anonymous

11th September 2018

TO ERR IS HUMAN (3)

 TO ERR IS HUMAN (3)

DR G.S. AMBARDEKAR

We normally advise a very strict NBM (Nil By Mouth, no liquids or solids orally) regime for a period of about 6 to 12 hours, depending upon the age of the patient, in the pre-operative period. This is to safeguard against aspiration of the stomach contents into the trachea (windpipe) if, perchance, a patient vomits during the course of anaesthesia. A general anaesthetic has the potential of depressing or totally abolishing the protective glottis reflexes which, in a normal conscious patient, prevents the stomach contents from entering into his windpipe, in case of vomiting. These stomach contents, if they enter the windpipe, cause very severe lung problems or even death.

It is in this context that we advise a strict starvation regimen. We certainly do not wish to deprive our patients of culinary pleasures. But I have noticed many a parent quietly giving some water to a crying child during the pre-operative period, not realising that their misplaced affection could land their child in an irrevocably ghastly situation. Such parents should be made to understand the gravity of their deeds and thoroughly admonished for their foolhardy behaviour. Readers will comprehend the importance of this strict starvation regimen after reading this tragic tale of a 5-year-old child who had to pay with his life for no fault of his.

This boy whilst playing with his friends had a fall and sustained a fracture of his leg bone. He was to be operated upon by a well-known orthopaedic surgeon of those days and the surgery being of an emergency nature, was scheduled for 6.00 p.m.

After proper clinical evaluation and confirmation of the child's starvation history from his parents, I started administering the conventional ‘open ether' inhalational anaesthesia that was prevalent in those days some time in 1949. After a few minutes a peculiar sound emanated from the child's throat and within seconds, the relatively unconscious child had a copious vomit and it contained some solid matter that faintly resen the Indian snack shev-gathi. I could not believe my eyes! It was clear to me that the child was in mortal peril. On examination I found that a shev-gathi had lodged itself in the tiny inlet of his windpipe. The solid matter could not be drawn out by a suction machine. So I immediately removed it with a Magill’s forceps.  No sooner had I removed one bit that another took its place. All my efforts to keep the windpipe open proved futile and the child became cyanosed (blue) due to lack and sustained an irreversible cardiac arrest. We tried in vain to resuscitate him but our efforts went unrewarded.

I was so overcome with grief that when I approached the parents to recheck with them about the starvation history and also to inform them as gently as I could of the calamity that had occurred, my eyes were brimming with tears. The grief-stricken parents told me that since morning the child had nothing to eat except for few sips of water around noon.

Next morning I was in for a real surprise. The dead child's father, despite his profound grief, had come to see me. I naturally co-related his visit to the numerous medico-legal hassles one encounters when confronted with an operation-table-death.

But what he told me was astounding.

At about 4 p.m. the previous day, about two hours prior to the scheduled surgery, three or four boys from his neighbourhood, all in the age group of 6 to 10 years, had visited the little boy—perhaps to wish him good luck—and fed him all the goodies that eventually led to their little friend's untimely death. When I gently reprimanded the grieving father for not having exercised his parental discipline, he lamented that he had briefly gone out of the room to attend to some urgent matter. During that interregnum the child had his fill and cleverly managed to keep it a secret. Not a trace of the wretched snack was in view when the father returned. The parents in this case were certainly not responsible for the boy's tragic death but what I am trying to emphasise is that a strict vigil is necessary on a child's activities during the pre- and post-operative period, both by the parents as well as the hospital staff.