Interviewer: Tell me some more case studies, some that where it was not possible for the patient, the patient said that’s it, nothing can be done but you still help them.
Sarim Mir: This patient we had, he was like in his early 40s. He (the patient) was actually working for public housing. He was their handy man and the thing is, this patient had the personality type of a complainer. He came to me and he complained about the job, about his employers, about how they make him do things and work very hard. On top of that, the patient was very anxious, too. He had been having pain in his neck and the way that he had made it sound—the pain had started after he was made to do extra hours by his employer. So it was really hard to believe that person. And he had been in the ER three times. He went to the ER three times for the pain and each time he did they would do an X-Ray and they would send him out saying that there isn’t anything wrong with him. He was a difficult patient.
Medical Specialists Have to Give the Benefit of the Doubt to the Patient
So the patient came to us. After I saw him I thought that we have to give this person the benefit of the doubt even though he has a personality that repels you and you don’t want to believe him. I said that we have to make sure there isn’t anything wrong with him, so when I was taking history, I found that he had pain that brought down his arm and he was telling that he was feeling dizzy. The other doctors he had talked to thought he was having panic attack. He would have a panic attack and during the panic attack he would feel anxious. I thought there was some difficulty with balance, too. I listened to him more and he told me that he would have to place a bill, every month. I think in that project there were about 250 houses.
Cervical Stenosis or Compression of the Spinal Cord May Cause Weakness in the Arms
So he said that they would begin early and he would have to put that bill under each door. He said that he would have extreme pain and he would have weakness in the arm. So actually what he was telling was the truth.
What I did was I ordered an MRI of his cervical spine and neck and I found out that he had cervical stenosis. So he had a buildup of arthritis in the neck and he had a compression of his spinal cord and it was because of these that he had weakness of the arms. On top of that, when we sent him to the surgeon, he was so worried and paranoid. There was a surgeon in town and he wouldn’t go to see him because somebody had a bad experience with him.
Delaying Treatment for an Ailment Can Have Extreme Repercussions
So we had to look for somebody he could trust so we could send him there and then.
We talked to his employer, told him that what he was doing—bending down and leaning down—he couldn’t do any longer. It was in his symptoms. So then the person had the surgery and after the surgery he got better. And if this person didn’t have the surgery, there was a good chance that he would have been paralyzed. His compression was very tight. He was like a time bomb. If he had fallen down or if he had a whip lash, he could have been paralyzed. Totally paralyzed.
The Preferred Order To Treat a Patient is the One Involving the Least Side Effects or Risks for the Patient
Interviewer: So can you say in general that you look to surgery as the last resort and medicine maybe as a second resort or what is your preferred order to help people?
Sarim Mir: The thing is, the preferred order is what will help the patient with the least side effects and the least risk. If they don’t have the surgery right away, they would have permanent damage. So we see patients like that. Then there are some patients who come to us after they have had a surgery which didn’t work out. So each case is unique. If they would benefit by surgery and they don’t have that surgery—the risk of disability or permanent impairment will send the patient but everyone else. We would assess them, evaluate them and surgery in those patients is our last resort. We do everything so they get better without surgery but when it has to be done – we will tell them.