Writing about medical issues is often depressing. What we talk about most often are subjects like disease, human suffering, and death, not pleasant topics at all. And yet for us as doctors there is much that is worth feeling good about.
Over the years I have performed thousands of complex and often life-saving operations yet one of my most pleasant memories as a surgeon is doing perhaps one of the simplest operations early on in my training decades ago.
A young man came to our hospital’s surgical clinic complaining of severe pain in his nether regions. He had suffered mightily for days and finally when he could not take it anymore he overcame his embarrassment and turned up for treatment. All that needed to be done was a swab and a spritz of antiseptic paint, a spray of local aenesthesia and a quick ‘cruciate’ (cross like) incision with a lancet. The infection was let out and with it the pain. In about five minutes, a smiling patient was thanking me profusely with a smile that literally ran from ear to ear.
I remember that incident because the result of the mini operation was almost immediate and extremely rewarding for the patient. There are other times when as a result of what we do, patients come back to see us after recovering from surgery and the improvement in their physical condition is extremely gratifying.
Putting aside personal experiences where the positive outweigh the negative by many times, remarkable improvement in medicine has taken place during my lifetime and especially during more than a half century from the time when I first turned up at King Edward Medical College (KEMC) as a medical student.
In almost every branch of medicine there have been major advances and many diseases that were known as killers can now be controlled or prevented if not cured. I remember as a child being inoculated against smallpox. Today small pox has disappeared as a disease. Other than that vaccines have virtually eliminated diseases like polio.
Those of us who grew up in the fifties might remember movies where the ‘other’ man after declaring undying love for the heroine would then conveniently and ‘nobly’ die from Tuberculosis (TB) but by the end of that decade TB was pretty much treatable. So were most bacterial infections from the common ‘strep’ throat all the way to serious infections like lung infections (pneumonias). Interestingly pneumonia was called the ‘old man’s friend’ since the old people that got it often died painlessly over a few days if not weeks. But no more; good or bad, I don’t know.
During the decades of the nineties, diseases like HIV-AIDs that were once thought to be a death sentence were treated with combination of drugs so that many patients could lead an extended life span. The same is now true of Hepatitis C.
Other areas where there have been major advances include cancer treatment. Just as an example, breast cancer once it had spread out of the breast was thought to be a death sentence. Today I know of patients that have lived for more than a decade after their cancers had spread. Many other cancers are now quite treatable including most blood cancers. But many cancers are still untreatable unless found early.
In my own specialty, early text books of medicine often said of heart valve infections that the ‘heart was beating muffled marches to the grave’. But by the time I started my practice of heart surgery, many of these infections could be controlled with antibiotics or excised through open heart surgery.
Heart attacks that were and still are the commonest killers can now be prevented and even stopped once they start. Heart valve problems can be fixed through surgery and more recently through nonsurgical techniques. Most importantly new medicines can prevent fat buildup in heart arteries that leads to artery blockages and heart attacks.
The other area where tremendous growth has occurred is in transplantation of organs. Many types of kidney diseases leading to kidney failure can be treated with kidney dialysis and eventually with kidney transplants. Transplantation is also capable of curing some otherwise fatal diseases of the liver. In Pakistan though cadaver and beating heart donors are not established as a source of transplantable organs, therefore these transplants are not available as often as could be possible.
Sadly even though more than fifty years have passed since the first successful heart transplant was performed, we in Pakistan have not been able to do that. The reasons are many but most important one is the unwillingness of the families of ‘brain dead’ patients to offer organs for transplantation. However, heart transplants are an established form of treatment of heart failure in western countries. Also artificial hearts or heart assist devices are becoming well established especially in patients awaiting a donor heart for transplantation.
I am confident that during the next decade heart transplantation will become established as a treatment in Pakistan. This will of course follow the acceptance of cadaver and beating heart (brain dead) organ donors for liver and kidney transplants. Already such donors for transplants are accepted in most Muslim countries so there is clearly no religious reason to prevent this from happening in Pakistan.
Another area where I have participated in the early years is the treatment of broken bones and damaged joints. In the early years of my surgical training I was involved in the care of such patients. I remember the cumbersome plaster of Paris casts that we had to place for patients with hip fractures that were often worse than the problem these casts were supposed to treat and needed to be kept in place for months. The same was true of many other broken bones.
Today surgery can replace the broken hip bone and there is no need for a hip plaster. Also many other broken bones can be fixed with nails and plates and screws cutting down the need for immobilisation in a cast. As far as many joints are concerned, if they become too painful or dysfunctional, they can be replaced with artificial joints.
The one area where perhaps progress has been lacking is that of ‘neurology’ (diseases of the brain). Yes many tumours can now be removed and treated with good long term survivals but it is diseases of old age like dementia and Alzheimer’s that are becoming a serious medical problem with no treatment in sight. As we are able to keep people alive for many more years, in a large segment of the population at advanced age, the added years are rendered meaningless by these incurable brain diseases.
And yes we all have to die some day. So as we conquer one disease after another, new ones arrive to take us off to the next world. Sometimes old nemeses comes back with a vengeance. The return of TB is an example of old diseases coming back as is the emergence of ‘super bugs’ (bacteria) that cannot be treated with presently available antibiotics.