How much.....is too much

 How much is too much????

I have been giving Anaesthesia for past 2 decades.
I have had to administer Anaesthesia to all age groups from newborn to extreme Geriatrics. Some have been very high risk and complicated.
Sometimes, after the procedure gets over and when the patient post Surgery immediately or after a few days or months lands up in morbidity permanently....or finally succumbs...
Not because of the procedure undergone....but due to stress of surgery and heavy pharmaceutical doses .....
I get disheartened.
Was all this worth it????
Had  my efforts on taking the challenge of Anaesthesia gone waste???
The situation in Operation Theatre and Intensive care period is obviously stressful fir the entire team.
If our patient shows better prognosis ,it's exhilarating and compensates all our tensed moments.
But if unfortunately, the prognosis turns bad....a feeling of disappointment creeps inside.
Each time a patient of extremes of age with underlying co morbidities lands into my hands for any procedure.....
I ask myself....
Is the body of this patient strong enough to tolerate the stress of procedure and poly pharmaceutical regime?
Especially when comorbidities have already weakened all systems in the body.
I was a Houseman working in Intensive care Unit .A 85 yr old lady with high sugars,high blood pressure and weak heart and kidney  suffering from Fungal Meningitis was admitted. In view of her advanced age and comorbidities,the in charge Consultant had planned a conservative simple single drug regime treatment.
Hence,the progress of recovery was slow but the condition of the Geriatric patient was stable.
Her son visited her from US.
He didn't get convinced with the treatment regime. So sought a Superspecialist younger Consultant to treat his mother.
The pressure to produce faster results made him to opt for polypharmacy regime .Multiple drugs intravenous was bombarded to fight the fungal infection.
The infection got cured.
But the aged lady couldn't tolerate the Pharmaceutical stress.
Her kidneys and heart both shut down .
She had a Cardiac arrest in few days and succumbed.
In history, the great Maratha warriors fought valiantly against the Mughals and won the Sinhagad fort.
But in the battle they lost their brave Mavala Subedhar Tanaji Malsure.
Grieved by the loss of his brave loyal Commander,Chatrapati Shivaji Maharaj exclaimed" We were victorious in winning the Fort but lost our Lion "...
Many a times, we do get victorious in defeating the disease underlying....but unfortunately lose the patient or make the patient morbid severely dependent for life.
Not all times,is the end result so depressing.
I was attending to a 95yr old lady for Hip Fracture fixation. She had fallen in the bathroom. The son didn't want the mother to end bedridden. Hence opted for surgery.
Inspire of being high risk for Anaesthesia, the old lady tolerated Anaesthesia and the Surgery very well.It was so gratifying seeing our patient walk back home all happy.
One day,an unconscious 80yr old man got admitted to Intensive care Unit.He had slipped in the bathroom and fallen on his head.CT scan showed Subdural Haematoma.
I had to start infusions to make him hemodynamically stable as his blood pressure was low and not recordable. He was on ventilator support. The entire situation was grim .
But as soon as the Neurosurgeon operated on him and controlled the bleed in the Brain.The Neurologist started few intravenous injections to bring down the swelling of the Brain due to the hematoma...... with in , 48hrs,the old patient was sitting up and talking to me .
In Medical college, Doctors are taught to save Lives.
How much and How far must we go to save a life is debatable.
Our only interest as Doctors has been to give better life with our treatment and procedures.
We develop our skills and expertise to treat a patient.
Never do we wish a bad outcome for our patients.
But yes at times our over zealous enthusiasm to cure a disease does give us success to cure patients from illnesses but may result in severe morbidity permanently or unfortunately mortality  .

Is too much....too much.....????
Always and ever remains a doubt.