anonymous

31st January 2019

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.