by Dr. Tilak Dayaratna

The old surgeon finished his ward round and lit a cigarette. He was really tired and fell back in his chair in the ward. His young house officer was now writing the diagnosis cards of the discharged patients who were eagarly waiting to head home, their surgery done and their wounds healing.

The surgeon’s mind went back to better days-his younger days. He had been handsome and smartly clad, and had loved his surgery. He had been very skilful and it was a joy to watch him operate. Infact in those days younger surgeons and registrars came to the theatre to watch his skilful use of the scalpel. But now it was different. Now the one thought in his mind was to get thro’ his list quickly and renew his vigour at the end of it all and at the earliest opportunity with a little of the "stuff that cheers"!

He would not even glance at the minor cases whom he left to his senior house officer who was happy with this since he could gain experience with each new operation he performed.

The old surgeon had retired about three years ago, but there was a shortage of surgeons in the dept. and he needed the money, so it had not been difficult to rejoin the department. He would be sent hither and thither all over the place when the regular surgeon at some station wanted a relief in order to take leave.

He had been for almost three months in his present station. His needs were few — he had the old surgeon’s bungalow all to himself, his wife and children remaining in Colombo. A large room with a bed, a single old table and 2 chairs. There was a water supply, a fairly decent toilet and 2 more chairs in the dining hall with another large table.

His meals were brought by an old attendant who lived nearby, had cataracts in both eyes and was riddled with arthritis. The old attendant refused to get has eyes operated and managed with limited eyesight. The surgeon supplied him with analgesies for his arthritis and paid him a decent weekly sum.

The surgeon finished his cigarette and was about to leave when the house officer reminded him "Sir our routine list is tomorrow" knowing that he wouldn’t sight the ward in the evening 12 noon was the end of the working day for him. The old surgeon nodded not saying anything. Another cursed list tomorrow he thought as he set off. His bungalow was just a stone’s throw away from the hospital and he trudged his way home.

At home he poured himself a stiff drink of arrack and started sipping it seated on one of the few chairs he had. The time now was about 12 noon and he was a trifle hungry though he never ate much. He heard a distant cough and knew old Carolis the attendant was bringing his lunch.

Carolis was bringing his lunch in a rusty old tiffin carrier. He stumbled on the top step of the verandah and some "kiri hodi" spilled out.

"Ah, Sir ada top malu kariyak thiyanawa." ("Today there is a superb fish curry") he said as he kept the tiffin carrier on the table-he then washed and cleaned the morning’s breakfast plate kept it for the surgeon to have his lunch.

After Carolis had left, the surgeon poured another ‘arrack’ and diluted it with water from the tap at the sink — he always drank with water. He lit his last cigarette before lunch. Later, he ate his lunch, closed the ‘tiffin’ and left the plate into the sink. He then went to the only bed he had and was soon fast asleep.

He got up about half past three and drank two glasses of water. He never drank tea or coffee. After a quick bath he got out of the house and went for his daily evening stroll. He didn’t bother to lock the house door anyone could get inside if he or she wished to.

He was back by about half past five and found a visitor waiting for him. The visitor himself was an elderly man and was standing outside the porch.

"Sir, you are Dr. Guneratne"? the visitor asked. "Yes, yes, what’s the problem" the surgeon inquired. He led him inside and motioned him to one of the two chairs available. There was a newspaper placed on the chair to prevent bug bites and as the visitor sat down his buttocks sank right in as the rattan was broken. He straightened himself and waited for the surgeon to sit on the only spare chair. He immediately fell the bug bites inspite of the paper.

The surgeon took a cigarette from his shirt pocket and lit it. He looked at the visitor and waited for him to talk.

"Sir, it’s about my elder brother" the visitor was saying "He’s in your ward and is undergoing surgery tomorrow-you see, he has a lup on his hand and its causing him a lot of pain-"They call it gang...gang..."

"Ah, a ganglion" the surgeon completed for him. "Aiyo, that’s a small thing no-so what’s the problem?" "No, No, Doctor there is no problem but he’s a little old and very frightened — he’s also a bit if a fussy character, I just thought I’ll tell you" the visitor said.

"Just a ganglion, that’s a small thing no, it won’t take me fifteen minutes-Nothing to worry about" said the surgeon now getting up and walking towards his bottle of arrack.

