Upali was the Private Secretary to a senior Politician in Polonnaruwa. On 11^th of October 1987 at around 9 am Upali and his Boss were at their office in the Polonnaruwa Town Centre.  An unknown assailant entered the office and lobbed a hand grenade to the place where the two of them were seated. The grenade exploded and both suffered injuries. The noise created by the blast caused pandemonium in the town.

The two victims were put in the politician’s new vehicle and rushed to the Polonnaruwa Hospital 2 km away.  The driver of the car was in an excited state of mind. He drove the car so fast that he lost control and the car crashed into the hospital building with a loud noise. The staff of the hospital got agitated and fearful as they thought that a terrorist bomb had  exploded in the hospital premises. But it was  not so. 

I was in church on that fateful Sunday morning. When I was returning to  my  residence,  just a  few  meters  away from the hospital,  I saw a large crowd at the hospital. After dropping my family at home I went to the hospital as I had the impression that some casualties had been admitted to the hospital following a terrorist attack.

In this case it was the injured politician and his secretary, both victims of the hand grenade blast, who had been admitted to my ward. The ward was chaotic and packed to capacity with supporters of the Politician, Policeman, Army personnel and media personnel.  

Injuries

It was my primary duty to attend to the patients straight away. When I examined the patients I realized that Upali’s injuries were critical and needed urgent attention. Upali was “pale as a sheet” and in a state of shock as he had bled from multiple shrapnel wounds all over his body. His left leg was mangled by the grenade blast as it exploded near his left foot. He also had a fracture to his knee cap on the right leg. That was not all.  The main blood vessel to his left arm was also damaged with impaired circulation to his arm. A metal fragment had penetrated his left eye and the eye suffered damage beyond repair.

The politician on the other hand had only a non penetrating wound on the back of his chest with the cap of the grenade being embedded in the chest wall. This was not a serious injury. There was no internal damage and his condition was stable. He did not require urgent surgery.

Problems – medical and Non medical

In keeping with the principles of surgery that I had learnt it was essential that the more critically wounded should be attended to first. This is what is called TRIAGE – categorizing the wounded  according to the severity of injury and priority of treatment. There was no doubt that in this case Upali’s injuries needed attention and surgery first. The situation was complicated in that I was the only surgeon to attend to all the injuries and it was my duty to save the lives of both.

However, the politicians in Sri Lanka being regarded as VIP’s, his stooges were calling for more attention to be given to the politician and taken up for surgery as soon as possible. That would have been a disaster as far as Upali was concerned. I had no hesitation to resist such requests in the interest of saving the life of Upali. I sent the so called VIP to the X ray department to pacify the agitators. That helped to some extent as they too went to the X ray room with their “Master”.

What did I do for Upali

He required urgent surgery after resuscitation with blood and saline without which death would have been inevitable. The left leg that was mangled was bleeding profusely. I tied a tourniquet round his left thigh and controlled the bleeding. With these measures and the rapid transfusion of blood and intravenous fluid to his circulation, his general condition and blood pressure improved. 

At this stage I decided to take Upali to the operating theatre for surgery.  Ideally there should have been a multi- disciplinary surgical team to attend on Upali. However in the absence of such specialized teams at this hospital I had to perform all the operations necessary for him single handedly with my house officer and the nursing staff.

Amidst the action and excitement, a hilarious incident that occurred at this stage must surely be related. I went to the changing room to get into the operating theatre attire which is customary before entering the operating theatre. The politician’s wife came to the operating theatre in search of me and located me in the changing room of the operating theatre. While I was changing the politician’s wife was on her knees, pleading with me to save her husband’s life. Only later did I realize that I was in my underpants and the politician’s wife was worshipping me. A historic occasion indeed!

Surgery for Upali and VIP

First I amputated Upali’s left lower limb above the knee joint as it was mutilated and beyond repair. That helped to prevent further blood loss from the damaged tissue. Next I repaired the injured  blood vessel on his right arm.  The fractured knee cap on the right leg was treated with a plaster cast. This was followed by the removal of his damaged right eye. It was multidisciplinary surgery under tremendous pressure by one surgeon. There was no ICU to care for this critically wounded patient and he was managed in the general surgical ward with utmost dedication and devotion by my staff under my constant supervision. Upali’s life was saved. People described this a “miracle” cure as no one expected him to survive with such serious injuries.

The politician’s surgery was not so complicated and was a simple procedure to remove the shrapnel embedded in his chest wall under general anaesthesia and recovery was expected without complications. His life was never in danger.

What next ?

The problem I had to face afterwards was even more demanding. There were numerous calls from those in “high positions” in Colombo to get the politician transferred out of Polonnaruwa to Colombo as he was considered as a VIP.  I rejected this idea as he could be treated in this hospital and transfer to a specialized hospital in Colombo was not necessary. If at all a transfer was necessary it was Upali who needed transfer to a specialized hospital.

If the local hospital was not good enough for the Politician of the area it is not good for others as well including Upali.  In that case it should have been the duty of this politician to improve the hospital for his people from the funds allocated from the decentralized budget. But, politicians cannot be expected to do such things for the benefit of the people at large.

My plan to keep him at the Polonnaruwa Hospital failed. The next morning a Helicopter was dispatched from Colombo to the  Air Base closest to Polonnaruwa. That was at Hingurakgoda. The Politician was sent to the Air base by ambulance and airlifted to be treated at a “Super Hospital” in Colombo.  The sad situation is that no one had the common courtesy to inform me or talk to me before he was taken out of the hospital. In fact he left my ward without my consent, which is highly irregular as far as patient care is concerned. But that is the way with Politicians who do not care for rules and regulations.

 What about Upali ?

He was asked by his boss to remain at the Polonnaruwa Hospital.  Upali had no regrets. I gave him the best of care! He lost his limb. He lost his eye. He lost his boss and lost his job as well. He was however sure that his surgeon would never desert him. He was completely disabled with no compensation. He is ever so grateful to me for saving his life and kept in touch with me until his untimely death from an unrelated cause, a brain tumour, five years ago.

Upali after complete recovery with an artificial limb and an artificial eye. My guest when I was Inducted President of The College of Surgeons Of Sri Lanka – 2001 (14 years after injury)

THE LESSON – NEVER BE TOO CLOSE TO POLITICIANS. THEY WILL DESERT YOU WHEN YOU LEAST EXPECT IT TO HAPPEN!

Dear Reader, Another interesting read is awaiting you in my next post, were I take you through the practises done by the doctors in the village : ‘QUACKS : UNQUALIFIED“DOCTORS” IN THE VILLAGE’

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