[Speaker 1] Many times what happens we get these geriatric patients where the patient has a heart issue. There's, he has a history of ISD and then he has taken some medical treatment. Angioplasty has never been done. And then he's come to me with a fracture. We show to the physician, we show to the cardiologist. On paper they will write that patient requires triple bypass or patient requires angioplasty. If we do any of these procedures patient cannot be operated for the hip. And after triple bypass and angioplasty they cannot be mobilized. So what now here becomes a catch 22 situation. Who will bell the cat? Basically whether the orthopedic surgeon should do the surgery in spite of the physician saying like this or the and the cardiologist saying that he requires angioplasty and he's not fit for surgery. And or should we let him basically get the bypass or angioplasty done and then wait for 20 days and the fracture is malunited. He's got some other complications because of the fracture, then what should we do?

[Speaker 2] See in such a situation Neeraj, we need to re-evaluate the patient and take a risk, calculative risk what we say. And here important is that since we know that fracture need to be treated and now bypass is needed or going to be angioplasty, angiography, whatever, which is not immediately possible. In spite of giving a unfit for the surgery and your requirement of surgery is mandate in that particular reason, it is important to explain the patient in detail with physician fitness and with possible risk in surgery, what we say is high risk consent or whatever. So have a proper information given to the patient with a possible outcome. There could be a possible death also because these are the disease, but if at all we go for this, this could be the possible complication or 20 days later it is not possible and could be embolism also can due to death or whatever in fracture cases. So showing the risk factor, doctor need to take either of risk. Like it is many situation where either go for this or go for that. In both the places risk are there. In such a cases, one need to take a calculative risk and take a high risk consent and take a proper consent with the proper explaining and go ahead with the surgery. In that, if at all untoward incidents happen or patient dies or whatever happens, we have got a very good defense to say we have tried to give a life but still died. Otherwise also he's going to die because of these disease and we can safeguard it in that. But defense need to be there because otherwise if you refuse a patient or don't do, chances are going to be the same. Either he may die during cardiac procedure or he may die because of the surgery or embolism. So naturally situations are very typical. In that case, you are the best judge to take a call and your call is going to be respected by the court.