I was the senior registrar…Those days General Surgeons handled Pediatric Surgery as well..We were on call thrice a week for PedSurg emergencies…The most common surgical references were for esophageal atresias and meconium ileus….Those days, the mortality following surgery for these conditions was almost 100%…One tasted ashes as you operated these patients in the middle of the night only to lose them them the next day….”Sclerema” was the most dreaded complication…The neonate’s skin became hard and inelastic….It portended uncontrolled infection and a sure sign of death…..Most of the birth defects were diagnosed late and had already complicated when they were referred for surgery…..
I was called in the middle of the night to see a newborn….The child had not passed meconium, the abdomen was distended, the child was vomiting……The diagnosis was clear…It was meconium ileus, an obstruction due to pellets of hardened meconium blocking the small bowel…
The answer was surgery….Till then surgeons explored the abdomen, resected the obstructed loop of ileum, did an anastomosis and prayed that it did not leak….Invariably it did, leading to the death of the infant…..
Recently in one of the journals, BJS or AJS, I am not sure, a new procedure had been described, the Bishop-Koop anstamosis. It involved bringing out the distal loop of ileum as an ileosomy and anastomosing the other loop to the side of the distal loop. In one of the study, it claimed a mortality rate of less than 30%… I decided to go for the Bishop-Koop procedure… I called up my Professor….
“What” he exploded on the phone..”You want to do an untested procedure on this infant?” Yes, I told him…I was certain that this would succeed…I had done the literature search and couldn’t find anything against it….I argued with him for ten minutes on the phone. “OK, I will come down and give you a hand. Shift the child to the OR”
This was the first time after three years that “old Pete” had scrubbed with me…The surgery went off smoothly…The child was sent to the neonatal ICU….
The next day, I went to the NICU with great trepidation. A very pleasant surpise awaited me…The infant was awake, off the endotracheal tube and breathing on his own..No sign of the dreaded sclerema…Prof saw the infant, grunted and left without making any comment…I was hurt…
The next week the infant was discharged…I was in the seventh heaven…I was told by the head nurse that the Prof wanted to see me after my rounds….
“Guru, come in. Sit down”…I sat in a chair opposite him…”smoke?” He pushed his packet of charminars across the table…I almost fell off the chair….”Thank you sir. I think I will” He tossed his lighter across and we smoked peaceably for ten minutes…..
“You know, I think you are ready to be independent. You have matured enough to make your own decisions. There is a post of Associate Professor vacant in the KEM hospital. I have spoken to the Professor. He is waiting for your CV”
I was ecstatic….Naina would be thrilled..The salary would be doubled! I thanked him and turned to leave.
“Guru, I will thank you to return my lighter” Prof said softly…There was a twinkle in his eyes….