14th September 1997

The Healing Cut - 10

To mend the bowels

by Roshan Peiris

The patient was a nurse by profession. Six teen years ago she had a Caesarian operation and for the last six years she felt a lump over the scar of her operation and another lump later near her navel.

At first she had occasional pain but it got worse and her abdomen protruded as if she was expecting another baby. There was the "para-umbilical" hernia near the navel and the incisions hernia near the scar.

The bowels were heavy and the defect could not be mended with only stitches but required a proline mesh; a rectangular nylon mesh had to be sewn in by the surgeon since the abdomen needed strengthening. Then the patient was given a general anaesthesia.

A local anaesthesia (that means making the area of surgical operation only numb instead of making the patient unconscious), the Chief anaesthetist said, may have made her abdomen heavy thus making it difficult for the surgeon to mend the bowels.

After the iodine disinfectant the surgeon made his lengthwise incision. First there is the skin, then a yellow layer of fat and then the muscles.

There was a large hole between the hernias. As the surgeon cut in using the diathermy probe to stop bleeding one could see the large bowel bobbing up and down like a big white ping pong ball.

The surrounding area is red like a macro maw - a huge cavity.

Then using the needle holder and surgical needle, the surgeon sutured back the incision with nylon thread and then inserted the nylon mesh to strengthen the place. Stitches could give away.

The proline nylon mesh will strengthen the bowels so that the patient will not have any trouble in the future.

The Chief Anaesthetist while keeping an eye on the patient taught medical students and doctors the art of administering anaesthesia. Much depends on this.

She inserts an endotracheal tube into the mouth to help the patient breathe.

The pulsometer on which she keeps an eye sets off alarms rather musical ones similar to that used by Walls ice cream vendors to indicate changes in the oxygen intake of the patient and the patient’s pulse rate.

After the repair the surgeon sews up the exterior with neat stitches inserting a suction tube (a small one) which empties the very little blood left over into a tiny round container like a dainty perfume bottle.

The blood loss is minimal with modern techniques. The surgeon covers the wound with a neat cloth and plaster bandage and the operation is over.

The patient will wake up to find that she has regained her figure and that no longer would her life be plagued with pain.

This operation is the tenth in our series and The Sunday Times wishes to thank the Management of Sri Jayewardenapura Hospital for their co-operation, the surgeons who allowed us to witness their operations, nurses and attendants and not least the friendly Chief Anaesthetist Savitri Wijesekera and finally the Consultant Surgeon Dr. Gamini Goonetilleke.

The doctor’s servant

By Dr. Sanjiva Wijesinha

"Its a good thing to travel to other countries," I recall my father telling me, as he accompanied me to the airport the first time I went overseas "because you will realise that the grass there is not always as green as it appears to be from here.’’

These thoughts of willing, able and obedient domestic staff, I must admit, usually come to mind when I am abroad and see my friends dutifully vacuuming the house, taking out the garbage bin on a cold dark winter evening, or having to go out to the takeaway to get something for dinner after a hard day’s work.

But having at one’s beck and call respectful and loyal servants who obediently carry out one’s instructions can have its own share of problems - as my old friend PJ once discovered.

Sometime ago, when we were living in the same neighbourhood, he asked me if I could drive him to the airport to catch his flight to Singapore. His flight was scheduled to take off on Saturday morning at 1015 - and PJ being PJ, he only remembered to ask me on Friday evening.

When I arrived at his house that morning at 5 minutes to 7, PJ was still in his bedroom on the third floor of his house, still clad in the sarong he’d slept in and still packing his bags. By the time PJ was ready and seated in the vehicle, it was almost 8.

Trying to make it to Katunayake (Now Bandara-naike) Airport before the flight closed was a tall order, but I decided to take on the challenge. We were making good speed and had reached the Maradana railway station when PJ suddenly smote his forehead.

‘My God!’ he exclaimed, "Turn back. I’ve left my ticket and passport at home!"

I promptly did a U-turn and headed straight back, cursing my pal under my breath. By the time we screeched to a stop outside his gate, it was half past eight.

PJ’s servant came running up. "Joseph," he wailed, "I think I’ve left my passport case on my dressing table in the bedroom. Run up and see if it is there."

Joseph took off like a dog who has had petrol splashed on to his bottom. He had three flights of stairs to tackle, coming and going. I sat there counting the seconds, my impatience and irritability plain upon my face. After what seemed an age, I spotted Joseph emerging from the front door, panting and empty- handed. "Well,’’ I barked, "wasn’t the passport case on the dressing table?"

"Oh, yes sir," replied Joseph walking towards us with the confident smile of the good and faithful servant who has carried out his instructions to the letter, "I saw it on the table with my own eyes and made sure. It is there as you said, safe and sound.’’

Continue to Plus page 10 - An onslaught on mental health

Return to the Plus contents page

Read Letters to the Editor