When the unexpected happened, would you accept?

“Doctor, I don’t want surgery, just give me some medicines to wash the cataract away from my eyes so I can see well,” shouted the 82-year-old-woman. Her children had warned me that she was apprehensive of surgery – any surgery at all – and had asked me not to mention that word lest she became uncooperative. It had taken a lot of persuasion before she accepted to come with them to the hospital.

“Mama, I promise not to do any surgery on your eyes without your permission. Just give me a chance to complete my examination. And let me confide in you, I personally don’t like surgery, So, mama you’re not alone! I only do it when it is absolutely necessary,” I said reassuringly.

She became more relaxed and responsive to my little jokes. “Why don’t you like surgery?” I asked inquisitively. “My husband died a few months after prostate surgery and my younger sister has never known peace since she had her eye surgery two years ago. Two of my neighbours have been visiting the eye clinic for several years after surgery.

My examination now over, I said, “Mama, I will treat you with medicines; you don’t need surgery.” Her face lit up like a candle and she smiled. That was the easy part! How would I break the news to her that she had more than ordinary cataract?

A diabetic of more than 20 years, the diabetes had damaged her macula, the most sensitive part of the retina, the inner coat of the eye responsible for fine vision. Removing the little cataract would only make a slight difference to her sight. Given her aversion for surgery, this would not be convincing enough of the success of the surgical intervention.

There was also the likelihood of further deterioration. And this would strengthen her conviction that cataract surgery was either useless or I was an incompetent surgeon. Either way, it would be a situation where the trio – patient, surgeon and profession – would be all losers and no winners.

The main reason we perform cataract operations is to restore or improve sight. Conditions such as macular degeneration, diabetes or glaucoma may co-exist with cataract. If undetected before surgery, the poor visual outcome would be attributed to the surgery. This would then serve as a discouragement to other patients. With every operation there are always risks involved and complications may occur even in the best of hands during or after surgery. Patients’ reactions are often uncomplimentary to the surgeon or hospital and sadly, may result in litigation.

The story is told of a king somewhere in Central Africa who had a close friend who had a habit of looking at every situation that ever occurred in his life (positive or negative) and remarking, “This too is for good!” One day the king and his friend were out on a hunting expedition. The friend would load and prepare the guns for the king. The friend had apparently done something wrong in preparing one of the guns, for after taking the gun from his friend, the king fired it and his thumb was blown off. Examining the situation the friend remarked as usual, “This too is for good!” To which the king replied, “No, this is certainly not good!” and proceeded to send his friend to jail.

About a year later, the king was hunting and strayed into an enemy territory. He was captured and taken to their village. They tied him and bound him to the stake ready to offer him to their god. As they painted his body with a special lotion before setting him on fire, they noticed that the king had a missing thumb.

It was a taboo for anyone to be sacrificed to the gods with any missing part of the body. So untying the king, they set him free. As he returned home, he was reminded of the event that had taken his thumb and felt remorse for his treatment of his friend. He immediately asked that he be released and brought to his presence. He recounted to his friend all that had just happened.  “You were right,” he said, “it was good that my thumb was blown off.  I am very sorry for sending you to jail for so long. It was bad for me to do this.”

“No,” his friend replied, “This too is for good!” “What do you mean, ‘This is good’? How could it be good that I sent my friend to jail for a year?” “If I had not been in jail, I would have been with you and I would have been killed.”