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THE LIMITS OF SURGERY 2

THE LIMITS OF SURGERY 2

DR R.H. KARMARKAR
 

The following case history shows that even a severely ill patient can escape from the jaws of death.

A young man in his twenties was admitted in my ward in the K.E.M. Hospital sometime between 1945 and 1950 with an infected wound in his leg. On examination, it proved to be a classical case of gas gangrene which had extended to the thigh. He was in a highly toxic state. Frank crepitations could be palpated on touching any part of the affected lower limb, due to accumulation of gases arising from the infected decomposing muscles. In those days, hyperbaric oxygen therapy did not exist, at least not in India. This method supplies oxygen under high pressure to the infected tissues and stops the growth of the causative anaerobic organism CI Welchi which thrives only in the absence of oxygen. The H.O.T. (Hyperbaric Oxygen Therapy) also reduces the amount of toxins produced by the organism. We did not even have anti-gas gangrene serum.

In this young man's case, the gangrenous muscles had to be excised intermittently and the only dressing we could provide was with hydrogen peroxide, with the fond hope that the nascent oxygen would be a useful therapy. Moreover in those days, there were only two antibiotics available. One was sulphonamide and the other was penicillin which was prohibitively expensive. (Even today, hardly any antibiotic works as a curative agent).

There was another major obstacle in my path. His highly infected condition precluded the use of the two major operation theatres on the first floor of K.E.M. Hospital. His surgical sessions could not be carried out in these theatres for fear of spreading his serious infection to other patients. He had perforce to be operated in a far-off and secluded place.

Now the problem was to find a suitable place to carry out my 'surgical feats'. Where do I operate without endangering the lives of other patients? But operate I must. Even in that toxic state, my patient's faint smile spurred me on. I approached the Assistant Dean of the hospital explained my dilemma. He very rightly refused permission to use any room for my surgical prowess anywhere near the main hospital building. However, very magnanimously he offered the corridor of the Infectious Disease Ward next to the Post Mortem room, to be converted into an operation Theatre. This corridor was duly improvised as an Operation Theatre and a wooden table was thrown in to be used as the operation table. Now where was I to get the lighting in this newly improvised Operation Theatre? By now, the authorities had become more generous and I provided with an overhanging 100 watt bulb for illumination during the surgical exercise

Looking back, I feel the situation was so ironical. Next to my Operation Theatre was the post-mortem room where the pathologist had to perform autopsies on dead bodies to ascertain the definite cause of death Their neighbour was exercising his surgical skills on a 'living corpse’. The dressings on alternate days were also done there, each time getting rid of the tissues which were necrosed.

As luck would have it, he survived this ghastly affliction and was discharged from the hospital after a stay of about two months. He not only went home but some twenty years later, came to my residence address and I was pleasantly surprised to find him absolutely hale and hearty and earning his own livelihood! When I first saw him, twenty years ago I had told myself: "Well, nothing can be done". Was it his determination and will to live that pulled him out of the crisis? In spite of the toxic nature of his illness and despite the minor surgeries being performed under the most appalling conditions, the patient still went home.

Compilation of professional reminiscences of specialists - edited by M.V.Kamath and Dr.Rekha Karmarkar