Tender is the Scalpel's Edge

Gautam Das

Description

Glimpses from the journal of an NHS consultant surgeon. What is it like to be the senior surgeon when a young woman is brought to casualty with a life-threatening bleed? What does the fear of cancer do to a person? Is it ever best not to tell the patient everything? Tender is the Scalpel's Edge draws on Gautam Das's real-life experiences working in Britain's busy NHS hospitals, from the plunging depths of a patient dying on the operating table to the euphoria of a life saved by teamwork and skill. Described in exquisite detail and with extreme sensitivity, Gautam shares his journey from a medical student fighting his own inner demons to a senior NHS consultant surgeon. Shards of his earlier life in India add to the richness of the narrative in tales that observe life with all its contradictions, like the little village boy with bone cancer. While other anecdotes take in the lighter side of life, Tender is the Scalpel's Edge is written to inform and engross the general reader, as well as those with a curiosity of life behind the surgeon's mask. Written in a manner similar to other medical biographies including Henry Marsh's Do No Harm, Atul Gawande's Being Mortal and When Breath Becomes Air by Paul Kalanithi, Tender is the Scalpel's Edge is a moving collection of true stories from a professional at the frontline of medical care.

Sujets

• Philosophie et théologie
• Memoir

Informations

• Publié par: Troubador Publishing Ltd
• Date de parution: 28 janvier 2017
• Nombre de lectures: 0
• EAN13: 9781788038423
• Langue: English

Extrait

Tender is the Scalpel’s Edge

Glimpses from the Journal
of an NHS Consultant Surgeon





Gautam Das
Copyright © 2017 Gautam Das

The moral right of the author has been asserted.

Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or transmitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction in accordance with the terms of licences issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers.

The real-life clinical scenarios chronicled in this book took place in England and India over a span of fifty years. The identity of all the patients have been carefully protected and confidentiality strictly ensured by changing names and dates, often locations, as well as altering age, gender and ethnicity.

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ISBN 9781788038423

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Matador is an imprint of Troubador Publishing Ltd
For Kamala: mother, high school teacher, Durga

and

Manindra: husband and father, who cherished us both
The unexamined life is not worth living

Socrates, circa 399 BC




A good surgeon is an operating physician

Satvinder Singh Mudan FRCS
Senior Consultant Surgeon
The Royal Marsden Hospital London,
who first made this incisive and insightful
observation in 1990 as a surgical registrar
at the Mayday Hospital, Croydon
Preface
From somewhere within came the intense urge to tell these stories about people, amazing in their own ways, hidden as they have been in deep vaults, some as far back as fifty years. It is more than just an account of harsh clinical facts, it is the thoughts, perceptions and emotions that I have tried to portray in these stories.

I have also endeavoured to show how powerfully fascinating it is to be a surgeon. That once the impulse has been sparked, there is no looking back.

The surgical life is all-consuming, you take your worries home and wake up with them, though like every other surgeon, I wouldn’t wish for any other existence. If this book provides even a modicum of understanding of the thoughts, feelings, fears and joys that animate such a life, I will humbly accept it as a success. If reading the book encourages a young mind to start on the surgical path, the book will have achieved the highest measure of fulfilment.

The identity of all the patients have been carefully protected and confidentiality strictly ensured by changing names and dates, often locations, as well as altering age, gender and ethnicity.

Gautam Das, Surrey
Contents
1. Emma
2. Appendicectomy
3. Reculer Pour Mieux Sauter – taking a step back to make a better throw
4. The Kidney Transplant and the Dropped Stent
5. Amelia
6. Haematuria (blood in the urine) – some technical aspects
7. Marjorie
8. The Big “C” Ramesh’s story
9. The Healing Touch
10. “Not to do Nonsense”
11. Who Will Feed the Camel?
12. St Peter’s, the Colonel and the Savoy
13. Mea culpa – Iatrogenic Injuries
14. 57 Woodcroft Road
15. Abandonment – Samir’s Story
16. Graham’s Story – Sunt lacrimae rerum
17. The Silence
18. A Multi-Millionaire in Harley Street –
19. “The Opium of the Masses” and a Man of Character
20. Rajmistri (master mason)
21. A tryst with destiny
Acknowledgements
Chapter 1
Emma
Mayday Hospital, Croydon – 1996
I was the senior urology surgeon on-call when Emma was brought to Mayday Hospital as an emergency that Sunday morning in December.
Every other day of the week, and every other weekend, I was the duty consultant for Croydon patients admitted with serious urological conditions – the distressed elderly man in worsening pain and panic, unable to pee, his urethra choked by an enlarged prostate; the restless, feverish young woman, acutely ill from a severe kidney infection; the tearful little boy, woken from sleep by the dreadful pain of a torted testis.
Far less common would be the person brought to our A&E with an injury to the kidney following a road traffic accident or assault. Nonetheless, when such an eventuality did occur, prompt assessment was a must – given that although most patients with kidney trauma settle with bed rest, intravenous fluids and close monitoring, a small, though critically important percentage, need an urgent operation.

