I am a 57 year old woman. I am the principal of a girls’ college in a small town, Jaunpur, in UP. In the months of September and October 2009, I had stomach ache, nausea and vomiting. After ultrasound (USG), it was diagnosed that there were stones in my gall bladder. I could have been easily operated in Jaunpur itself or a nearby bigger town, but my nephew, who is a doctor in Aligarh (University Health Services), asked me to come there and get my gall bladder removed in Aligarh. I was admitted to a nursing home in Aligarh on 28^th October 2009. Next morning at 7 AM, the operation (laparoscopic cholecystectomy) was done. After the operation, I felt deep pain in my abdomen which became severe. On 30^th October evening, the operating doctor sent me to the medical college hospital in Aligarh. Throughout the night, I cried with pain and the next morning I felt very weak. Due to vomiting I could not take anything by mouth. Many injections were given but there was no relief. Gradually, my heart beat increased and reached above 140/ minute. A senior physician suspected a heart attack and suggested TROP T test which was done but was negative. It became difficult for me to breathe and I began to lose consciousness. By the evening of 31^st October, my doctors decided to shift me to the Cardiac care Unit (CCU). So my husband decided to take me to another private hospital in the town. I became unconscious (my husband was told that I had developed abdominal sepsis) and was put on ventilator at once. Because of sepsis and unconscious state, my memory faded and I could not even recognize my husband and my son. It was after about 7 days on 8^th November, that I regained my consciousness and memory and could recognize my daughter who had arrived from Lucknow to see me. Because of lying straight on my back in the bed for 9 days, a bed sore had developed at my lower back.

At this hospital US, CT and blood tests were done but abdominal pain and distension continued and there was no sign of relief. Two senior surgeons visited me but of no avail. After taking liquid diet from 10^th November to 14^th November, my condition grew from bad to worse. On the request of my husband and on my doctors’ advice, I was shifted to Lucknow by an ambulance.

On 15^th November, a surgeon in Lucknow examined me and sent me to a Gastroenterologist, who at once referred me to SGPGIMS. I was immediately admitted to SGPGIMS and was operated that very night when a perforation was found in my transverse colon and a colostomy was done. I faced several problems with the stoma. I had to be very careful in lying on either side as the bag could disconnect or leak. Many a times, my bed sheets and dress would become soiled with stools. I could not take bath. My son had to clean and change the stoma frequently, sometimes even three to four times in a day; he could not go anywhere for long. Day and night, my husband remained with me. The feeding pipe in the stomach gave me much trouble and hurt me. Sometimes, I would have pain in the abdomen and would need painkillers. The open wound of about 10 inches had to be cleaned and dressed daily. I had to bear the pain and the discomfort at the time of these dressings. The stoma was finally closed on 18^th February 2010.

I stayed for 3 days at Aligarh nursing home, 24 hours at medical college in Aligarh, 14 days at critical care hospital in Aligarh and 24 days at SGPGIMS. We had to stay at my elder brother’s home in Lucknow from 8^th December 2009 to 20^th January 2010 to go for regular checkups at SGPGIMS. On 21st January 2010, we came back to Jaunpur for some time. I was admitted at SGPGIMS again from 9^th February to 26^th February 2010 for the second operation. Then I stayed at my brother’s home in Lucknow again till 2^nd March and finally returned to Jaunpur on 2^nd March 2010.

On my behalf, my husband informed the manager of my college about my illness and I remained on medical leave for more than 4 months from 24^th October 2009 to 4^th March 2010. As I am a Principal of a college, teaching and administration at the college were disturbed. My husband took long leave from his college. Due to long leave from the college, the students of my husband suffered. My daughter, a student of MBA in Lucknow came to Aligarh and visited me several times in SGPGIMS at the cost of her classes and studies. My son, who has completed his engineering studies, could not appear in competitive exams. My younger brother, the manager of a bank, took emergency leave to help us at Aligarh and then again to see me at Lucknow. My other brother, a railway employee, also took leave to see me at Lucknow. My sister-in-law remained with me all the time; her daily routine and household works were disturbed.

The treatment at Aligarh was too costly for us. We had brought 30,000 rupees with us and my husband had another 60,000 in his ATM. Soon, we ran out of money. My husband requested his friends and relatives in Jaunpur, Varanasi, Pratapgarh and Lucknow to send him money through his bank account. My sister-in-law, my sisters and brothers all helped us. My younger brother came to Aligarh and lent us 70,000 rupees. Money gradually poured in and we spent about 3 lakhs rupees in Aligarh. We had to pay 25,000 rupees for the ambulance, attendants, oxygen, etc. when I was transferred from Aligarh to Lucknow. As we both are earning (I get Rs. 30,000 per month and my husband gets Rs 34,000), my relatives were assured that the amount lent by them to us in this period of crisis would be positively returned to them, and in time. Luckily, a fixed deposit in bank matured to around 2 lakhs rupees in February 2010 and we have repaid half of the borrowed money. My husband has applied for 2  lakhs loan from his provident fund and soon rest of the debt would be repaid by April 2010. At SGPGIMS, costly injections had to be given to save my life; the stoma bags and plates were also very costly. We have spent more than 5 lakhs rupees on my treatment at Aligarh and Lucknow. This amount does not include other expenses e.g. travel, hotel stay, food and lodging, and many other daily expenses. During this period, our life was full of torment, torture and turmoil. Our house looked haunted and deserted as it remained locked for three months. It seemed as if the sweetness of life and the joy of living had vanished. Our friends, family members and near and dear ones prayed for me night and day with tears. After the second operation to close the stoma, I am fine now but my health has gone down. We thank all those who give relief and comfort to the suffering.

 

We are trying to forget this time but it will not be possible for me forget that in my subconscious state, I felt as if I were in another world imprisoned by ‘ghosts and witches’.

Comment (Dr V.K. Kapoor):

The commonest intra-operative injury during cholecystectomy is bile duct injury (BDI), diagnosis and management of which is well documented. Laparoscopic cholecystectomy can, however, be associated with bowel (duodenal and colonic) injury also – almost always caused by injudicious and careless use of electro-cautery. Since these injuries are less common, they are not thought of and because they are usually thermal, they present late and are often missed, as happened in the case of Mrs. Arjumand Bano. She was lucky to survive severe intra-abdominal sepsis –mainly due to the prayers and support of her friends and relatives, but many other patients may not be so fortunate. Any patient, who is not comfortable (sitting up in the bed having her morning cup of tea and wanting to go home), does not have stable vital signs (pulse, temperature and respiratory ate) and does not have a settled (soft and non-tender) abdomen the day after laparoscopic cholecystectomy, should be strongly suspected to have sustained an intra-operative injury (usually to the bile duct but may be to the duodenum or the colon) and appropriately investigated and managed. We ourselves have had mortality because of a duodenal injury caused during laparoscopic cholecystectomy which was missed. Mrs. Bano has forgotten and forgiven, but it is the duty of all of us, the surgeons, to take  very precaution to make each and every cholecystectomy a ‘safe cholecystectomy’ so that ‘ghosts and witches’ stay away from our patients.