It was the morning after surgery, and we were just about to step into the ward. The robotic anterior resection had gone smoothly the previous day, and every box in our ERAS (Enhanced Recovery After Surgery) checklist was neatly ticked.
“Urinary catheter removed?” I asked our resident.
“Yes.”
“Pain well controlled? No opioid requirement?”
“Yes. No.”
“Sitting up? Walking?”
“Yes.”
“Vitals okay? Labs okay?”
“Yes.”
“Started sips of liquids yesterday?”
“Yes.”
“Good. So do you think we can start her on oral solids and stop IV fluids today?”
Silence.
I turned to look at our resident. I repeated the question. She avoided my eyes, staring instead at the floor.
“She… hasn’t taken anything orally today,” she said quietly.
That was concerning.
“Any vomiting? Nausea? Abdominal distension? You said her vitals and labs are normal, right?”
“It’s not that.”
By then we had reached the patient’s room. Our patient — a cheerful, soft-spoken 71-year-old woman — was sitting up in bed, bright-eyed.
“Hello, and good morning to all of you doctors!”
“Good morning, ma’am. How are you feeling today?”
“Very well, thank you! I thought the surgery would be much tougher. I didn’t expect to be sitting up like this so soon!”
She looked comfortable. No nausea. No bloating. No pain. Clinically, everything fit perfectly with an ERAS recovery. So why wasn’t she taking oral feeds?
After reassessing her, I finally asked:
“Ma’am, you’re recovering very well. All your parameters look excellent. You tolerated oral fluids yesterday. But today you’ve refused everything. May we ask why?”
She smiled warmly, as if the answer were obvious.
“Oh yes, doctor,” she said. “Today is Karva Chauth.”
For a moment, the entire team fell silent.
Of all the postoperative issues we had anticipated, Karva Chauth was not on the list.
I glanced at our resident, who looked both relieved and faintly embarrassed. The patient, meanwhile, continued smiling serenely, utterly unaware of the minor panic she had triggered in our clinical reasoning.
“Ma’am,” I said gently, “you underwent major colorectal surgery just yesterday. Fasting today is not advisable. Your recovery depends on early nutrition.”
She nodded thoughtfully. “I understand, doctor… but I have been keeping this fast for over forty years.”
The room softened. This wasn’t non-compliance. It was devotion — sincere, quiet, and unshakeable.
We sat down with her and explained the medical risks. She listened carefully. Finally she sighed, still smiling.
“Alright. If you say it is necessary, I will take something. But only a little. You must allow me that much.”
And that was that. A small bowl of porridge and a few sips of water later, equilibrium had been restored.
As we stepped out of the ward, I couldn’t help smiling.
“We need to add a new item to the ERAS checklist,” I said.
The resident raised an eyebrow.
“Cultural and festival considerations — yes or no?”
We all nodded. Lesson learned.