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A challenging surgery far away from home

A challenging surgery far away from home

ENT surgeon Dr Kumaresh Krishnamurthy narrates his dilemma in operating on a young Iraqi patient and why he finally did the surgery despite the pitfalls
Dr Kumaresh Krishnamurthy

As a senior consultant and trainer in international hospitals, I often travel to different cities in Iraq and Tanzania to perform ENT, head and neck surgeries. There is a lot of respect for Indian doctors in these places and for me it is a matter of great pride to represent my country there and help patients, some of whom may have serious and challenging ailments. Due to my connections with hospitals there, patients sometimes contact me for treatment, when they have reached a dead end in terms of medical care in their own country.

About three years ago, the family of a 35-year-old woman from Karbala, Iraq contacted me since she had an abnormal growth in her thyroid gland. Despite being operated upon twice in her country by two different surgeons, the thyroid adenoma had recurred and was rapidly increasing in size. It extended from her lower jawbone almost till her collarbone and was growing towards the back of the neck. An adenoma is a benign growth in the thyroid tissues and often it does not produce major symptoms. But if the adenoma is severe — like in this case — it can lead to hyperthyroidism, compression of the windpipe causing breathing difficulties, speech problems and even be fatal.

The woman’s family had consulted many doctors in Iraq, but most felt that a third surgery would be risky. Since the procedure was complicated and we have better facilities here, I asked them to travel to Bengaluru for the surgery. But they refused, saying that they could not afford the travel and other costs. Her family members urged me to come to Karbala, assuring that they were willing to take the risk and would not blame me if anything happened to the patient during the operation.

I was reluctant to take up the case and it was a big dilemma — without advanced facilities and the right medical team to assist me it would be a high risk to operate in a hospital in an unknown land. The hospital had modern technology and good infrastructure but there was a lack of experienced surgeons and trained medical staff. Even simple things like sterilisation, infection prevention and so on were not done properly.

But if I refused to treat her, she wouldn’t survive for long since no other local surgeon was ready to remove the growth. My conscience and medical ethics got the better of me, and I decided to go to Karbala and operate on the woman.

The procedure to remove an adenoma usually takes about one-and-a-half hours. It is called a thyroidectomy, wherein the growth and part of the thyroid is removed. But this surgery took me more than six hours because of the location and size of the growth, and also because I was mostly on my own, without any trained doctors and nurses to assist me.

The resection has to be done minutely and with a lot of care. The tumour was huge and stuck to important structures in the neck — blood vessels leading to the brain and nerves that controlled important functions. A small mistake and she could either bleed to death or lose face and tongue movements.

The procedure went well but post-surgery she collapsed while removing the anaesthesia tube. We revived her soon. The patient recovered well and was home after a few days. I followed up with the patient over a year ago and she was fine. The tumour had not recurred.

Even though I have performed about 400 thyroid surgeries, this was the most challenging, but it also boosted my confidence as a surgeon. After doing the procedure, I felt that all my advanced training in the United States had been put to good use and helped me do this complicated procedure.

Sometimes, when you are at the crossroads, you just have to take a reasoned call and hope it will work out well. Putting the patient first helps to make the right decision.

(As told to Sahana Charan)

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