"Will you have a drink?-only I don’t have any soda, you’ll have to drink it with water-"

"Thank you, thank you doctor, I don’t drink or smoke" said the old visitor." I suppose it’s nothing but I’m worried about my brother-"

"No, No, there’s nothing to worry about — what the hell, it’s only a ganglion" and he began to sip his arrack.

The visitor got up, thanked the doctor and went away. The next day,.... the day of the operation there were two setbacks for the old surgeon. For one thing, his senior house officer was on leave to attend a wedding — also, his ward sister was having the flu and wouldn’t be coming to the hospital. This meant that he would have to do all the cases including the minor ones-the rest of his ward staff were rather inefficient in addition to being indifferent and could mess things up. It had happened before!

While scrubbing up in the theatre the surgeon inquired of his young house officer who was assisting him-"How many cases in today’s list?"

"There are about 12 Sir including the small ones. There are 2 major ones including that explorative laparotomy which you wanted to do-the others are all minor ones including 4 haemorrhoidectomies, 4 hernias and 2 abscesses-Sir I can manage the abscesses-Ah Sir, I forgot, there is also that old patient with the ganglion-"

The surgeon remembered yesterday’s visitor at the mention of the ganglion-"How old is that bugger?-I hope he was kept fasting-I prefer to do that under general anaesthesia-can he stand it?" he was asking.

"He’s about 70 I think Sir, bit of a fussy character yeah I kept him fasting-his blood pressure, lungs and all are O.K."

"Ah, then we’ll do it under general-better relaxation with that-" he put on hs gloves and stood still while a theatre attendant tied his gown and mask. He began with the explorative laporatomy first he deftly cut open the belly of the middle aged man with a chronic abdominal pain.

And so the list went on. Midway thro’ the list the surgeon was kept waiting for sometime as there had been a mix-up in the bed head tickets, the result of his efficient ward sister being absent.

The surgeon was annoyed and shouted at the theatre staff-"What the bloody hell, ask them to send these patients quickly, otherwise we’ll take the whole bloody day-" The next patient was then quickly wheeled in.

"What’s this case?" he asked the house officer. The house officer was fiddling around with 2 bed head tickets and for a moment was not sure. Finally he said-"It’s a haemorrhoidectomy Sir" and the patient was set up for removal of his piles.

The surgeon cursed — the time was now past 11 o’clock — Normally he would finish before 12 noon but today it would be different — He’d have to wait a while for his afternoon drink — he was growing increasingly impatient!

Finally he finished his last case past 1 p.m. and breathed a sigh of relief — Today had been a difficult day. His young house surgeon was in the side theatre incising the abscesses. He prefered not to be with his boss in this foul mood!

The surgeon was grumpy as he changed into his normal clothes and left the theatre not talking or even looking at any of the theatre staff — he only nodded at the young anaesthetist as he walked away — Now for that drink!

After 3 stiff drinks he sat down for his lunch which had been kept on the table by old Carolis. The food was cold and the time was about 2 p.m.! "Can’t go on like this" he thought-that sho (senior house officer) and his damn wedding — otherwise he could have done those messy haemorrhoids! After lunch he slept.

Mr. Wakwella, the old gent with the ganglion on his hand was quietly coming off the anaesthesia, in the ward. He felt the nurse take his pulse and it took him sometime to realize what he had been thro.

His lips were parched and he asked the nurse for water but was refused-"Nothing by mouth for six hours Sir" she said sternly.

Six hours! Ah O.K. he’ll wait-anyway the great thing was that painful lump on his hand had been removed-he silently blessed the old surgeon — No more pain for him now. He fell into a deep and long sleep — when he awoke it was past 6 p.m. Now he was fully conscious and the drowsiness had worn off. Only he had a terrible thirst and his lips were parched. He looked around for a nurse or attendant but there was none. He felt a strange feeling in his anal area which he thought maybe due to the anaesthesia. He then looked at his right hand expecting it to be heavily bandaged but low and behold,!-The hand was not bandaged and what more the lump was still very much there!-At first he thought he must be imagining things but he moved his face closer, then felt it with his left hand-No, certainly not imagining things, for that ugly lump was still very much there. His eyes opened wide and his mouth opened too "What the hell has happened?" he thought. And then he felt that strange feeling at his anal opening as if something was stuck there! He gently lifted himself and felt his anal area. To his utter surprise their was a kind of tube stuck there — there was a tube up his anus! He was horrified. He shouted at the top of his voice for the nurse. Almost all the patients looked at him and so did the visitors for this was visiting time even though there were no visitors for him.

