SURGEON'S DIARY: Operation on immigrant boy with grossly inflamed small intestine

On reaching the Casualty Department, we saw the boy, who looked petrified despite his parents hovering around him. We could see that the boy and his parents spoke little English, so Andre handed over the history taking to me. ILLUSTRATION| JOHN NYAGAH

What you need to know:

  • Lest we forget, I want to narrate a case history which happened in the late 50s when the doctors working in the health department were not conversant with some diseases the scanty immigrants suffered from.
  • It happened at City General Hospital in Sheffield, where I was a house-surgeon, junior-most trainee.
  • Andre Roux, a South African, was the Surgical Registrar, a middle-grade trainee, and Mr O’Gorman, an Irish man, was the consultant.

Like Kenya, Britain has undergone many changes in my lifetime. Talking about the United Kingdom, I first flew to London on February 2, 1955 to qualify and train as a surgeon. Being very few then, we were treated as a novelty and were greatly respected and admired.

Apropos of this, I remember being requested to be a judge at a baby show at a church in Maidenhead, where I did my first job as a casualty officer in the local hospital. The era of racial prejudice had not started yet, which happened in the late sixties when the influx of blacks and browns from East and West Africa, the West Indies and south-east Asia, starting as a trickle, soon became a deluge.

Some arrived as refugees and others came in search of greener pastures and strained the free health and education services of the tiny island. They took jobs that the “natives” did not wish to do. In fact, I got the job of casualty officer because there were no “local” contestants. Naturally this became a fertile ground for prejudice and since it was based on the amount of pigments one carried in one’s skin – very easily verified feature – it was dubbed as racial. Soon Britons became wise to the fact that these “outsiders” played a significant role in sustaining the welfare services they were accused of stretching thin. This realisation and laws enacted against discrimination in general and ethnic bias in particular put Britain on the way to becoming a multi-racial society, an evolution, the making of which I observed in my subsequent visits to the UK.

On my last visit there recently, I was heartened to see people of African and Asian origin manning senior positions on TV, schools, universities, supermarkets, law courts and hospitals. In fact in a hospital I visited in London, I heard two girls conversing in Swahili. One of them turned to me and asked. “Mr K. what are you doing here?” She addressed me by my abbreviated name used in the hospitals in Nairobi and I recognised them as nurses with whom I had worked and who, in a wave of brain drain and in search of better prospects, migrated to the UK and have settled there.

Looking at the happy cohesion with which they work together, I reckon that Britain has evolved into a non-racial nation. To prove my point, I want to mention an interesting thing I saw on BBC television. It was a news item to the effect that while traditional “pubs” are closing in the country, “Deshi Pubs” or Indian ethnic pubs, are sprouting. I saw on the screen a “Deshi Pub” in Birmingham serving beer to British men and women to the tune of Indian music, the clients enjoying curries and merrily dancing “bhangra,” the traditional Sikh dance, with their Indian friends. The annual Notting Hill Parade simulating the three centuries old Rio Carnival is also staged to promote African and Caribbean culture.

LEST WE FORGET

Lest we forget, I want to narrate a case history which happened in the late 50s when the doctors working in the health department were not conversant with some diseases the scanty immigrants suffered from. It happened at City General Hospital in Sheffield, where I was a house-surgeon, junior-most trainee. Andre Roux, a South African, was the Surgical Registrar, a middle-grade trainee, and Mr O’Gorman, an Irish man, was the consultant. Mr O’Gorman was an interesting character. He was a bachelor and had triple post-graduate qualification: he had fellowship in surgery, membership of the College of Physicians and College of Obstetricians and Gynaecologists. He justified his bachelor status by saying “Busy doing the exams, no time to get married!”

Being single, the hospital administration had allotted him a bachelor flat in the doctors’ residence. His constant companion was his pet dog, whom he took out for a walk every evening on the hospital lawns. We saw him carrying a brown paper bag to collect the dog’s pooh and drop it in the bin on the lawns. He did so wearing his theatre garb which he wore as he left after his operating session, a rare amenity. The theatre Sister allowed him because of his seniority. Arrangements were made for the maid to collect it the next morning and leave a clean set behind.

