)  in the SKIMS was wrong and the decision of operating him by some one in private sector is correct. I tried to introspect the faculty involved in the decision and I can proudly say that we had a member trained from all the premier institutes of the country including AIIMS-Delhi(1), PGI-Chandigarh(5), SGPGI-Lucknow (1), NIMHANS- Banglore(1), BHU-Varanasi(1). Besides some of the members are associated with the world ‘ s best neuro groups like American association of neurosurgeons, congress of neurological surgeons(USA), just to name a few. So I can reasonably assure the concerned people that he was being treated on the best possible lines of management.
Second reason could have been that the department is not capable of operating of the patients with intracranial hematomas, the answer can be obtained from the departmental census which we can provide to anybody interested. Besides innumerable patients who reposed complete trust in us we are thankful to so many dignitaries who trusted us and got operated here including one   ex- chief minister and spouse of another ex- chief minister.
Third reason for shifting can be “social” as we want to have everything from Delhi due to deep inferiority complex lodged deep in our minds and for that there is no treatment.
Than the question arises as to what is the best treatment of “hypertensive putaminal hemorrhage”, I will not go into the details of the subject as I am writing at the moment for the paper which is to be read by common people, but I will certainly mention that the treatment for this entity is opposite of what it was 30 years ago , now a days on basis of the international multicentre trial named as “STITCH TRIAL” the treatment has moved from predominantly surgical to predominantly medical  as the neurological outcome is same after both modalities. Readers especially the ones who were instrumental in shifting  are requested to search on internet the details of the trial and judge for themselves what is right and wrong?)
Why was he operated outside the state?
The answer can be either of the two: no doubt the hematoma was small as is clear in the CT scans available with us, but he was made to travel one thousand kilometers (by some  `well wishers')   out of which nearly 100 kilometers are by road, so he has bled again due to the stress of the travel and ventilation problems as the transport ventilators are never as good as are available with the department of  anesthesia and critical care in SKIMS on which he was being managed. Second possibility is that in the private sector here is very low threshold for doing surgery due to financial implications. I have worked in the private sector in Delhi before joining this place and hence I know the details but due to ethical reasons I am refraining from making a detailed comment. I can answer this question exactly when our dear friend comes back with all the scans done there.
Should we believe the Face book content?

The internet has revolutionized our lives but not without inadvertent vices so the Face book content should be critically analyzed before accepting it and it is easy for someone in gulf to make a comment on our working. I can assure readers that we in SKIMS are providing the treatment which is comparable to any academic institute of the country. Please do not compare us with private hospitals as their way of functioning is purely commercial)

(Dr Abrar Ahad Wani is Assistant professor in the Department of Neurosurgery at SKIMS and can be contacted at abrarwani@rediffmail.com. The views are his personal and not that of the institution he works in)

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