Good morning. This week opens in a Bihar courtroom, on a complaint filed in 2005 and decided last Friday. After that, Round 2 counselling for Orthopaedics, and the air you are breathing while you read this.
— DR. ADITYA SETH, EDITOR-IN-CHIEF
01 · THE LEAD
MEDICOLEGAL
Vault cancer surfaced fifteen weeks after her hysterectomy. The family asked for ₹10 lakh and never produced a single doctor.
A 35-year-old woman walked into a small nursing home in Vaishali with months of bleeding per vaginum. Her uterus and adnexa were normal, so the gynaecologist called it dysfunctional uterine bleeding and treated her medically. Three weeks on nothing had changed. A Pap smear came back clear of malignancy, with the pathologist noting he had read it on blood and inflammation. A month later she was still bleeding, so the two of them sat down and agreed on surgery. A cervical biopsy taken eleven days before theatre showed chronic cervicitis, with a query over dysplasia. The hysterectomy went as planned, and the uterus was handed to the family to carry for histopathology.
She came back twice with vague complaints, then stayed away for nearly two months. When she returned there was a friable growth bleeding on touch. She was referred to Patna that day and reached a cancer institute within days, where the diagnosis was carcinoma of the vaginal vault, the cuff of vagina that stays behind once the uterus and cervix are out. She died about nine months after the operation. Her husband and four relatives sued for ₹10 lakh. A medical board at Patna Medical College Hospital went through the file and found no negligence. The District Forum ruled against the surgeon anyway, twelve years after the complaint was filed.
WHY IT MATTERS
The burden of proof sat with the family, and they led no expert medical opinion at all, which is the only thing that can displace a medical board’s finding.
What cleared the surgeon was authorship: two independent laboratories had logged her specimens, a named witness had signed the consent bond, and the Patna gynaecologist’s prescription recorded the month of the operation, none of it written by her and none of it written for a court.
The one gap is the specimen that left her theatre in the family’s hands, and the order never says whether that histopathology was ever done.
She had charged the patient nothing. The operation came through a referral.
02 · EXAMS AND ADMISSIONS
Almost half of last year’s Orthopaedics allottees never kept the seat. Round 2 then moved the typical college 1,695 ranks deeper.
Round 2 opens on Friday. Round 1 filled 1,858 Orthopaedics seats this year and the last government MS Open seat went at rank 15,591. Last year Round 1 stopped at 12,429 and Round 2 carried it to 17,062, so a rank between 15,592 and 17,062 was inside the window twelve months ago.
The branch moves that far because people walk away from it. Of last year’s 1,785 allottees, 841 never reported and 36 surrendered, and Round 2 filled 1,001 Orthopaedics seats fresh. Nothing else we have counted shifts like it: General Surgery moved 1,379 ranks, Radiology 77. The other number worth knowing before you fill the form is DNB, which is now within 34 seats of government MS.
03 · THE NUMBER
Delhi’s 397 is the number doing the rounds. It is not the worst air in the country and it is not close.
Every city on the ten-worst list sits above it. Nine of the ten are in Punjab and Haryana, and four are past 600. If you hold an OPD in any of those towns, that is what walked in this week.
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04 · DOCTORS
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Doctors
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Two miles from home his beeper went off. The eleven-month-old whose second operation had gone without a hitch was gone, and nobody ever worked out why.
He knew which patient it was before he reached a phone. Ben Carson has written that this is the case that hurt him most, and what he remembers is standing in front of her parents afterwards and crying in front of them. We ran it as a carousel this week. A reader left a note under it about his own first year of residency, about the self-doubt that follows a death on your list, and about the anaesthetist who sat him down and told him he had done everything he could. The comments under that post are worth as much of your time as the story is.
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