Fillers A memorable patient

Students forever

BMJ 2006; 332 doi: (Published 09 February 2006) Cite this as: BMJ 2006;332:346
  1. Sadananda B Naik, physician (sadananda{at}
  1. Alvas Health Centre, Moodabidri, Karnataka, India

    An elderly woman was admitted under my care after an extensive myocardial infarction. After I had explained her prognosis to the waiting relatives, they asked me to speak to another family member, a retired professor of medicine. When I telephoned him, I was surprised to discover that he was my professor from 20 years ago when I was at medical college. He cautioned me about the risk of conduction block as well as heart failure.

    On the third day after the patient's admission, he called me to suggest referring the patient to him for further management. This pricked my ego as a senior physician, and I declined—the patient was recovering well, and I said I was able to handle any emergencies. Barely two hours later, she collapsed as she sat up in bed. I found that she had intermittent heart block and had collapsed because of a Stokes-Adams attack. I advised transfer to a specialist cardiac centre for emergency pacemaker implantation. Once again the relatives contacted my old professor; oddly, he asked me not to transfer the patient, as the risk was unacceptable. I did not argue, the patient made a smooth recovery, and her family applauded me for my bold decision to treat her.

    We tend to become more confident with age and experience. We may even feel more knowledgeable than our teachers and deride their unfamiliarity with state of the art tools and modern treatments. But incidents like this teach us that, in their eyes, we remain students forever.

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