Laxmi (name changed), a 19-year-old mother of an 18-month-old child, lay in a surgical ward bed, recovering from a laparoscopic cholecystectomy, a minimally invasive gallbladder removal surgery. The operation was smooth, and she was due for discharge the next day. She had insisted on staying an extra day. But when the treating team arrived on the morning rounds the next day, she showed no interest in leaving.

“The pain is very severe. I’m unable to eat or drink anything. I vomit out everything. My whole body is hurting. I do not want to get discharged,” said Laxmi. 

Her mother was by her side, looking anxious. Her husband, on the other side of the bed, looked rather annoyed. 

The senior doctor of the treating team asked further questions to figure out the cause of her symptoms while two other doctors checked her pulse and blood pressure and examined her abdomen. Everything seemed completely normal. 

The team reassured the patient and her mother that it was sometimes normal to have vomiting and mild pain after the operation, and she would recover soon. Laxmi, however, insisted on staying at the hospital for another day. 

The husband followed the team as they walked out of the ward and asked if he could take her home that day. “She is not able to take any food right now and will require IV fluids. It is better to keep her for another day and observe,” said one of the doctors, and the husband obliged with some dissatisfaction.

The puzzle of an unnecessary surgery

Laxmi had initially presented to the hospital with the same complaints - severe pain, vomiting, and inability to eat and drink. Her scans showed a tiny stone in her gall bladder, for which she underwent the surgery she was now recovering from. 

The treating team, however, was not fully convinced from the start that the gallstone was the cause of her symptoms. However, as no other abnormality was found and she continued to complain of severe pain, the team decided to remove the gallstone.

The symptoms of gallstones can often be vague, like abdominal discomfort, bloating, nausea, and intolerance to fatty food. At times, private hospitals make use of the vagueness of the symptoms of gallstones to perform ‘unnecessary’ surgeries for profit.

The definite indications for surgery include cholecystitis (infection of the gallbladder due to gallstones), biliary pancreatitis (inflammation of the pancreas due to obstruction of the pancreatic duct by gallstones), repeated attacks of biliary colic (cramping pain in the right upper abdomen lasting for a few hours) and in patients who have a high risk of developing complications (uncontrolled diabetics, immunocompromised and patients with malignancies). 

However, this patient did not exhibit any of these indications. 

The root cause of her pain

But Laxmi had repeatedly visited the surgical outpatient clinic, complaining of severe pain and insisting on surgery despite the doctors explaining to her that it was unnecessary. In many Indian communities, surgery is often seen as the ultimate cure, and persistent pressure from patients can lead to procedures that aren't medically necessary. The treating team soon realized that that is exactly what happened in her case.

It was time for the night rounds when the doctor on call approached the patient, hoping that she would have recovered. The patient was on her bed, stooping forward, trying to regurgitate. Before the consultant could ask anything, there was the answer to all the doubts. 

“Doctor, I do not want to go home. I do not want to go back to my miserable life. They treat me like a slave. They do not give me food. I have to do all the work the moment I get home. He abuses me. He beats me up.” 

According to the Journal of Epidemiology and Community Health, one in three women in India is subjected to intimate partner violence of a physical, emotional, or sexual nature. Yet only 22.4% ever disclose the abuse, and just 13.5% seek help. Alarmingly, only less than 1% report the offense to the police (0.5%) or approach a healthcare professional (0.1%). 

India’s Sustainable Development Goal (SDG)-5, which aims to achieve gender equality and eliminate all forms of violence against women and girls by 2030, appears increasingly out of reach given the 53% rise in domestic violence cases between 2001 and 2018.

How healthcare professionals can help

Victims of domestic violence rarely disclose abuse to healthcare professionals. Instead, they often present with physical complaints such as pain or loss of appetite. These symptoms are frequently unexplained, with blood tests and scans returning normal results.

Studies show that violence is directly associated with the presence of such unexplained symptoms. The more a woman is exposed to violence, the higher the number of symptoms she presents with. It, therefore, becomes crucial that the medical professional does a thorough assessment of these symptoms before labelling them as a ‘disease’ that needs medicines or surgery. 

Clinicians must routinely ask women patients about physical and sexual violence. Doing so can help uncover hidden abuse, reduce unnecessary treatments, and prevent avoidable complications.

Like many others, our patient was unwilling to report her husband, fearing his arrest, public shame, and scrutiny. Filing a police complaint felt too drastic, but she was open to couples counselling.

She was discharged the next day, with the team requesting her husband to let her recover at her mother’s home. The husband was counselled to receive anger management and psychological support.

Her surgery may have been avoidable, but it offered a brief escape and, hopefully, a chance at change.

Edited by Parth Sharma
Image by Janvi Bokoliya