A patient who changed my practice: Shattered hope
Authors: K. A Choudhari
Journal: BMJ (2002)

During the late 1980s, while working as a neurosurgery resident in Mumbai (Bombay), I came across Krishna, a 7 year old boy admitted with a six month history of blindness. Orphaned at an early age, he had been brought up by his elderly grandfather, a farmer from a village 300 miles from Bombay.

Being a clever child, Krishna could follow basic English as well as his native Marathi and Hindi languages. Though blind, he was unusually quick at navigating his way round the ward. Once he heard them speak, he could recognise people's voices unfailingly. With amazing dexterity, he helped pushing nursing trolleys, tidy up charts, and file reports. But the two qualities that made him especially popular were his continuous smile and his continuous singing. With a gifted voice, he sang movie songs and kept everyone spellbound. His infectious smile would brighten up everyone's mood, and his songs transformed an otherwise serious neurosurgical ward into a big happy family. Krishna inspired life. He loved everyone, and everyone loved him.

Krishna's magnetic resonance image revealed a huge craniopharyngioma—a formidable brain tumour, benign but potentially lethal. Krishna and his grandfather, however, were not unduly worried. They had complete faith in their doctors and did not want to know anything more. A long operation was planned. As always, Krishna was smiling. The operation lasted 10 hours and was a success in surgical terms: near total resection of the tumour was accomplished, and Krishna remained well postoperatively. His blindness, however, was unchanged. Within 48 hours, he was back on his feet, with the same smiling face and, of course, his singing.

Krishna's fourth postoperative day was the day of the professorial grand round. During the ward round, I briefly presented Krishna's case, proudly described the technicalities of the surgery, and was unanimously congratulated on the excellent results. Krishna and his grandpa were listening but understood little. After some discussion, one junior doctor asked, “What's the prognosis for his vision?”

“Poor,” I immediately answered, “He's been blind for six months. The vision won't improve.” The doctor was entirely satisfied with my dogmatic answer, and the professor patted me on my back, presumably because of my thorough grasp of the subject. The round carried on to the next patient. But something was amiss. Krishna had heard my last comments and had understood them. No one except I realised the terrible mistake. While the round carried on, I looked back at him again and again. He could not see me, but I could see very well. The familiar smile had vanquished. From that day, he did not say much, did not smile, and did not sing. He remained quiet and seemed withdrawn into his shell. He was discharged after two weeks and looked normal. But I knew that my abrupt and thoughtless remarks had caused an irrevocable damage.

I revisited the hospital in 1994. Krishna had died eight months after his discharge. His grandfather also died after a few months. His vision did not improve. Mustering all my courage, I inquired further and was devastated to learn that, until his death, Krishna was never seen to smile, nor did he ever sing again. With my inappropriate remarks, I had snatched away his hope, depriving him of happiness in life long before his death.

I am yet to come to terms with this event. Since then, in my neurosurgical practice I have had many successes and failures. However, the most important lesson I have learnt is—never take away patients' hope, it could be the only thing keeping them alive. I see Krishna's smile on each of my patients, and have not made the same mistake again.