Life is like a book. Each page has a new content. This quote pertains to my adventurous 38 years of life as a surgeon in Sri Lanka. There were many times when I had to make my own bold decisions especially in life or death situations.

Here are a few illustrations of patients treated at a hospital with limited resources during the period 1982 – 1988

Nihal was a 26 – year old Commando of the Police Special Task Force who was then fighting the terrorists in the Eastern Province. On 11 December 1986 he was travelling by train to Batticaloa after his home leave, clutching his T-56 machine gun and standing on the footboard. As the train approached Welikanda, a rural village bordering the Eastern Province, a gunshot rang out from nowhere. Nihal was on the floor, grimacing in pain. He was bleeding profusely. His colleagues brought the train to a halt. He was carried to an army jeep parked nearby and rushed to the Polonnaruwa Hospital many miles away. There was no doubt that he had been shot and injured by the terrorists.

He was admitted to my ward at around 6 p.m. on that fateful day. I was in hospital at that time and was able to attend on him without delay. On examining him I discovered that he had a serious injury to his left arm. The gunshot had damaged the major blood vessel, the lifeline to his hand. If the blood vessel was not repaired immediately, the arm would have had to be amputated. The blood vessel was quickly repaired to avoid this.

A few days later, complications had set in and he started bleeding profusely from the wound due to an infection. This happened on Christmas day when I was on holiday in Colombo. I asked the junior doctors in my ward to control the bleeding in whatever way possible without compromising the circulation to the hand. This was done. His hand remained viable, but was swollen with restriction of movement of his fingers. If bleeding continued, he could have died. Something permanent had to be done as bleeding could recur, resulting in grave consequences. I cut short my Christmas vacation and returned to Polonnaruwa the next day and decided to perform a second operation. He was warned that he may lose his arm. He consented to the operation. After removing the infected part of the artery, a small segment of a vein was taken from the thigh and this was used to bridge the defect in the damaged artery. The bleeding stopped and gradually the circulation to the hand improved. His arm was saved, and is functioning well today 34 years later. He remains a Special Task Force Commando even today. He has not forgotten the surgeon who saved his life and his arm. Even now, he is convinced that I should be consulted for the slightest pain in his arm.

Ibrahim was a businessman living in Kathankudy, South of Batticaloa. He was on one of his business trips to Polonnaruwa. At the Polonnaruwa railway station, he tried to board a moving train. He missed his step and fell between the platform and the moving train. Though the cries of the people on the platform brought the train to a halt, it was a little too late. The damage had been done. Both his legs were mangled below the knee. He was admitted to the Polonnaruwa Hospital in a state of shock due to severe bleeding from the injured limbs. There was no way of saving his legs. I had no option but to amputate both his legs, one above the knee and the other below the knee. That was to save his life. He recovered but remains disabled, unable to continue his normal chores as a businessman. A few months later, I received a letter from him thanking me for saving his life and also a photograph showing him trying to walk with artificial limbs. A tough task indeed, after losing both lower limbs!

Rani, a 12 years old girl was attacked and gored by a domesticated buffalo.. Her abdomen had been perforated and had resulted in the small bowel being pushed out. This injury occurred 40 miles away from the Polonnaruwa hospital. No one had any idea of first aid and there was no vehicle to transport het to hospital leave alone an ambulance.
In desperation Rani’s father hired a van from a friend. The seats were removed, and she was kept on the floor of the van and transported to the hospital. Rani reached the hospital many hours after sustaining the injury. It was just after midnight when I was called to see her. She was in a state of extreme shock and collapse. The pulse and the blood pressure were not recordable. Immediate and active resuscitation with saline and blood improved her condition. Surgery followed with the support of my staff. The damaged small bowel was repaired and replaced in its normal position. She recovered completely and went home after a few days.
The timely treatment by the surgical team saved Rani’s life.

Gunshot injury to chest

My phone rang at seven O’ clock in the morning on the 22^nd of June 1986. The caller was my House Officer. He was rather excited. He informed me that a young man with gunshot injury to his chest has been admitted to the ward. I rushed to the ward. The patient was a young officer in the Sri Lanka Army. He had been hit on his chest by a terrorist bullet in the early hours of the morning. In view of the critical nature of the injury he was airlifted to Base Hospital, Polonnaruwa. On examination, I found that he was extremely pale and in a state of shock. His pulse could not be felt and the blood pressure was not recordable. He was gasping for breath and was in imminent danger of losing his life. No doubt he was bleeding inside the chest cavity due to damage to his lung. There was no time for X rays. I inserted a tube to his right chest cavity to drain the blood that had collected following the gunshot. Three litres of blood drained out rapidly and the bleeding continued. The blood that was transfused was leaking out from the damaged lung. The only option that was available was to open his chest, identify and tie the bleeding vessels and remove the damaged part of the lung. This procedure called thoracotomy is usually done by a chest surgeon. However there was none at this hospital and those days chest surgeons were available only in Colombo, 240 Km away. No doubt transfer to Colombo even by air would have been fatal. I had to take a quick and a bold decision to open his chest. That was the only option available to save his life. I took the plunge and opened his chest. The chest cavity was full of blood and clots which had to be removed to identify the site of bleeding. The bleeding was stopped and the damaged parts of the right lung were removed. The young officer’s life was saved and he continued to serve the Army for a further period of 33 years before retirement in October 2019. When I met him in 2020 after such a long period, this is what he said : Sir you saved my life, can you remember me ? I was rather elated. I looked at him  and remembered that it was Dharmasiri, the Army Officer whom I operated at that rural hospital in 1986. I wished him good luck and good health in retirement!

These examples are but an indication of how the life of a doctor is laced with joys and sorrows, challenges and pitfalls, anxieties and concerns, successes and failures. This is all in a day’s work of a doctor. It is the future that awaits all doctors when they take the Oath of Hippocrates: “I will use regimens for the benefit of the ill in accordance with my ability and my judgment, but will keep away what is to their harm or injustice”.

All the cases that a doctor encounters every day are nothing but a little education; nothing but the first step to something better. It is the beginning of wisdom; a wisdom born out of life’s varied experiences, which can never be found in books.

Many were the situations that I found myself in, which I had never dreamed of facing as a doctor. I have responded to these challenges with faith, persistence, courage and an indomitable spirit which have stood me in good stead all these years. Such experiences came to me in the most unexpected of circumstances. They were not learnt in the great halls of learning but in the remote parts of the island, serving especially the poor, the marginalized and the helpless.

“Life is a promise; fulfill it”

                                                                   – Mother Theresa

Many more stories will follow ……………..

Key words : surgery, saving lives,  limited resources, rural surgery, surgical emergencies

Dear Reader, you might be interested to read my next post : ‘An Unusual Patient’ were I volunteered to treat an elephant hit by train.

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