I Will Abide by Your Advice

CONQUEST OF DEATH 4

One afternoon, as usual, I was about to begin taking tuition to a batch of medical students. One of my students suddenly started talking,

“Sir, my uncle went out of town. There he developed fever and pain in the perineum. He consulted a local doctor. The doctor advised him to undergo an operation. My uncle came back and consulted his family doctor. The family doctor also advised him to undergo an operation. He got admitted into a hospital near his residence. The operation was not successful. He is worsening; his general condition is deteriorating, “she was narrating fervently.

“Worsening?,” I interrupted my student and said,

“This is perineal, perianal or ischiorectal abscess, I guess! After proper incision and drainage, and antibiotic cover, the patient should improve! If the drainage is inadequate, the operation can be revised to provide adequate drainage……" 

“Everything has been done, but instead of improving, he is worsening and deteriorating,” she started explaining to me, “the pain is incessant, the purulent discharge from the wound continues, the fever continues….. “

“Well, well! We have to change our diagnosis then!” I interrupted again!
 

“Yes! “she continued “They are also thinking on a similar note. Now he has developed chest congestion and he is breathless a bit. His chest x-ray and CT scans are done. Having viewed them, the doctors have advised him to go to a bigger, better equipped hospital. My uncle however is reluctant, very stubborn and refuses to leave the hospital. All relatives, friends, even his family doctor and his other doctor friends are trying to coax him to shift to a better hospital; but he refuses saying,

‘Whatever is going to happen, let it happen here itself!.....”

I interrupted again saying,

“But for want of proper care, what if something goes amiss??”

“That’s what…. “she sobbed and said,” we all point out to him, should not happen! We must make every attempt and avert a debacle! At any moment, my cousin brother will be here with all the reports .You view them and coax him, chide him if required, to get admitted to a better equipped hospital. Maybe, he will follow your advice.”

“I will, I will” said I in agreement.

    

 We began our tuition class. 

Her cousin brother arrived after a while with all the reports.

Viewing them I exclaimed, “The infection is spreading. He is developing ‘sepsis!’ Connect me to your uncle!”

She did.

“Uncle, I viewed your x-rays, CT Scans and laboratory reports. They are ominous! You come to a public hospital attached to a medical college. As you are approaching it, contact me, within minutes I shall be there!”

“I shall be guided by your advice,” he agreed to abide by my plan.

I examined him in the casualty department.

He was wan and pallid. His complexion was sallow, he had fever with rapid pulse, was breathless a bit (rather rapid than distressed breathing) and his B.P. was normal. He had abscess in the perineum which had already spread in the subcutaneous tissues up to the loin and deep to the muscle plane, the skin was dead at places and he had developed Fournier’s gangrene (infection in the dead skin of the scrotum).

His chest was congested, repeat x-ray of the chest showed haziness in the lung fields and bilateral pleural effusion (fluid in the lung coverings) i.e. ARDS! (a serious condition).

He was posted for an emergency surgery. The abscesses were drained, the pus sent for culture and antibiotic sensitivity test, the dead skin excised (removed) and appropriate antibiotics started.

He subsequently needed repeated excision of the dead skin, desloughing, (removal of the dead soft tissue) and drainage of the abscesses as and when required. He was not a known diabetic but due to this hyperstress, his blood sugar was raised to a level higher than the normal.

Because of repeated operations in the perineal region, he developed incontinence of stools.
These were the hindrances in the progress.

With proper management, he started showing signs of slow but steady progress. After a prolonged stay in the hospital, when his progress was satisfactory, he was discharged from the hospital.

That marked the end of an ordeal!

He required periodic dressings for his wounds. With proper aseptic precautions, his wounds healed. He became continent as well!! 

It turned out that he was professor and chief, Department of Computer Technology in a premier, prestigious engineering college.

He had undertaken a project of writing a textbook: ‘Object-Oriented Programming with C++’. His sudden, unforeseen, unexpected, precarious, serious illness had marred the project. His stay in the hospital and his recovery period had also been unexpectedly prolonged. He had therefore requested his colleagues to help him.

As soon as he recovered, he completed the manuscript. Soon the book was published. One day he came to my house. With a joy of satisfaction on his face, he presented the book to me. The field of computers was Greek and Latin to me. I still started browsing the book. After browsing a few pages of the book, I kept it aside.

I felt he was watching me very closely, for later he remarked that I should view the first few pages more closely.

I opened the book again. Inscribed on the third page were the following words:

                                               To

                                    Dr. Hemant Vinze

                               Poet, Teacher and Surgeon

A True Story in Real Life!!

