Chinnamma: A Brave patient. Novel surgery - Dr. Baiju Senadhipan Chinnamma: A Brave patient. Novel surgery - Dr. Baiju Senadhipan

Chinnamma: A Brave patient. Novel surgery

August 10th, 2016   
For what reason does a patient become a cherished memory to a doctor?

May be due to the rarity of the disease or treatment. May be due to the indelible memories of how the Doctor could help relieve suffering. May be something else. Beyond these, there is a reason why Chinnamma is an unforgettable memory for me.

She is the one who made me realise how much trust and faith a patient places on the treating doctor. Its her confidence in me that led me to travel through unprecedented ways in medical science. To seek an innovative solution for her agony.

When the treatment was over it paved the way to the introduction of a pioneering mode of treatment in medical science. I invite you to read the story…………

­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
“All I want is to swallow a drop of water before I die” said the sixty year old pale woman in a voice resembling deep sighing. A feeding pipe was attached to her stomach and agony was evident as she tried to utter those words.
“She is Chinnamma, my mother” said the lady who accompanied “I brought her here as you are our last hope”
“Tell me what happened” I was concerned.

A thyroid surgery that Chinnamma had a few months ago else where had left her in great distress. The nerves around the vocal cord had been damaged. She was unable to speak or swallow her saliva. As a result, a feeding tube had been inserted into her stomach to administer liquid food. Her pain was unbearable.

We immediately swung into action to diagnose further. Initially it appeared as though a blockage existed in Oesophagus-a tube through which food passes from mouth to stomach- due to which Chinnamma couldn’t swallow.

Next day we performed endoscopy on her. Endoscope is a flexible tube with a light and camera attached to it, which helps us view pictures of digestive tract on a color TV monitor.

But the scope would neither go down the throat nor go up the small slit made in her stomach for the feeding tube. A dye introduced through the endoscope into the oesophagus to trace the canal also disappeared mysteriously. It was greatly confounding and we called for an unconventional approach. We inserted two endoscopes simultaneous, one through the throat and another through the stomach, and obtained an x-ray image to get a clearer picture. A glaring gap of about 10 cms between throat and stomach w as revealed by the x- ray image. One third of the oesophagus that connected mouth with stomach was missing!

How could we tell that poor lady that she could never in her life again taste a cup of coffee or have a bolus of rice? Her plea that she wanted to die after swallowing a drop of water was reverberating in our ears.

While thinking what to do next, suddenly an idea dawned. The oesophagus and the large intestine both push food down the path using the same peristaltic movement. Peristaltic movement is wave like muscular contractions of the digestive tract by which contents are forced onward.

So, why not take out a small part of the large intestine and graft it to complete the missing part of oesophagus?

Although it seemed simple to hear, the surgery involved many risks. A vascular part of the large intestine had to be identified, removed, attached carefully to the oesophagus after making a tunnel through the chest, and the blood supply at the new location preserved. If the blood supply of the transplanted large intestine did not restore within 48 hours of the surgery, the graft would become useless and the whole procedure would go in vain.

This complex procedure had been attempted before as an open surgery. Never through miniature openings of a keyhole surgery. Not anywhere in the world. Thus it was a challenging and daring path before us. How ever, as a skilled surgical team, we were determined to do whatever we could for Chinnamma.

Keyhole surgery approach involves insertion of a thin cable with a camera into the patient’s body through keyhole sized incision. It allows the surgeon to view a magnified image of the affected area. Applying this advanced technique and with the backup of our highly committed team we completed the surgery successfully. After a crucial 48 hrs wait, the dark clouds of our worst fears were swept away when the blood supply was restored. It was like the climax of a thriller which finally had a happy ending.

A visit to Chinamma three weeks later was a profound experience for us. She had resumed eating. Resumed speaking. And resumed smiling. ‘This is a second birth for Amma. For this, we are indebted to you all. You showed the same care and concern you would have shown to your own mother!’ remarked Beena, Chinamma’s relieved daughter, wiping away a tear. The trauma had finally ended as mother and daughter sat down to enjoy a meal together after months of suffering and pain.

Chinnamma continues to do well. Has let go of the unpleasant past and delights herself in the reclaimed flavours of life. That may be the secret of the pleasant smile that adorns her face even when she recalls those painful days.