The knife that is used by the surgeon consists of a scalpel blade and a handle. That’s my “Healing Knife”. When performing surgery this healing knife is used meticulously together with other surgical instruments to excise diseased parts of the human body and carry out the necessary repair to restore body function, relieve suffering and save precious lives.A surgeon does this with care, compassion and love. That is a surgeon’s duty and that was my duty for over three decades. I have used that healing knife a countless number of times with many happy memories.

There is also the other side of the coin. That is the bad news about knives. Those are the various types of knives that are used to kill or inflict injury to another usually in anger.The injury could take the form of a stab or a slash on the body. Over the years I have seen and treated many such injuries and I suppose every surgeon would have had that experience. It is the responsibility of the surgeon to do his best to save the lives irrespective of how it was caused and who inflicted the injury. There may be rare cases that we see from time to time as the one described below.

A bizarre stab injury

A young man was stabbed by a sharp knife. The assailant was his own brother who was under the influence of alcohol. The reason for inflicting injury on the brother was a family land dispute. The knife had been thrust into the head with tremendous force in that it went right through the skull bone, penetrating the brain and the point of the knife ended at the base of the skull bone as shown on the skull X ray. This was the only investigation available to me. The assailant tried to pull it out but failed. The patient was unconscious on admission to hospital. I managed to pull it out with great difficulty.But that was in vain as I could not save his life. Autopsy findings revealed that there was damage to the brain at its junction with the spinal cord, the area called the “brain stem” which has the vital centres controlling body function.

This no doubt is a bizarre injury and once in a life time experience.

Stab to the chest

The common site for a stab injury is the chest. This results in the collection of blood in the chest cavity called haemothorax and had to be drained via a tube inserted to the chest. Major surgerywhere the chest has to be opened to stop the bleeding inside the chest cavity from the lung or a major blood vessel is rarely necessary.

A memorable operation

A patient with a stab injury to his elbow region wasadmitted with severe bleeding from an injured major blood vessel. This injury could have killed him due to bleeding or there was also the possibility of him losing his arm.

This was in 1991 but remains etched in my memory even to date. The patient was under the influence of alcohol and almost comatose. He was bleeding profusely and required urgent  surgery. The only anaesthetist in the hospital was on leave as it was a public holiday.

How shall I proceed to perform surgery to save his life and his arm without an anaesthetist. I wondered ? As the only surgeon on duty and working with a single house officer. I had to make a bold decision that day. The patient was almost comatose because of the alcohol and did not need additional anaesthesia. I injected a bit of local anaesthesia to the injured site to anaesthetise that area in case the patient woke up during the surgery because of pain. The damaged major blood vessel was repaired and the bleeding stopped. It is only when he recovered from the comatose condition that he realised about his injury and that an operation had been performed on him. About a week later he went home with an intact arm. Many years later the story was depicted in cartoon form by the house officer who assisted me that day. This was in the journal that was published by my house officers and presented to me on the day of my retirement from service on 7^th October 2014 which also happened to be my Birthday. That was a kind gesture indeed!

Dear Reader, you might be interested to read my next post were I share my experiences of various injuries caused to farmers in Polonnaruwa and their dangerous practices and what was my part on helping them : ‘INJURIES TO FARMERS IN POLONNARUWA’

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