WHAT WOULD YOU DO???? DILEMMA!!!!!

WHAT WOULD YOU DO? I know that I have been away for a while but I was away in my own world in a journey of self-actualisation, career concentration and personal development. I have been through a tirade of scenarios while dealing with my patients that have put me in a dilemma and made me wish not to ever be personally in such situations. Mostly we take life for granted and presume many things. There comes a time when you find yourself at crossroads and unable to choose what path to follow.

 1). THE AZOSPERMIC PARTNER. Azoospermia is a medical condition in which a man has no spermatozoa at all in his ejaculate fluid. It is mostly irreversible and is a cause of male infertility . I handle such cases atleast once fortnightly. What would you do if found yourself in such a situation? Do you involve the young wife in breaking the news? If you do so, don't you risk having her disrespect her husband and tell everyone in the society putting the man in emotional turmoil?(Remember this is Africa). Isn't it her right to know what is causing infertility in the union and save her from the mean pointing fingers of in-laws? Do you tell the wife and hide it from the husband so that she can secretly look for a child elsewhere and save the marriage?(this only happens in Nigerian movies and is unethical). I have heard cases of men committing suicide due to the stress they go through when their wives 'spread the news.' This is a very tricky situation and I have always tried to handle it with utmost wisdom, privacy and maturity. I let the man do the honors of breaking the news to the wife but I'm sure many of them end up not telling them. A young lady followed me the other day and demanded answers on why I had told her to leave the office and talked to the husband alone. What would you do, as a doctor and as the patient?


 2). CANCER IN PREGNANCY. What do you do if you get a patient who has been looking for a child for many years and when she finally gets pregnant she also realizes that she has cancer. Does she carry her pregnancy to term and postpone cancer treatment or does she disregard the pregnancy and carry on with surgery and treatment. If she disregards the treatment, won't the disease be too advanced in 8 months? If she carries on with treatment, what if she doesn't get another pregnancy? WHAT WOULD YOU DO?


 3) PRE-CANCEROUS CERVIX AT 30 YEARS
 A lady comes in,quite young with an abnormal pap-smear result for pre-cancerous condition . Recently married with only on child. What do you do? Do you do cone-excision of the cervix or remove entire uterus and cervix. She is scared of the condition converting to full blown cervical cancer and insists on Hysterectomy( removal of uterus). However, as a doctor you remind her that she is very young and might need other children or may get re-married later in life. Dilemma! Do you go ahead and do the surgery and risk her regretting in the future? Secondly what if you deny her the surgery and she ends up with cancer later on?


 4).THE HUGE GOITRE The patient who comes in with a very big Goitre causing moderate obstruction symptoms. If you don't do surgery, she might end up with severe obstruction of airway later in life. If you do the surgery, she might never wake up from the surgery due to expected collapse of the trachea. What do you do?


 5). CANCER IN THE ELDERLY I have seen relatives coming in and insisting on referrals for chemo-radiotherapy for their elderly relatives. How will chemotherapy change the life of a 95year old man with prostate cancer? Won't the effects of the chemotherapy affect the patient gravely more than the cancer itself based on their age and frail bodies? If you don't refer them, the relatives will forever blame you. But this is easy, you refer and shift the burden of blame to the oncologist.

 I hope you now appreciate what we go through. The burden of being a decision maker in matters health as well as social. The profession can really get to you. Who said that doctors are not community leaders? Have a nice week ahead. I promise more posts sooner.