The time to understand the situation and find the solution is very short

Sometimes you can come across a surgeon who only knows the knife and the organ he has to examine and the sole purpose is earning and not the welfare of the patient on has to be conscientious. To quote a case a patient was scheduled for micro laryngoscopy by a junior. On reaching it was found that the M.L.S. was for a nodule on the cord. When enquiry was made about the age and other medications, the patient was receiving it was revealed that the patient was on regular treatment of mitral stenosis. The patient gave history of dyspnoea, mild exertion. In this case on advice the surgeon and the Physician was questioned about the hoarseness due to enlarge left atrium causing recurrent laryngeal nerve palsy and the propriety of undertaking such a dangerous surgery in a small nursing home. The physician and surgeon were trying to convince me that he will take only 1 minute it was agreed upon to give one small dose of scoline after safe medication with Thiopentone and diazepam inflation with 100%. The surgery was terminated with examination (which was not necessary). In such case dealing with unscrupulous and ignorant persons one should decide to walk out. While in another case of compensated mitral stenosis with a history of 5 pregnancies. No dyspnoea on exertion (walking 5 miles from the village to bus stand). No previous history of dyspnoea, cough, blood in sputum. No oedema or ascites. G.A. was given in a small nursing home for hysterectomy with an understanding between the patient and the surgeon that if any thing went wrong they would have to shift to a bigger hospital. In this particular case patient was refused anaesthesia in the big public hospital after full investigation and the senior anaesthetist walking out on arrival knowing the diagnosis. The only precaution one has to take is to treat the case as of mitral stenosis for induction and maintenance.