“If my life story was a play, I would call it – Rebirth,” said Kalloor Raveendran. I smiled at this man seated across from me. His eyes brimming with emotions validated his words.
“Well then, the drama has a happy ending,” I said.
My words did not ease the guilt on his face or bring a cheer on his lips. He folded his hands and dropped his head a little; his eyes refused to meet mine. “My life had come to a standstill and I had lost all hope. You blessed me with rebirth. You are the hero of my life story,” he said.
“A story with a hero, but no villain?” I asked.
Many emotions flashed across his face. He was thinking of the junior Doctor who had robbed him of six precious years of his life. He was silent but at the peak of his anger, I had heard not so pleasant words to describe the junior Doctor. I had attempted to convince him that it had been an error of judgment but he refused to accept my explanation.
I first met Kalloor Raveendran about six years ago when I was serving in my native town, Kottiyam. I was the surgical gastroenterologist in Holy Cross Hospital.
Raveendran was a dramatist from the town of Kundara. Almost 60 years in age, he was short, and thin, an ordinary man, the kind of person who would go unnoticed in a group.
Raveendran had been defecating infrequently and often spotted blood in his stools.He also complained of severe abdominal pain.A colonoscopy, confirmed that he was in stage 1 of rectal cancer.
I explained to him that since the cancer had been detected at an earlystage there was no cause of worry,
but the thought of a surgery made him nervous.
It was difficult for me to explain to him that laparoscopic surgery (keyholesurgery) would not cause him much pain
while recovering.The fact that the surgery would not involve large cut comforted him and he was also happy to learn that he would be able to leave the hospital in a short time.
I took him through the details of the surgery and that gave him the confidence and courage to give me the go-ahead.
After the colorectal surgery (rectal cancer surgery), I performed a temporary colostomy. Temporary colostomy is a surgical procedure that brings one end of the large intestine out through an opening made on abdomen near belly button, to avoid passing stool through rectum till the wound of the colorectal surgery heals. Once the wound heals, the tube can be removed and large intestine is joined back so that the person can pass the stool normally thereafter.
I had assured Raveendran that he would be able to leave the hospital in 2-3 days but would need to be back after the wound healed, to remove the temporary tube and reverse temporary colostomy.
The day he was discharged, I held his hands and assured him, “In a few days, you will be back to your playwriting and acting as before.”
“A short break from drama, isn’t it, Doctor….?” Raveendran smiled.
“Yes a very short break,” I replied.
I got back to my busy hospital schedule and forgot Kalloor Raveendran.
The short break turned out to be a long one. Six years later, he came back. I recognized him when I saw him at the door to my cabin. He looked hesitant, almost as if he was there against his own will.
When he finally came in, I was stunned to see the plastic bag full of his defecation in his hand. He was supposed to have been rid of it after two weeks of the surgery. Why was it still with him? Had he been living with the temporary tube and the plastic bag all these years? What had happened in this time?
Since, he was the last patient of the day. I had all the time to hear his story.
After his surgery, he had returned home. Many visitors came to see him and when they heard of the procedure he had been through, advised him that he should have gone to Regional Cancer Centre (RCC) at Trivandrum.
I have always had a great regard for RCC because the Founder Director, Padmashri Dr. M. Krishnan Nair had sat at his desk in a small, dingy corner of a room in Thiruvananthapuram Medical College and dreamt of a specialty centre for cancer. And, he had brought that dream to fruition when he established RCC 30 years ago. But, the RCC over time had drifted away from the vision of Dr. Krishnan Nair. The Centre was not able to efficiently service the huge number of patients it received.
The pressure from relatives and friends convinced Raveendran to go to RCC. The junior doctor examined the colostomy, and declared that I had botched up the surgery and Raveendran would have to spend his entire life with a tube carry the bag with him forever.
Raveendran looked crushed as he told me about that moment. The thought of a foul smelling defecation filled plastic bag being carried on his body for the rest of his life was unbearable.
A person who had taken pleasure in the smallest of things of life started hating everything. Slowly he started moving away from his life and isolated himself from his near and dear ones. The next six years were lonely and dark.
So what had brought him back to me, I wondered.
A few days ago old abdominal pain returned. It was then that someone told him about me, “Dr. Baiju Senadipan can help you of this. You won’t find a specialist like him in keyhole surgery.”
Initially, Raveendran was reluctant to follow the referral. After all, he believed I was responsible for his misery. But when more people offered the same advice, he decided to visit me. He also realized that it had been a mistake not to meet me after two weeks of surgery.
As he finished his story, I saw in his face fear and remorse and a little hope.
An examination revealed a layer of small bubbles at the end of the large intestine. All that was needed was a small prick to sort out the problem. The junior doctor had not only misdiagnosed this occurrence, but, he had also concluded that a slip on my part had led to the permanent colostomy!
Raveendran was overwhelmed when he heard my diagnosis. The very next day, I removed the bubble-like layer. Finally, Raveendran was rid of the discomfort and stigma of carrying the foul smelling plastic bag round the clock for life time. The tube and bag that should have been removed in two weeks had stayed with him for six, long years!
‘Please forgive me, doctor,” said Raveendran, tears rolling down his cheeks. “I was so angry towards you, that there were many times I wished you ill.”
“There is no need for an apology,” I said. “Though this drama went for a little longer, isn’t it good that the drama has had a happy ending?”
It would be some time before Kalloor Raveendran would be able to think about this episode of his life without the feeling of anger. For now, an expression of wonder lit his face, wonder from the disbelief at his rebirth.
Colorectal cancer affects the rectum or the lower part of the colon that is connected to the large intestine. An uncontrolled growth of body cells in this part leads to colorectal cancer. This may spread to the urinary tract or the prostate gland, and in women, to the opening of the uterus.
It can be treated with surgery even if the cancer spreads to the gall bladder or intestine or liver.
The carcinoembryonic antigen (CEA) test is used to measure the glyco protein levels to determine the possibility of colorectal cancer. The antigen is usually formed at the time of the development of the oesophagus and the intestine in the foetus. The formation of antigen stops once the foetus is fully developed. Thus, a very small amount of antigen exists in our body.
However, the occurrence of some cancers, including colorectal cancer, the level of carcinoembryonic antigen rises. In clinical terms, this is seen as a marker for identifying cancer. For a non-patient, the level of antigen in the body is less than 5 nanograms /millimetre. A higher level indicates the possibility of cancer and further examinations and tests need to be carried out to reach a conclusion.
Laparoscopic surgery has been exceptional in the treatment of internal body parts like in the case of colorectal cancer and has been effective in curing the cancer completely.
Since it does not require a big cut or opening, the pain is less and the possibility of an infection is also reduced. Another big advantage is shorter stay in the hospital which means that the treatment is lighter on the patient’s pocket and he can return to the comfort of his home once the wound heals