anonymous

7th December 2018

THE LIMITS OF SURGERY 1

THE LIMITS OF SURGERY 1

DR R.H. KARMARKAR

I did not hesitate to accede to the request made by the editors of the book, to contribute my professional memoirs depicting the human and emotional aspects of a doctor-patient relationship. These aspects of the article fitted in with the background of my training as a medical student under the influence of my great father. My father was a general practitioner practising in Bijapur, having passed the L.M.S. examination University of Bombay in 1906. He devoted his energies solely to his patients, treating the rich and poor alike, without caring for monetary gains. Whenever I went home during the vacation whilst I was a medical student, I spent time in his dispensary and learnt unknowingly what human touch meant to a patient. Striving for excellence for the sake of his patients, was ingrained in his nature. No wonder then, that he was the only doctor in Bijapur to own and use a Microscope in his daily practice before labelling a patient as a case of pulmonary tuberculosis, anaemia etc. and to use an Ultraviolet lamp to cure kids with rickets.

He was an avid and regular reader of medical journals and I consider myself lucky to have been initiated into medicine by him.

In 1942 I set up a small hospital with three beds near Dadar Railway Station in Bombay and started my surgical career. Some two years passed when one morning, a group of four of five fishermen from a village near Bassein landed in my hospital. One of them carried a hefty but unconscious patient on his back, like a fully loaded gunny bag. He had carried the patient on his back all the way from the railway station. Four days earlier, I learnt, the patient had sustained an injury to his perineum just behind the scrotum (genitals) as he hit the edge of his fishing boat while alighting from it on the shore of a stormy sea.

The very sight of the patient convinced me that I was facing a challenge. He was unconscious due to Uraemia, and was suffering from extravasation of urine due to the rupture of the urethra. The scrotum was blown up to the size of a watermelon due to collection of blood clots, and the urine had spread beneath the skin of the lower abdominal wall which was swollen, tense and haemorrhagic. I operated upon him the same day: By a very simple surgery, the clots were removed from the scrotum and multiple incisions on the abdominal wall relieved the pent-up urine. A temporary suprapubic drainage of the urinary bladder was done. This did the trick. The patient regained consciousness after about 36 hours. At the time of his discharge three weeks later, he was passing urine normally. The relatives were so happy that they arranged to have the patient, now fully recovered, taken from the entrance of his village to his home with band and music. But what embarrassed me was their insistence on my joining their 'fiesta'. I gently declined their request, thanking them for their naive but sincere gesture.

After this amusing episode, the fishermen have continued for more than four decades their good relations with me and insist on sending me their prize-catches from the Arabian Sea. Their gratitude touches my heart and I firmly believe that it is the goodwill of such gentle-hearted souls that kept me going throughout my surgical career.