Dr. Priyam Bordoloi@DocPriyamMD
Today during evening ward rounds, I almost had a full verbal argument with an attendant.
The kind that stays with you long after duty ends.
A 39-year-old woman.
Eyes so yellow they didn’t look real.
A distended abdomen, tense with fluid.
She had been admitted 3 days ago.
She came with her elder sister.
No male attendant.
No money.
They told us they couldn’t afford tests.
So we helped activate Ayushman.
All investigations were arranged free.
Her reports were alarming:
Bilirubin: 21 (normal ≈ 1)
Hemoglobin: 6.1
Liver enzymes (AST,ALT) badly deranged
This wasn’t “jaundice that will settle.”
This was serious liver disease.
Treatment was started.
The next day, her husband arrived.
The sister was sent home.
He asked only one question again and again:
“When will she be discharged?”
“There are children at home.”
“She needs to take care of the house.”
We explained calmly:
This is not a minor illness.
Recovery is slow.
Evaluation takes time.
He looked angry.
We did an ultrasound.
In simple words, we explained to him:
Her liver is enlarged.
There are signs of hepatitis.
And the main vein carrying blood to the liver may be blocked.
(When that vein is blocked, blood backs up, fluid collects in the abdomen, and the liver slowly fails.)
We sent viral markers.
Hepatitis A, B, C, E.
HIV.
Leptospira.
Scrub typhus.
Conservative treatment continued
because in this situation, aggressive treatment can do more harm than good.
Then we advised one more test:
CECT abdomen.
That’s when he snapped.
“You doctors are only doing tests.”
“I don’t have money.”
"I am tired of running around."
"Whatever happens to her let it happen, i can't do more than this"
We explained again:
All tests are free under Ayushman.
Money is not the issue here.
And it's not been 2 days, this kind of presentation needs a detailed workup
This CT will decide whether the vein is blocked or not.
And treatment depends on it.
The CT was done.
Today, the report came.
Cirrhosis of the liver
Her bilirubin had improved from 21 to 17.
Yes, there were signs of improvement.
But cirrhosis is chronic.
It needs time.
And more evaluation to find the cause.
We explained this gently.
That’s when he said:
“No more tests. I’m taking my wife home. Today.”
Negotiation failed.
Reasoning failed.
And then… I lost my calm.
In front of others, I said:
“So you’re basically killing your wife.”
“Is that because you want to get married again?”
He froze.
He wasn’t expecting that.
Maybe no one had ever said it out loud before.
After a long silence, he agreed to stay.
I don’t know for how long.
But today reminded me of something medicine never teaches you:
Sometimes the disease is not the biggest threat.
Sometimes it’s
impatience, denial, and abandonment
from the very people the patient depends on most.
In times like this, all we need is patience.
Because if our loved ones abandon us when we are sick…
who will stay?
