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The first time I opened a patient’s chest in theatre

Sunday January 19 2020

SURGERY

Apparently, the knife had pierced the pericardium, the covering of the heart, and cut the heart muscle. ILLUSTRATION | JOHN NYAGAH | NATION MEDIA GROUP 

Yusuf K. Dawood
By Yusuf K. Dawood
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As I said earlier, Marie and I were extremely happy in Nairobi.

The year 1964, just like 1958, proved a lucky year for me. At the end of my three-year contract, I was promoted to the position of a full-time consultant surgeon.

We were also blessed with a daughter, whom we christened Jenny after my sister Zainab. She’s fondly called Jenny because she was like my mother after her death.

It also gave us a reason to move from our rented flat and buy a house with a garden for Jenny to play at.

The country had just ushered in independence, and it was the right time to buy property because prime properties in prestigious areas were going for a song.

Eventually, we bought a house in what was known as Livingstone Drive, renamed General Mathenge Drive after independence.

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The full-time position in my contract was stipulated to bring all my work to Aga Khan Hospital, and when the facility converted the trainee nurses’ home to a private wing, I was also allowed to do private practice.

CONSENT FORM

The measures I had taken to improve bed occupancy paid dividends and my private practice took off.

I remember two episodes from that era. One was a middle-aged, plump Kikuyu woman who had acute cholecystitis.

Her gallbladder was on the verge of bursting and cause life-threatening peritonitis. Despite my warning to that effect, translated by a Kikuyu night Sister, she refused to sign the consent form.

I put her on conservative treatment as a last resort, left her in the care of my house-surgeon and went home in utter frustration.

I didn’t sleep that night, worrying about my patient, who could neither read nor write, when mercifully, the phone rang.

It was my house surgeon, who said. “The lady has given her consent. In view of the urgency of surgery required, I am ringing you at this unearthly hour.”

I rushed to the hospital and removed the patient’s inflamed gall bladder due to the risk of rupturing since it was blocked by a big stone.

CONDUCTOR STABBED

My house surgeon was cagey when I asked him how the patient changed her mind.

I remarked when I realised that I was not getting anywhere with him: “You obviously have more charm in that age group!”

The mystery was resolved when he finished his term and came to collect his testimonial. He was hanging around nervously after collecting it. “I have a confession to make, sir.”

He said apologetically. “It’s about that ‘gall bladder lady’. After the morphine injection you prescribed for her pain, she became very drowsy and confused. The Sister and I agreed that she was killing herself because of her fear of surgery, so I put her thumb on the ink-pad and pressed it on the consent form. The Sister signed as a witness.”

"The end justified the means in this case,” I comforted him, seeing his remorseful face, “but don’t do it ever again.”

Another case was Ogutu’s, a bus conductor who was stabbed in the chest by an irate passenger after an argument over fare.

He was admitted in my unit from the casualty, where my intern, Dr Dhir, rang me.

CHALLENGING TASK

Though I had seen a lot of chest surgery to acquaint myself with the subject, enough to pass the final Fellowship examination, I had never opened a chest before.

My FRCS had not prepared me to work in the developing world, where a general surgeon has to be a Jack of all trades!

Changes have been made in the syllabus now to put the matter right, but I was not a beneficiary of that amendment.

I rushed to the hospital and saw Ogutu. The blood transfusion that Dr Dhir had set up was not keeping pace with his blood loss and I thus needed to open the patient’s chest and stop the bleeding.

I asked Dr Dhir to organise the theatre and call the anaesthetist. “Please ring me when you are ready,” I said and made my way home, straight to the study room.

I refreshed my knowledge about chest wounds and referred to the illustrated volume of Thorax to remind me how to open the chest, when the phone rang to say they were ready and waiting for me.

SUCCESSFUL SURGERY

I drove wearily to the hospital, realising that the moment of reckoning for me had arrived.

On arrival in the operating theatre, the anaesthetist’s remarks did nothing to lift my spirits.

The late Mary Robertson-Glasgow was on call and had just seen the patient. “You need an undertaker and not an anaesthetist,” she said.

On hearing this, I examined the patient again; Ogutu’s blood pressure was falling and his pulse was feeble; indicating that surgery was urgently essential or we lose him on the table — a hazard that every surgeon dreads, especially a budding one.

He was put under anaesthesia. Thankfully, nobody checked my pulse but it was faster than Ogutu’s!

I removed a rib and opened the chest and there was lot of blood in the pleural cavity, the source of which was a stab in the lung.

I stitched the lung and it stopped bleeding. There was still some active bleeding and Dr Dhir spotted its cause.

Apparently, the knife had pierced the pericardium, the covering of the heart, and cut the heart muscle.

I repaired the heart, evacuated all the clots, closed the chest and connected it to an underwater seal. Ogutu recovered, and during his outpatient visits, I came out clean and said: “It was the first time I opened a chest.”

“It was the first time I was stabbed by a passenger!” Ogutu replied.

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