This young lady is 94 admitted with a fracture neck femur. She is totally fit on paper. But she has a clot in the left atrium, calcified aortic and mitral valve, giving Aortic stenosis and Mitral Regurg, ejection fraction 50%. Admited with Hb of 5.6 and irrelevant talk and behaviour. She was given pack cell with a central line and Hb was brought to 10.5 over 3 days.
On table the patient was deeply drowsy. awakened only if the fracture leg was lifted. I did not like the patient and postponed the surgery. I asked for a repeat work up and electrolytes. Sodium turned out to be 119. We explained a very high risk of surgery till all corrections were made. Relatives did not want to take risk and took her home.
Next day, I get a call from another hospital, now a very small clinic, with hardly any facility, no ICU and not properly equipped. It turned out to be the same patient, with a surgeon now very keen on doing surgery. I am asked to give anaesthesia as the relatives are now willing to take risk.( Remember that in Mumbai we have hundreds of tiny clinics of 12 to 20 beds each, managed privately by surgeon alone.)
I have given her fitness once, then made her unfit once, and now without any improvement in the condition of the patient, will it ever be right to give fitness and do surgery? The previous hopspital was much better with all departments, and an ICU managed by anaesthesiologists of my team and cardiologist.
What is my status, if I give anaesthesia to this patient in countries where you practice?