A couple of visitors rushed outside to summon a nurse and soon an elderly bespectacled nurse walked slowly up to his bedside-"What’s the matter?" she asked.

"What’s the matter, what’s the matter you ask you damn woman-What have you all done to me," he showed his hand.-"This lump which I came to get removed, it is still there and what is this thing up my backside-" he was shouting at the top of his voice.

"Just a minute, just a minute" she said and walked away a little quickly this time towards the nurses desk at the corner of the ward where the bed head tickets from the theatre were lying. She looked for Mr. Wakwella’s ticket — she read it and then held her head with both hands. She regained her composure quickly and took a telephone call to the house officer’s quarters and asked for the young ward house officer.

The old surgeon got up a little late after his afternoon slumber. He was having a bath when he heard the telephone ringing. As usual he ignored it and continued his bath. It stopped ringing after sometime. He towelled himself and got into his evening clothes. He would not be doing his traditional evening walk today for it was now about 6.30 p.m. — Time for his evening drink. He poured a generous drink started sipping it seated on his favourite chair.

The telephone began to ring again and he cursed. Was it from the ward? The damn senior house surgeon should have returned by now and he should tackle any ward problems if there were any — he had given them instructions!

"Sir, Sir this is Dr Gamage (his house officer) — there is a big problem Sir, I don’t know what to do...

"What’s it, what’s it" the surgeon inquired as cool as ever. "No Sir, it’s that old man with the ganglion on the hand Sir. We have done the wrong operation on him. You have done a haemorrhodectory (removal of piles) instead of removing the ganglion! — he’s shouting at the entire staff and is threatening to take action against all of us including you Sir — What shall I do?"

The surgeon asked-" But how did it happen?"

"No Sir, the bed head tickets had got mixed up and you have done his haemorrhoids-"

"Ah, so, the bugger would have had haemorrhoids anyway-otherwise what can I remove — tell him we’ll remove his ganglion later" said the surgeon.

"Sir, please Sir, can you talk to him — he nearly assaulted me and he has removed his rectal tube and thrown it at the acting ward sister-he’s violent and shouting like hell."

The surgeon thought for a moment and said-"Get some ‘Largactil’ from the medical ward and give him 75 mg intramuscular — I’ll come and talk to him later — anyway where is our S.H.O.? (senior house officer)?"

He was told that the S.H.O. hadn’t returned yet. Then he put down the phone.

The surgeon smiled to himself — so, in the hurry the tickets had got mixed up. Ah, so what — "I’ll remove the ganglion later" he thought. He poured himself another drink and lit a cigarette.

There was a knock on the door and the old man who visited him the previous day was before him again. The surgeon recognized him and saw the worried look on his face.

"Ah, your patient — there was a small problem you know — when I examined him later I found he had bleeding piles so we left the ganglion for the moment and did his piles first "he told Mr. Wakwella’s brother- "We’ll remove the ganglion later — 2 operations on a patient of that age is too much you know — that means prolonged anaesthesia which is dangerous — come, come sit down."

The younger Mr. Wakwella did not say anything but sat down gingerly. In his hands he held a bottle of expensive arrack which he had brought for the surgeon in anticipation of the ganglion removal.

"My brother want’s to be discharged Dr" he said "you know he’s a fussy type. He was not aware of the haemorhoids and really he had no symptoms-"

"No, No" the surgeon said "It was good that we removed them — otherwise it would have given him a lot of trouble later you know. The ganglion is nothing as I told you. I’ll remove it in a day or two-"

"Thank you Dr, anyway I think it best that you explain things to him — right now he’s sleeping — he has been sedated I understand. Here Dr. this is a small present from us" and he handed over the bottle of arrack.

"Ah, thank you, thank you" the old surgeon said as he took it "Don’t worry, I’ll speak to him and remove the ganglion later."