BEHIND THE CURTAIN 3
DR SATEESH R. GUPTE
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,