Some of us noticed his many female visitors, mainly from the Sister’s Mess next door, staying the night with him but we knew that the hospital authorities turned a blind eye to that on the basis that he also had to satisfy his “biological needs”! He was full-time, a brilliant surgeon and did not indulge in private practice. His mantra was “I have no time for people who have more money than sense!”

One evening, while we the resident doctors were watching TV in the doctors’ lounge after dinner, the telephone rang and, since Andre was sitting next to the phone, he picked it up and I heard him say: “Yes, he is here with me.” And then added “As soon as the news is over, we both will come to see the emergency.”

As soon as the news anchor finished reading the news, Andre twined his arm with mine and said: “A Pakistani boy has been brought to the casualty with acute abdomen and the Sister has called us.”

Acute abdomen is a term in our jargon to describe a sudden abdominal emergency, the cause of which has not been ascertained.

TYPHOID PERFORATION

On reaching the Casualty Department, we saw the boy, who looked petrified despite his parents hovering around him. We could see that the boy and his parents spoke little English, so Andre handed over the history taking to me. I talked to the parents in Urdu and, having collected the relevant medical facts, conveyed them to my senior. “They are recent immigrants from Sukkur, a town in Sind, Pakistan,” I said. “The father works in a steel mill here which makes cutlery. The boy started with high fever, diarrhoea and discomfort in the stomach but today his condition has worsened, with unbearable pain in the stomach, the temperature shooting to 106 degrees and excessive sweating.”

Andre examined the eight-year-old boy and said: “If he was an English boy, I would call it ruptured appendix and rush him to the theatre.” He then took a thoughtful pause, looked pointedly at me and added:

“Since he is from a tropical country, we need to consider other possibilities. Why don’t you examine him and see what you think?”

Feeling mighty important, I went over the lad and expressed my opinion. “At home, I would have thought of typhoid perforation.”

“What would you do?” Andre asked. “Would you operate on him?”

“The outlook in typhoid perforation is poor because the small intestine is inflamed with typhoid bacillus and leaks at multiple points, causing fulminating and often fatal peritonitis,” I replied. “But I would put him on intravenous chloromycetin, the specific antibiotic for typhoid fever.” “We will do so but let us ring the boss and ask him to come and help us with the diagnosis,” Alex Roux suggested.  

WAS WITH US IN MINUTES

Being resident in the hospital, Mr O’Gorman was with us in minutes. He heard the history with rapt attention and went over the little boy carefully, thought over the matter for a while and said: “Certainly a case of peritonitis but, since as you say he is a recent arrival from Pakistan, we must consider causes other than those common in our country.” Then looking at me, he added: “Could be typhoid peritonitis but we can’t sit on him with that assumption.”

With a flourish of his membership in medicine, he went on: “Let us do a white blood count on him because in typhoid it is low but I think you should open him, establish a diagnosis and do the needful.”

The oracle had spoken and Alex and I did an exploratory operation on him at around midnight, driving Alex to keep on saying his oft-repeated expression, confirming his South African origin. “This is tiger country,” he remarked as we confronted grossly inflamed lower small intestine with multiple perforations, all of which we closed. We took a swab from the inflamed ileum for culture, left a drain and closed the abdomen.

WE LOST THE BOY

We lost the boy a couple of days later. Being a death after surgery, a post-mortem was mandatory, for which we had to take permission from the parents. In reply, the father spoke in his broken English. “No need,” he said. “Allah’s wish, the boy dies. He gives and He takes.”

We approached Mr O’Gorman with all the details and he sympathised with the bereaved parents. His advice – Since you opened the abdomen and saw with your own eyes what was inside, you can certify the cause of death. In the meantime, wait for the culture report on the swab you have taken. The white blood cells count is low, commensurate with and in favour of typhoid fever. If necessary, you can testify at the inquest and explain to the coroner and he might think as I do. Why cause the newly arrived couple further trauma? They have suffered enough stress losing a child soon after arrival in a new country with a different climate and vastly different culture.”

The swab came positive for typhoid bacilli, which we presented as exhibit A at the inquest. The coroner, a kind lady, looked at the parents, the mother in  three-piece Pakistani suit and the father in loose Sindhi shirt and flowing trousers, an uncommon sight in those days, accepted our death certificate and did not insist on an autopsy.