CONQUEST OF DEATH 25
(Hernia Inguinale)
“I have a case of hernia. Please examine him and operate” Said my friend.
After finishing my consultation work I went to his hospital and asked the ward sister
“Sister where is the patient of hernia?”
She took me to his bed and introducing me to him said
“He is ‘surgeon’ he has come to examine you”
“Hello. I am a sailor.” He started narrating. “About three weeks ago our ship was anchored off the coast of France. One evening all of a sudden I started getting pain here. (He pointed to the lower part of the right side of the abdomen.) The doctor on our ship took me to a surgeon on the port. He examined me and said ‘you have hernia. You are required to undergo an urgent operation.’
“I said our ship will leave the port in two days. I cannot stay back. Please give some medicine.
‘There is no medicine for hernia. It can be cured only by an operation.’ He said.
“But doctor I can not stay back. Please give me some medicines to relieve my pain.
“With a great reluctance he prescribed me some medicines. Here is the prescription.”
He held before me the paper.
Written on the letterhead of the doctor was:
(R) Hernia inguinale
Adv. Surgery
Written below were trade names of some drugs available in France.
I handed over the paper back to him and said
“Please lie down. Let me examine you.”
He was a typical sailor with a classical alcoholic facies:
Congested eyes, poached egg lids, puffy flushed face, obese, bulky stature, corpulent belly red and warm palms…….
He had tenderness in the region of the appendix. No inguinal hernia. I was perplexed. I made him stand, cough, strain, walk about. I could not find any sign of inguinal hernia.
“The episode of pain in your abdomen a few days ago was in fact an attack of appendicitis. You do not have hernia. You do require an operation for appendicitis and not for hernia.” I said.
“But that doctor said ‘you require operation for hernia’. He even reported this to our doctor on the ship!”
“In hernia” I started explaining to him, “The contents of the abdomen, usually the intestines come out in the region of the groin. Did you get swelling there at that time?”
“No”
“Do you get inguinal swelling now? Or did you ever have such a swelling before?”
“No”
“Well you require an operation for appendicitis and not for hernia.”
“I am willing for operation but also give a cut for hernia operation and if there is no hernia take skin stitches…..”
“I do not practice in such a way.”
“Please doctor…..otherwise I shall loose my job”
“You shall not because there is no inguinal swelling.”
“You will fight for me if it comes to…..”
“Certainly”
“OK. When would you operate?”
“Day after tomorrow”
“OK”
On that day I equipped the operation theatre. The anaesthetist arrived on time. He started the intravenous drip. As he started the induction of anesthesia the anaesthetist became restless.
“The patient is not breathing, his B.P. has dropped, and he is pulseless.....CARDIAC ARREST…..” Declared the anaesthetist.
I immediately scrubbed off, started giving external cardiac massage, (external massage to the heart) put mask on the face of the patient and started ventilating him. The anaesthetist took over from me. He attempted intratracheal intubation but failed. He continued ventilating by using the mask. I continued giving cardiac massage. To counter the ill effects of the anaesthetic drugs and to revert the patient from the anesthesia the theatre assistant started pushing the drugs as directed by the anaesthetist through the intravenous drip.
Soon I could feel the pulse. It was feeble and intermittent. But the pulse reappeared. We all breathed a sigh of relief. After a little while the patient became stable.
Later he was fully conscious. We then shifted him into the ward. We monitored him for two days.
“Previously also for some other problem doctors could not give me general anaesthesia, because I have double chin and short neck.” He said.
The anesthetist was stunned. “Had you told me this before I would have used some other anaesthesia. Two days later we shall post you for the operation” He instructed the patient.
“OK”
Because the patient was bulky and on standing had bulge in the inguinal region I decided to take second opinion. I requested a friend of mine to evaluate the case. He agreed with my diagnosis. I requested him to assist me. He agreed.
“We shall first perform the appendicectomy, and as I start closing the abdomen you explore the inguinal region for hernia. Let us not be overconfident and miss the small hernia if he has one.” I explained the plan of operation to my friend.
“Quite right” He said.
As per our plan we performed the operation under regional (spinal) anaesthesia. MY friend explored the inguinal region. There was no hernia. We told him about that.
The post operative recovery was uneventful. We discharged him from the hospital on the tenth day.
I gave him the discharge card with detailed notes.
“Needless to criticize and comment who was right and who was wrong” He said. ”I am grateful to you doctor because with this scar of hernia operation, I am sure now I will not lose my job”
A TRUE STORY IN REAL LIFE!
A DRAMA IN MY LIFE!!
DR. HEMANT VINZE
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