A Drama in My Life!! 

Doctor, I am pain-free

CONQUEST OF DEATH 3

‘You will need to undergo surgery (operation) immediately,’ I advised. I was at a patient’s house. This was my second visit to his place; the first being four days ago. 

‘Operation?’, my patient was perplexed. 

‘Yes!’, I remarked.

‘But doctor, now I do not have any pain in my stomach. It has stopped suddenly!’ 

‘Suddenly! That’s what is dangerous!’ 

Not convinced fully, he said, ‘Please discuss this with my family doctor.’ 

His family physician’s office was nearby. I went to him personally and explained it to him. Our conversation went as follows.

‘Doc, four days ago when you referred this patient to me, he already had an appendicular lump, fever, tachycardia (fast pulse). I advised him to get admitted into the hospital for treatment, but because of financial constraints, he requested treatment at home. With a great reluctance, I started the treatment. However, I also explained to him to watch for rising fever, increasing pulse rate, increasing pain, and more importantly, sudden stoppage of pain, which is ominous! He now requires an emergency exploration!’ 

His family doctor was convinced. We both went to the patient’s house, explained to him the gravity of the situation and the need for the urgent operation. He and his family members were convinced. They agreed to the operation but the financial constraint was a major hindrance. 

“I will pay all your bills now, but you get operated first, get well, and then you can pay me back later as per your convenience, and as much as you can afford! Not a mite I demand from you!” 

He breathed a sigh of great relief. 

“A senior surgeon known to me is nearby, we can hire his operating room and bed,” his family doctor said. 

I went to the senior surgeon and said, ‘Sir you are a senior surgeon, this is an important case; in the interest of saving the patient’s life, if you desire to operate, I am willing to assist.’ 

“No no, a day should rise in your life when you become senior and help your juniors become seniors! You are operating and I am assisting!”

‘I am very much grateful to you. Gurus of your quality are hard to find. I shall follow your teachings lifelong!’ 

We started the operation. There were lots of adhesions. With great circumspection and dexterity, I released the adhesions, separated the appendix from the surrounding tissues and searched for the tip of the appendix. To our surprise, it was normal and the appendix was perforated at the base! (The appendix is attached at the base to the junction of small and large bowel. It usually perforates at the tip.) A fecolith (stone comprised of fecal material) was expelled out in the peritoneum (the sac covering the intestines); this itself is a very dangerous condition. I removed the appendix, washed the peritoneum, inserted a drain and closed the abdomen.

I started strong antibiotics. The next day, he had fever and jaundice. I was worried. I monitored his vital signs every hour. On the third day, his vital signs were normal and the drain stopped flowing. On the fourth day, he moved his bowels, the yellow tinge in his eyes diminished and he was hungry. In due course, I started feeds. On the seventh day, the jaundice abated. 

I decided to shift him to a better equipped hospital, preferably one which was attached to a teaching institute. He and his relatives agreed. I shifted him there. 

The professor in charge of the ward said, ‘Doctor, I have yet to see a patient of portal sepsis (poison circulating in the liver) survive! Kudos to you!! Young man, you have done a great great job!!! I don’t think I could have done anything  more than this. He has survived; his vitals are normal, his wound is dry and healed. Still, if you wish I shall admit him for observation. On the tenth post operative day, we will remove half the sutures, on the twelfth day we shall remove all the sutures and on the fifteenth day, he goes home! O.K.?’ 

‘I am very much grateful to you sir!’ I said

Every thing was going according to the plan. 

I narrated the anecdote to my wife. She expressed her desire to give her best wishes to the patient.   

The next day I took my wife to the hospital.

‘She is my wife’ I introduced her to the patient and his relatives. 

‘Don’t worry, you will soon regain your health,’ said my wife. 

Her words touched everybody’s heart!

‘With a great fight, your husband has brought me back my son from the crooked clasp of death. He spent from his pocket. Above all, he never ever demanded even a single penny. The value of life cannot be compared with money. My son’s life is much more precious than any amount of fees. We have no words to express our gratitude towards Dr. Vinze.’ 

His father’s words were followed by a hush. The prolonged calm was disturbing. His wife could not contain her sentiments. She reclined on my wife’s shoulder and shed silent tears. My wife caressed her to pacify her, but the outburst of her emotions was stormy. She started weeping aloud. My wife also burst out into tears.

I could not stand the poignant scene. I left the ward, went to a secluded place and wept away my mind. 

A True Story in Real Life!!

A Drama in My Life!!