Resuscitation Dilemma Monday, July 6, 2015
For a pregnant lady in labour with baby in Foetal Distress if I conduct caesarean I am greedy and asked why I did not wait for normal delivery to occur. If I wait and intrauterine death occurs I am responsible for not having conducted caesarean in time and penalized Rs 1.10 crore as happened in the Apollo Hospital case recently. If child is born and does not cry at birth or has birth asphyxia for other reasons and I revive the child, place him in NICU on ventilator I am keeping dead body in ICU to make money as alleged recently in Chandigarh. If I succeed in saving him/her I am penalized for causing mental retardation and pay compensation for life long care of the child. If, however, I do not resuscitate a baby who does not breathe at birth and the newborn dies it is against everything I have learnt in my training and medical ethics.
The same scenario is often repeated in adults who suffer cardiac arrest, ventricular tachycardia and ventricular fibrillation. We resuscitate to the best of our ability not knowing what the outcome will be. We are accused alternately of keeping dead body on ventilator, or of not being aggressive enough in resuscitating depending on whether “Bill” for treatment has been presented or not.
Why at all did Dr Narang have to receive his graduation, postgraduation, fellowships trainings abroad and teaching neonatology at PGIMER for decades? The goons, reporters and police persons having received their training at the College of Satyamev Jayate by Professor Amir Khan and the Institute of “Gabbar is Back” by Dr Akshay Kumar obviously know more about brain death, neonatal ICU care and legal provisions of switching off ventilator while patient’s heart is still beating.
What then is the society’s message to its healers? Do not resuscitate. It is cheaper, no one has to pay exorbitant bills, no one can claim you are treating a dead body, no policeman with shoes, no violent relatives need to barge into the Neonatal ICU to personally check whether their child is actually alive putting at risk other patients’ babies in the ICU.
Only problem with the message “Do not resuscitate” is I myself was resuscitated in 2005 by my cardiologist Dr Jagmohan Verma having suffered ventricular fibrillation / cardiac arrest on table in Fortis Hospital. If this message of ‘Do not resuscitate’ were ringing in his head at that time, I would not have been writing this page today.
Dr Neeraj Nagpal
Convenor, Medicos Legal Action Group
Ex-President, IMA Chandigarh