France, Fistula* and Family
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(*A kind of medical condition)
A family of five members ( Mr . and Mrs. R. and their three young offsprings ) had come to India from FRANCE. As such,they ( parents) were migrants from India but have settled in France for many years. They have acquired the French citizenship .
They came to India to attend the family wedding function. . Post celebration,they took up the trip ,visiting multiple cities of Rajasthan. They were travelling in the cab with chauffeur.
On the last leg of their journey, they were coming back to their home town ,when the car met with the accident in the early hours of the morning. The driver had a brief spell of lack of concentration , possibly due continuous hours of driving ,and lack of adequate rest breaks .
Luckily, all escaped from the injury except Mr. R. He had severe pain in his tummy ( abdomen) just above and the left side of navel but without any external mark of injury. He started feeling weak,nauseous and became pale.
They were in south of Rajasthan ,near the district town.,where he was driven in the ambulance.
After emergency examination and CT scan, at the private hospital ,he was advised for the emergency surgery.As that seemed to be the best available option under the circumstances,He was operated.
After the surgery, the relatives were informed about the injury to the small intestine . They were advised to go to the tertiary medical centre for further specialised treatment. The family contacted their relative Mr. K. in Baroda.
Mr. K . Had vast experience of dealing with medical field.
He was running NGO for poor patients assisting them in procuring health care , giving financial help . My surgical hospital provided care to many of his patients ,thus developing trust and rappo with him . He tried to contact me for Mr. R.
I was in the Europe for the road trip ,(2012) , criss -crossing the continent with my German friend and experiencing the culture, cuisine and comforts of my fellow couch- surfers across many destinations . Mr. K left the message at my hospital.
Mr. R. was shifted from Rajasthan to Ahmedabad and was admitted in private multi speciality hospital under qualified surgical gastroenterologist. He underwent second surgery on the 9th day of the injury due to peritonitis.
By this time,I came back. Mr. K .
narrated the whole medical history of the patient and requested me for the transfer of the patient under my care .
Intially,I was reluctant but my long association with loyal and considerate friend nudged me to change my decision.
I gathered that there were many complications due to injury, intestinal leak,intraabdominal sepsis, chest infection, soft tissue necrosis, nutritional deficits,to name the few.
He was transferred to the corporate hospital where I had experience in dealing with abdominal trauma surgery.
To describe the patient ' s condition is like visualising the artwork ,a kind of mixing of style of Salvador Dali and Goya - a dark skinned , shrunken eyed , emaciated figure with aura of mortified melancholy with motifs of negativity.
His thinned out body was connected to multiple tubes and machines. He was breathless, dehydrated with swollen legs and dejected looking face as if he has given up the battle .
Tubes were inserted in his tummy to drain out the leakage from the break in continuity of the injured intestine. He was loosing fluid, amounting many litres per day along with electrolytes,proteins vitamins and other nutrients. This medical situation is what we term FISTULA .
Identifying corrective issues was my first task along with its available medical solutions.
Eating by mouth( oral feeding) was not advisable due to leakage from proximal gut , so he was given nutrition through his central vein. To reduce the burden of infection ,dead ,necrotic tissue was excised off from his tummy wall . It was done piecemeal ,on daily basis, minimising blood loss and surgical shock.
He was continuously monitored for his volume of leak ,heart and lung functions and life threatening sepsis.
Surgical colleagues opined for the further operative intervention . My understanding and logical thinking were against the combative approach . To open up fresh battle on the twice violated surgical field was like leading the troops on the terrain full of minefield ,a sure shot for mayham of morbidity, mortality.
So our team continued the non operative approach.
After 23 days of intensive care in ICU,he had improved enough so as he could be shifted in the non ICU room. .
His leak was reducing everyday and it was periodically checked with CT scan to visualise what is happening in the nooks and crevices of complex anatomy of affected part of the body.
He underwent skin grafting to cover the raw area of his tummy wall .
Along with this positive progress,his oral feeding and gradual mobilization started to build his strength, stamina ,that stabilized his physiology. His changed fascial features reassured me about the final victory.
By the 49 th day , leak become almost zero. All tubes inserted in his body were removed . He has recovered enough to walk to home.
It was great to see so many smiling faces of kith and kins and extended family members on the day of discharge.
Along with my team ,
we were being thanked ,congratulated and complimented .
The best compliment came from the
Mrs. R.
With moist eyes and a choking voice.,
She said,
" Doctor,you have not saved only one person but the five persons -our FAMILY of Five ".
It was music to my ears .
Those words still linger in my personal audio space and reverberate from time to time .
Thanks to the the Almighty for the profession and vocation HE has chosen for us , doctors.
