It was a typical Thursday, my OPD day. After rounding the wards, I took my place in the clinic, surrounded by my medical residents. The waiting hall buzzed with life, crowded with patients, many standing near the door, each waiting their turn. Mornings like these were routine, yet they never lacked purpose. Our hospital, a beacon of hope for rural patients, is where many seek care they can’t afford elsewhere. As part of a medical school, we don’t just treat—we teach.
The OPD is where residents learn that Medicine isn’t just a science; it’s also an art.
I had just finished explaining to my residents how to approach patients with acute unexplained fevers when she entered—a 24-year-old mother of two, her eyes full of life yet clouded with fear. “I have a hole in my heart,” she said, her voice trembling with both anxiety and hope. “Can you fix it, sir?”
She clutched a battered file, its edges warped, bearing the unmistakable scars of the rains—smudged ink, crumpled papers, and the faint musty scent of dampness. Inside were two crumpled, handwritten discharge summaries with fading ink and blurred words, an ECG strip so pale it was almost illegible, a creased chest X-ray in a yellowing envelope, and a damp-stained echo report.
Her husband stood beside her, holding out the file with trembling hands. “Doctor, please look at this first,” he said, his voice taut with urgency.
I gently set the file aside. “We’ll come to that,” I reassured him, meeting her anxious eyes. Because sometimes, the story a patient tells is more revealing than the one written in their file.
I listened intently as she shared her story, piecing together the details. Diagnosed with an atrial septal defect after her first childbirth, she spoke of no breathlessness, chest pain, palpitations, or swelling in her feet—only the lingering worry of what the diagnosis meant.
Despite the defect she described, she appeared remarkably well. Her pulse was steady, blood pressure normal, feet un-swollen, breathing effortless, and lungs clear. Her neck veins lay flat, showing no signs of pressure. Her body seemed at ease, hiding any hint of the condition within, as though shielding her from the weight of her fears.
But as I leaned closer, her heart revealed its secret: a soft murmur, faint yet distinct, like the delicate rustling of leaves in the breeze. The second heart sound split widely, its two components perpetually apart, like doors left ajar in quiet defiance, hinting at the unseen defect within.
“Are you certain her heart condition was only discovered after marriage and pregnancy?” I asked, my tone soft yet searching.
Her husband stood beside her, his hand resting on her shoulder, both comforting and weary. “Her parents were poor and uneducated,” he replied, his voice tinged with a quiet frustration. “They didn’t know, and even if they did, they couldn’t afford it. We found out only when she was pregnant with our first child.”
Two pregnancies later, she had sailed through both without complication, her heart remaining steady and unburdened despite the years of unnoticed strain. She had required no medications, and her daughters—aged four and two—had become her world, her reason to endure. Now, with the visit of a cardiac surgeon bringing a glimmer of hope, they saw a chance to repair what had been broken for so long.
The surgeon arrived, his reputation preceding him. He was confident, calm, and kind—everything a patient or doctor could hope for. Reviewing her test results, he said, “This is a simple hole in the heart. The surgery is straightforward. She’ll probably wake up right after surgery and be home by the weekend.”
His reassurance filled the room with hope. The procedure seemed routine—another day’s work for a seasoned surgeon.
On the day of the surgery, the operating room was quiet and focused. Her husband waited outside, holding his phone, pacing but staying in one spot. Inside, the team worked quickly and carefully.
The surgeon made the incision, and the heart-lung bypass machine took over. With steady hands, he carefully sutured the hole, about the size of a small coin, in the wall between the two upper chambers of the heart, sealing the defect with precision.
“I’ll be done in less than three hours,” the surgeon had reassured us. After all, he had performed hundreds of such operations. Three hours passed. Then four. Four stretched into five. Something was wrong.
Anxiety crept in. The minutes stretched endlessly, each one heavier than the last, as if time itself had slowed down.
