Heart Matters: Stay Alert... Always!

One early morning in 1977, Dr. Cherian’s team at the Railway Hospital Cardio Thoracic Department was suddenly alerted to a patient being brought back to the operation theatre from the post-operative ward. His abdomen was bloated like a balloon, he was as pale as a sheet and his pulse was fast with blood pressure dropping alarmingly. 

Dr. Cherian diagnosed the condition as internal bleeding. This was in stark contrast to the jubilant situation just hours earlier. 

52 year old Mohammed Kunju from Kasergode, North Kerala had been suffering from an Abdominal Aortic Aneurysm, a dangerous condition which could burst anytime leading to death. The corrective surgery was resection of the aneurysm and replacing it with a tube graft, while bypassing the aneurismal abdominal aorta connecting to both groin arteries.  The surgery for Abdominal Aortic Aneurysm was new to many of the hospitals in South India and was only being performed occasionally in Mumbai by Dr. P.K. Sen, Dr. G.B. Parulkar and their team at King Edward Medical College Hospital. It was a risky procedure but critical to survival. 

This procedure required the ‘Dacron’ tube graft with 2 limbs which was not available in Chennai. Dr. Cherian’s research led him to a source in Mumbai through the advice of Dr. Parulkar and Dr.  Pandey. They helped him procure the graft from their contacts in Mumbai. 

The graft was made from a special type of polyester (Dacron) which allowed blood to ooze out,  but it had to be soaked in the patient’s own blood to seal it. The surgery began in the morning and every procedure was followed to the letter. It was successfully completed with the graft sutured in place from the abdominal aorta to serve both the legs by 7 pm, leading to relief and jubilation. 

Hours later however, the patient’s condition had deteriorated and he was rushed back to the operation theatre where he was thoroughly checked for the source of bleeding. When all the sutures were found to be intact, the team was stumped. 

Then suddenly, Dr. Cherian had an epiphany. “I realized that the small injection prick on the major blood vessel inferior vena cava used to withdraw blood to pre-clot the graft was the source of bleeding. I immediately sutured it and the bleeding stopped.” What it required was a simple single stitch. 

The patient recovered without incident and was discharged in ten days. He visited Dr. Cherian for follow up review for 3 years. 

The major take-away from this event was, “Despite following every procedure to the letter, a very small oversight could have led to tragedy. A minor fault can have major consequences. We need to have a personal eye on everything as “the devil is in details”. With no one to guide me, I had no option but to learn from mistakes.” Today, there are many regulatory bodies and multiple sets of protocols. Even then, there is no substitute for a surgeon’s alert eagle eye.