THIS CAN HAPPEN: VOLUME VII
Dr. Gangadhar Sahoo
This can happen: Volume VII:-
I think it was in early part of 21st century. I was the Associate professor and Unit head of 3rd unit of O&G department, VSS Medical College Burla. My unit was the busiest unit and most disciplined unit of the department. Patient load was maximum. We were getting varieties of patients, referral cases and complicated cases not only from western Odisha but from neighborhood states like Chhatisgarh and Jharkhand . On priority basis we were keeping limited number of cases to maintain the quality of service. But at times we were subjected to too much pressure and persuasion to keep more than required number of cases. Knowing fully well that it would be beyond my control to supervise and guide each and every case, I had to rely on my skilled senior and experienced doctors to finish all cases. It was no doubt exhaustive, it was risky and complication prone also. Here I will be narrating an incidence related to overcrowding the operation theater table.
We had two OT days per week. OT list was prepared on the previous day. Cases were selected on the basis of emergency and according to the booking date. Unless acute emergency each routine case was put up for surgery once she was medically fit and getting clearance from the cardiologist and anaesthesiologist. As a routine during evening round on the day before the operation my team was used to counsel the patients , prescribe the medicines required during and after the operation and got those checked up to avoid use of any wrong medicine. We planned who should operate which case during that evening round. As the team leader I always took the decision. For one such operation day ten cases were kept six major and four minor. It was really too many.
Out of those cases there was a case of post partum vaginal fistula. The patient was about 25 years of age and it was her 1st delivery . She had her vaginal delivery with episiotomy (a minor operation done to widen the vaginal opening) around five months back at a district headquarters hospital. Around two weeks after delivery she had leakage of fecal matter through the vagina . It's a complication of episiotomy. During repair, if proper care is not taken the lower gut wall gets stitched with the vaginal wall and later a communication develops between the gut wall and the vagina causing leakage of flatus and feces through the vaginal canal. This condition is called ano vaginal or recto vaginal fistula. It's a very embarrassing situation for mother. The lesion appears very simple but very difficult to repair. If it's not done by an expert hand with utmost care chances of failure is quite high.
It was decided during the evening round that that fistula case would be operated by me. Such cases are kept for operation just after menses and at least three months after delivery. Seventy two hours before operation special preparation of the gut wall is made. But the irony is that in the best institution and best of the best hands success can't be guaranteed.
On the date of operation, because of two emergency cases, starting of routine operation was delayed. It was difficult to finish all cases in time. So I took up the cancer cervix case on the 1st table and another major case by my assistant professor on the 2nd table. After she finished her case, I asked her to start the fistula case. She had assisted many such cases with me but never operated independently. She had the confidence to operate. So I allowed her. She completed her operation without difficulty. After I finished my cancer surgery I congratulated the surgeon and the team ,discussed with them regarding the post operative care of the fistula patient. As a principle I discharge such cases after 10th post operative day because failure of such operation (known by leakage of fecal matter through the stitches) usually occurs around 10th post operative day. Even if the patient wants to be discharged on the 5th post operative day after she takes normal diet and bowel is moved, I usually refuse .
After the operation, from the very first day the patient was very happy. When she started taking normal diet and had no leakage she felt as if she got a new life. Her husband, leaving her wife and the baby girl went to join his duties. On the 9th day he returned from home hiring a taxi, so that she can take his family after his wife is discharged. He was so happy thinking of being discharged next day . He came to meet me with sweets, fruits and dry fruits. He had world of praises on me and my team for our marvelous work.
Next day morning my team was in a jubilant mood, pouring all good wishes on my assistant professor for her maiden success in a fistula case. Then like a champion team we marched forward for the routine round and at first went to the bed of the fistula patient, hoping a memorable welcome and farewell as well . But when we reached the bed we were taken aback what we saw there. The patient was lying on the bed in prone position sobbing , with face buried on the pillow. Her husband was standing in one corner of the ward with drooping shoulders and giving a vacant look at us . I could guess what might have happened. When I cast a curious look at the staff sister, she told me the whole story. Since morning the patient was quite upset when she noticed fecal matter in the vagina . The jovial atmosphere of the ward had suddenly dropped to a dead silence. I had no courage to tell anything to the patient or her husband.
The husband followed us to my office chamber. His last expression I can't but put down here. “Doctor! I had come with a great hope. After hearing your name and fame not only as a good doctor but as a good human being and your success story of handling difficult and critical cases, I brought my wife with recommendations from many doctors.
But what I got? What is the result? It became bad to worse for me. My wife can't show her face to anyone. She will be an outcast . She will be a psychotic . I am not blaming you. It's my misfortune. What I will do ? "
I became speechless. I had nothing to say. I could understand his agony and the pitiable condition of his wife. This was the first failure case of mine but it took away the glory of my thousand and one successful cases . I felt terribly guilty not operating the case myself. Till date I haven’t forgiven myself. Till date when I see a fistula case the face of the husband starts dancing in front of me and his final words echo into my ears.
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