When the surgeon finally came out, his face said it all. He looked pale and exhausted, his eyes heavy with what he had to say. His voice trembled as he began, “I’m so sorry. We did everything we could, but… air got into her brain during the surgery.”
He paused, then explained carefully, “The oxygenator—the machine that keeps the blood flowing and oxygenated—ran low on blood. The level dropped too much, and under pressure, the perfusionist missed it. Air got into her arteries and went to her brain. We tried, but there was nothing we could do to reverse the damage.”
He took a deep breath and spoke softly, “Her heart’s still beating, but… her brain is gone.”
The room fell silent, heavy with sadness. How could this happen? A simple surgery. A young mother. Two daughters waiting at home.
Her husband sank into a chair, crying. The nurses cried too. Even the perfusionist, who had made the mistake, cried hard. I stood there, frozen, unable to speak or cry.
Doctors are trained to act, to find answers, not to emote. But in moments like this, all that training feels empty. How do you measure the loss of a life full of hope? How do you tell a husband that his wife, who arrived full of hope, will leave in a shroud?
The surgeon visited the family repeatedly, preparing them for the worst. He admitted his error, and to his relief, the husband placed the blame on destiny rather than on the surgeon’s hands.
The next day, she passed away. We waived the hospital charges and arranged transport for her body, but those gestures felt hollow. What could possibly console a man who had lost his wife? How do you comfort children too young to understand why their mother wasn’t coming home?
I stood there, feeling a deep emptiness. We had tried, but it hadn’t been enough. Despite the hope we had clung to, we had failed them.
Weeks passed, but her memory lingered. It surfaced quietly, catching me off guard. I thought I had moved on. Then one evening, while sitting with my sister—ten years older—and my wife, the grief came crashing back.
The tears came suddenly, as if they had been waiting. I cried like I hadn’t in years. Just an hour earlier, I was laughing and joking with them. The house felt warm and full of life. Now, the room was still. The lightness was gone, replaced by an unbearable silence.
They watched in stunned silence. Their faces froze in confusion. My sister’s eyes widened. Her hand hovered near my shoulder, unsure. My wife sat motionless. Her mouth was slightly open, struggling to find words. Neither had seen me like this before. After what felt like forever, my sister placed a hand on my shoulder. “What’s wrong?” she asked, her voice gentle.
Through my sobs, I managed to say, “I lost a young mother a few weeks ago.” My voice cracked. “She came in with so much hope, and I couldn’t save her. Now her daughters are without her.” The words cut deep as I continued, “Those little girls… they’ll never know their mother because of us.”
It wasn’t just guilt—it was helplessness, regret, and the crushing weight of knowing that, sometimes, despite everything we do, we still fail.
Doctors aren’t supposed to cry—or so we’re told. We’re seen as strong, the last hope. We project confidence—not just for our patients, but for ourselves.
But behind closed doors, we do cry. We’re trained not to, yet we do. We cry for the lives we couldn’t save, for the families left behind, for the mistakes that linger.
In the days following her death, I replayed every detail in my mind. I consulted with heart surgeons and studied cases of air bubbles during heart surgery. Could we have done something differently? Was there a sign we missed? These questions lingered, casting shadows in quiet moments.
Textbooks, case studies, and experienced cardiac surgeons all agreed: ‘Even with the best care, things like this can—and do—happen. But they are rare.’
How do you cope with the weight of a life lost? That day, I cried because I thought of her daughters—two little girls waiting for a mother who would never come back. I cried because I couldn’t escape the feeling that I had failed her. I cried because I cared, and sometimes, caring is what breaks us.
But we carry on. We return to the hospital, to the operating rooms, to the clinics. We smile, comfort, and reassure. Because we must. If we let the tears take over, they might never stop.
Medicine is full of contradictions. It empowers us, yet makes us vulnerable. We save lives, but we also lose them. We perform miracles, yet we’re not immune to tragedy.
In the end, we’re not just doctors—we’re human. And sometimes, the weight of that care becomes too much to bear, like a heart struggling under the strain of a hidden defect.