THE LIMITS OF SURGERY 3
THE LIMITS OF SURGERY - 3
DR R.H. KARMARKAR
A patient in his mid-thirties was suffering from chronic
duodenal ulcer. I did his vagotomy and pyeloroplasty in March 1969. Whenever
possible, this operation is to be preferred to partial gastrectomy. It reduces
gastric acidity without compromising the normal intake of food. Unfortunately
he developed postoperative biliary fistula. Majority of such fistulae close on
their own in 2-3 weeks. But this one refused to heal. In April, three more
operations were performed successively to stop the leak, but the external
drainage through the fistulae persisted. Whatever was taken by the mouth found
its way out through the fistula, thereby reducing this once handsome man to a
state of skin and bone.
This led to a great emotional strain on me, as I was
responsible his condition. However, the patient continued to have faith in me
and our relations remained congenial. Not once did he show his irritation and
annoyance with me this depressed me even more.
In the month of June, about three months after his first
surgery, I left for London to attend a surgical conference where a doyen of
abdominal surgery, Prof. Tanner, was present. I took this opportunity to
consult him. To my surprise, he told me that he too had a similar experience
once or twice. His advice to me was brief. He said: "As your patient has
lived for more than two months, the fistula will definitely close. Probably by
the time you go back to India after two or three weeks, it will have closed of
its own. Do not perform any more surgeries on him".
His reassurance had a calming effect on me but yet at the
back of my mind there was a lurking fear that something terrible may have
happened to him. To my pleasant surprise when I returned, I found that the
words of the great seer had come true. I could hardly believe my eves. The
fistula had simply vanished! I saw the patient about twelve years ago when he
came to me, hale and hearty, to invite me to attend his daughter's wedding.
This case is a fine example of how patients recover in spite
of us doctors. On the advice of Prof. Tanner, by not exercising any more of my
surgical prowess, I had, in fact, actually helped the patient.