Member

Unlike other doctors who deal directly with people on a daily basis, a radiologist rarely encounters interesting individuals. My work is usually dull & drab, dealing with grey shadows and densities. But I do on occasion meet someone who makes an impression.

This is the story of one such encounter with an interesting person a few weeks ago about a fortnight before the second anniversary of the killer tsunami of 2004.

Late one morning, I got a call from the Neurologist asking if I could do a Colour Doppler study of the Carotid arteries for an elderly western gentleman who was in his out-patient clinic before I went home for lunch. I asked if I could do it that evening as I had two kids waiting to get their abdomens scanned. The Neurologist told me that his patient had to go to Cuddalore and it would be better if the scan was done as early as possible.

Note: Cuddalore is about 160 km from Salem. But the journey would last 4 to 6 hours depending on whether one went by car or by state-run bus because of the really bad road which is unfortunately classified as a State Highway.

I agreed to do the scan and asked him to send the patient to the Ultrasound room. A few minutes later, I got a call from the Radiology reception that the patient had arrived. I went out to explain to him that he would have to wait till I saw two kids who were waiting to get their abdomens scanned.

I saw a trim and fit-looking sixty-ish white (as in Caucasian) gentleman sitting in the waiting area. He was dressed in a T-shirt and a pair of khaki cargo pants. I walked up to him, introduced myself and told him that I had to scan two kids before I could see him. He smiled and answered in heavily accented English, “That’s Okay Doctor. I’m retired and I’m not in a hurry. Call me when you have seen all your other patients.” He pulled out a book from his bag and settled down to wait.

I smiled, thanked him and walked back to the ultrasound scan room thinking how good it would be if all my patients were this polite and understanding. (And some of the referring consultants too). I liked this man already.

My assistant got him in about half an hour later after I had seen the second kid. His requisition form had an unpronounceable Italian-sounding name (I’m going to call him Angelo for the rest of this story) and stated his age as 74 years and that he had undergone a Carotid endarterectomy.

I was surprised because he did not look that old. I asked him if he was from Italy and a few questions about his medical condition and when the Carotid surgery was done.

Angelo said he was of Italian origin but had emigrated to Australia some years ago. He had come to India in March 2006 as part of a Catholic volunteer group which was involved in Tsunami relief and rehabilitation. His group was initially based near Salem. Sometime in April, he experienced some mild chest pain and breathlessness, so he went to a hospital in the city. An ECG showed some ischemic changes so the cardiologist advised him to get a coronary angiography done. He went to one of the best centers in Chennai where the angiogram showed a triple vessel disease which was not amenable for percutaneous intervention.

So he went back to Australia to get a Coronary Artery Bypass Graft (CABG) surgery done. During the pre-operative work-up in Australia, a Carotid Doppler Ultrasonography showed a 90% stenosis at the origin of his left Internal Carotid artery (ICA) and a 50% to 69% stenosis at the origin of his right ICA. (See the Doppler Ultrasonographic criteria for ICA stenosis here).

He underwent a triple-vessel CABG in May 2006 and a Carotid Endarterectomy for the left side in August 2006. He was advised to check the right ICA stenosis on a regular basis as he would require surgery if the narrowing became more than 70%. He had a review Doppler study done in Australia in early November 2006 which showed a normal left ICA (the operated side) and no change in the stenosis of the right ICA.

He had then returned to India in late November to rejoin his group of volunteers. He was currently based in a small village near Cuddalore. As he was most familiar with the medical facilities available in Salem, he had come to see someone about having a regular follow-up schedule for his Carotid arterial disease.

That was his story.

I did the scan and found no great changes from what was mentioned in his last scan done in Australia. I noticed a mild irregularity in the wall of the (operated) left ICA and asked him about it. Angelo said that the surgeon who had operated on him told him after the surgery that he had such hard calcified plaques that the surgery which usually lasts about 2 hours, took more than 4 hours. And they had injured the wall of the artery so they had to put in a graft from his saphenous vein (the one that was left after his CABG!).

After I told him the results of the scan and asked him to wait for half an hour for the report, Angelo asked me when he should come back for a review scan.

I confessed that I did not know of any protocol but told him that it ought to be safe to do a scan after three months.

Angelo smiled, thanked me and said he’d see me in three months time if he was still alive!

I believe I am going to see him again.