anonymous

BEHIND THE CURTAIN 3

 BEHIND THE CURTAIN 3

DR SATEESH R. GUPTE

 
I started learning anaesthesia in one of the North England hospitals. Three senior consultants used to teach us during the day. I was quite serious about my studies and would wait till the last operation got over. .........
 

Eight months later, I passed my diploma examination in the same hospital and started conducting cases independently. One Saturday, the ENT surgeon wanted to operate in the morning so he could catch flight to London. He told the Resident to get him the senior most anesthetist available, as this was his private paying case. Derrick, the Resident, looked for me all over the place and finally located me, "Gupte " he said,”Mr Kearsley is calling you”. He had told the surgeon that I was the seniormost anaesthetist available on the premises! Luckily for me, I had worked with Mr Kearsley many times and he was happy to have me. The operation was on the septum of the nose. In those days sixties- way back in the sixties-we used to administer a special drug for bringing down the blood pressure so that the operation is comfortably performed in the absence of bleeding. This procedure is called Induced Hypotension. Having the procedure from the very first day of my training and done many similar cases, I was at ease and started the special drug infusion on the patient. In this procedure, you have to take the blood pressure repeatedly to steady it at a particular level; too much fall in the pressure is dangerous to life, so one has to be quite vigilant to adjust the infusion accordingly. A fall in the BP beyond a safety level can cause lack of oxygen to vital tissues like brain, heart and kidneys.

Mr Kearsely started the operation and probably to encourage me he said: "Gupte, this is the best hypotensive anaesthesia anybody has given for my septum case, excellent!"

I always felt worried when I was complimented, so I immediately took the blood pressure and found to my horror that it had dropped considerably! I immediately stopped the infusion and kept on taking the blood pressure all the time. Mr Kearsley, not aware of what had happened, kept joking and complimenting me, even as I kept watch on the BP like a hawk, inwardly praying and hoping that nothing untoward had happened.

The operation was over in fifteen minutes but I was in a tizzy! I was worried whether the patient would come out of his anaesthesia whether, perchance, he had suffered any brain damage. To my relief, BP rose steadily in the next ten to fifteen minutes and the patient woke up, but I was still worrie over any possible brain damage as a result of lack  of oxygen. Dear Mr Kearsley must have wondered why a normally jovial person like me was tongue-tied that day!

To add to my embarrassment, he wrote out a cheque for ten guineas and gave it to me. When I told him that I was a resident and was not entitled to accept it, he thrust it in my pocket and said: "You have done the case. This is your fees!" And he left.

My fright, however, did not leave me. All afternoon, patient a number of times to make sure that there was no change in his sensorium (intelligence and general behaviour). I can't describe the agony I suffered that Saturday. It was frightening to think of what might happen had the patient's brain been in any way damaged. Would he ever be able to work? What would his family survive on? How would it take the shock? The next forty eight hours were horrendous. But the patient recovered without any complications,

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