*

That weekend was my last on-call before Christmas. It had been relatively quiet with not many emergency admissions. On the Sunday morning, not even a telephone call disturbed the tranquility of Grove House, in the Surrey village of Woldingham.
There was no familiar ‘Hello Mr Das, Trudy from switchboard here, surgical registrar needs a word.’
I wanted to go into Croydon town centre to make a start on an important task which I’d kept putting off – Christmas shopping.
Before that, I had to drop into Bensham 2, our urology ward, to check on patients that I’d recently operated on.
I clipped on my pager – three bars showed that the battery was full – before leaving Grove House for Mayday Hospital.
When I went into Bensham 2, all seemed quiet. Many of our patients were waiting to go home, having recovered from surgery carried out earlier in the week. There were no problems with the others, and my ward round didn’t take long.
As I was about to leave, the telephone on the nursing desk rang and was answered by Audrey Lemay, staff nurse in charge. Instinct made me wait. Audrey listened attentively for a minute, then looked up at me as if to say, ‘Don’t go, this one’s important.’
She put down the receiver and said, ‘They’ve got a suspected renal trauma that was brought into casualty about an hour ago. Someone saw you in the staff car park and thought it best to let you know.’
‘Is the patient still in A&E?’ I asked.
‘She’s just been moved to intensive care. That was Sister Morell on the phone.’
I went into the corridor outside the ward and headed straight for the stairwell down to intensive care one floor below.
As I went down the flight of stairs, people coming up, gave me a wide berth. On the ground floor of the surgical wing, I pushed open the swing doors and entered the controlled calm of ITU. All eight beds were occupied. The one nearest to the nursing desk had its curtains drawn.
Roger, the charge nurse on duty, was changing an intravenous infusion drip at another bed. He had a white plastic apron, tied at the back, protecting the front of his dark blue uniform. The flimsy material of the disposable apron rustled as he reached up to replace the fluid bag hanging from the top of the drip stand.
Roger pointed to the nursing desk with his free hand. ‘Be with you in just a sec, Mr Das.’
As I placed my briefcase on the desktop and lowered myself into an armless orange plastic chair, the drawn curtains of the bed nearby were sharply pulled open with a metallic screech – my gaze fell upon a young woman lying motionless on the bed.
The two most striking features of the tableau were the pure white of the woman’s face and bare arms, contrasting sharply with the bright crimson that filled a visible length of transparent tubing connected to a catheter bag fixed on hooks at the bedside.
The stark contrast of the deathly pallor of her face and the thick red blood in the catheter tube jolted an instantaneous frisson in my mind.
I was conscious of the first shiver of apprehension, bordering on fear.
My focus took in the intravenous line connected to the cannula taped to the inside of her forearm – the crystal-clear drops of Hartmann’s solution hurriedly falling in the transparent drip chamber with the urgency of a heavy rain shower, agitating the floating anti-embolism ball inside.
Sarah, our experienced year-five surgical registrar who’d been attending to the young woman, saw me at the desk. She nodded and came over.
‘This girl Emma was brought into A&E with severe left-sided pain. Said that she and her boyfriend were horsing around, and she accidentally got kicked.’
Sarah glanced at her patient.
‘She felt sudden pain, that quickly got worse, and then she started passing blood. Boyfriend called an ambulance. He’s sitting outside, worried sick, and feeling sorry for himself.’
‘Has she had any imaging?’ I asked.
‘We’ve done an IVU and ultrasound. I’ve requested an urgent CT.’
(In those days, apart from cases of head injury, you didn’t have the godsend of CT scanning immediately available in casualty, as we do now.)
The ultrasound scan and the IVU (intravenous urogram) dye test showed a large collection of blood around an indistinctly outlined left kidney. The right looked perfectly normal, as did the spleen and liver.
Sarah and I walked over to the bedside and looked at the charts – Emma’s vital signs of pulse and blood pressure were fine. She didn’t have a low dipping BP and fast pulse rate, signs of shock from blood loss. For the time being at least, she appeared to be, in medical terminology, “haemodynamically stable”.
I looked at Emma as I stood at the bedside. Her eyes were closed, she seemed to be asleep; tranquil, for the time being, from the analgesics she’d been given.
I sa