On pulmonary embolism

She had had a very active life and it had taken its toll. The wear and tear in her joints, especially her knees, had made basic perambulation excruciatingly painful. Her orthopedic had told her that her quality of life would dramatically improve if she could have a double knee surgery. Summer was fast approaching and her son’s family along with her grand children were going to pay a visit. She missed them a lot. She had always wanted her kids to study hard and excel. Through her hard work she had taught them perseverance. When her eldest went abroad for higher studies she didn’t think twice about sending him. It’s always hard for a mother to let her offspring go far far away. But it perhaps never dawned on her that they would settle down in a foreign land. Although communications had improved over the years and she got to see her grand kids on FaceTime every week, it was not the same as spending time with them in person. She was anxious to get everything sorted out before they arrived.

Knee surgeries had become a common routine for the elderly and there weren’t many complications. Her doctor came highly recommended and she had no reason to take a second opinion. She was a religious sort and had put her faith in god and knew he would take care of her. So when her doctor recommended that he would operate in St. Philomena’s she didn’t think twice. When her younger son raised an objection and asked her to have it done at a more reputable hospital she admonished him. She didn’t want to change her doctor and decided to go ahead as her doctor recommended. The next step was to pick a date. It was decided to do it all in April with a short break between the two surgeries. For an elderly person that was probably a little taxing, but she knew she could bear the pain and hardship. Knowing her from my childhood I have never once seen her blink an eyelid just because a task was difficult. Her elder sister advised her to wait a little longer since the timing was not so auspicious, but she remained adamant to have it done in April at the chosen date.

The preparations got in full swing once the date was fixed. Her sister-in law agreed to come into town to help with post-operative care. She started planning for the surgery and what would happen after. In my conversations with her she was confident that everything would work out. I had no doubt either, for she had borne a lot of pain in her life. In a family with three men, her husband and two sons, she was the glue that kept them all well bonded under all circumstances. She was always there to take care of them but this was the first time that they had to care for her. She was a talkative sort and had many friends and well wishers all of whom wished her the best as she got ready to leave for the hospital over the weekend.

The first surgery happened on a Monday and after a couple of days recuperating, the second one was performed on the following Thursday. Knee surgeries are painful and having two performed back to back is probably a lot for anyone. She just wanted to avoid having to go through all that angst multiple times. Both surgeries were successful and the recovery started soon after. She was in a lot of pain and I can still hear her complaining to me how painful it was (“Romba velikarthu da, she told me”). She found it difficult to get up and walk and it was well into the weekend before she made her first attempts.

Clots are common in knee and hip surgeries and patients are advised to walk as soon as they can. Blood thinner is also used in many cases to avoid complications. But in her case that was not considered. After a check up on Monday morning her surgeon thought she was borderline anemic and would benefit from a blood transfusion. So he prescribed a vial of blood. Doctors know best and no one raised an eyelid. Her younger son had to leave for a meeting in Dubai, but as she was recovering well and stable, there was no cause for worry. She was on the phone with relatives and friends and in good spirits. She had also taken her first steps after the surgery.

The search for the blood was probably on, no one knows how that happened. Were proper procedures followed? One can only hope they were. Monday went by and no blood showed up. Tuesday dawned and she was in much better spirits and actually walked on her own for the first time. I spoke to her on my way to work on Tuesday ( it was evening her time ). I asked her about the blood transfusion and she said they said they would probably do so by end of her day. She told me about her day and in my hurry to get to work I forgot to mention that I had purchased our tickets to India for the summer. I made a mental note to tell her when I called her in the evening. I had an odd feeling about the blood transfusion but never spoke up, I wish I had. Nine years prior faced with a similar situation with our infant daughter in the middle of the night at U Chicago hospital, my wife and I had resisted. The student doctors at the teaching hospital listened to us and decided to wait till 6 am to consult with the senior physician who saw the charts and our reticence and decided against it. I wish now that I had spoken up.

Two hours later I was huddled in a meeting with Jerry ( my boss ) and Jason when my phone rang. Seeing that it was from my wife I stepped out to take the call. My wife was all excited. She says something like Amma’s condition is critical and she is in the ICU. I didn’t understand, how can someone who was fine two hours before suddenly become critical. My wife is trying to explain as my mind is racing for I am not sure what to do. She beckons me to come home and I am like I need to leave for India. She explains that they started the blood transfusion and within minutes her condition deteriorated. The doctors were battling to revive her. I pop my head into the conference room to tell Jerry and Jason that I have to leave and rush home. As I am driving on highway 6 I get a call from my sister in law who is in the hospital with my mom. She has conferenced me and my brother who is on a plane in Dubai on his way back to Bangalore. She places the phone to my mothers ear and we both are frantically trying to speak to our mom. She is I believe in a coma and we are urging her to fight and telling her that we are on our way home. Not sure if she even heard us, she probably died before I reached home. I drive on Highway 6 almost everyday to work and the memories of that day keep coming back when I drive.

It was a shock to us; how could this have happened? Could it have been avoided? Who could we blame? Was it just FATE? Was the blood tainted? Why was the blood administered by just an inexperienced nurse, who when we started asking questions of the hospital, suddenly became untraceable? Her death certificate has probable cause as a pulmonary embolism ( a clot traveling to the lungs). Could it have been avoided? Shouldn’t the doctors at-least have foreseen that such a situation could be possible and taken adequate precautions. What if the blood was tainted? We will never know as we choose not to do an autopsy.

Today marks the seventh anniversary of my mother’s death and the circumstances are still fresh in my mind. There are still a lot of unanswered questions. It was quite heart- breaking to lose someone you love in this manner. Probably something that could have been avoided. The hospital got jittery when we started asking questions. Since we didn’t do an autopsy we couldn’t file a criminal complaint. We filed a case in the consumer court to seek answers which the hospital has continued to get a stay order for ever (The case has been adjourned 30 times since 2013 when it was filed ).So the case has never come up for hearing. We wanted answers, we wanted to understand if any mistakes were made and stop it from happening to another person / family. Her condition had improved significantly since the doctor prescribed the blood two days earlier. She probably didn’t need the blood. Would she have lived if it were not for the blood transfusion? We will never know. She died an untimely death. My only lament was that I wasn’t by her bedside when this happened (It had been two years since I saw her in person).

Life is precious and one never knows when fate will steal it away from us. The next time a close relative is having surgery, do not hesitate to spend the money to be with them. You never know what turn of events might happen. It’s not worth regretting later for money spent can be earned back but a moment lost is gone forever.

Another useful learning when the worst happens unplanned, is that you need others to survive. In our moment of sadness we wouldn’t have been able to handle the grief and everything else but for the help of countless relatives and friends who did so without being asked. Whilst you appreciate those that celebrate your successes, it’s those that can spare a moment to help you in times of sorrow that you can count on.