The Phimosis Operation

One incident occurred with Prof. Tarun Kumar Chaturji (fictional name) while he was resident at AIIMS, New Delhi.

One of Dr. Chaturji's fellow doctors was going to USA for further studies. He was suffering from phimosis.

For Non-Medicos: In phimosis, the foreskin at the end of the penis is tight with small opening. The foreskin cannot be pulled back causing difficulty in passing urine and other related activities. The cure is circumcision which involves cutting the tight foreskin and stitching the inner and outer surface of the remaining penile skin together.

He requested Dr. Chaturji to perform circumcision on him, before he left for USA. Due to nature of his disease and the organ affected, his friend requested Dr. Tarun Kumar Chaturji to protect his privacy and do other operation with utmost secrecy.

One evening Dr. Chaturji took his friend to the Emergency Operation Theatre or EOT in the Emergency Department. This operation theatre was isolated and few doctors or para-medical staffs used to come there.

Before starting the operation Dr. Tarun Kumar Chaturji even requested that only one staff nurse to stay in the operation theatre (OT) and other staff members to stay outside while his friend's genitalia was exposed during operation. Dr. Chaturji did not ask any other resident to assist him for sake of privacy.

Dr. Tarun Kumar Chaturji started the operation. He first cleaned the operative body part with antiseptic lotion and put sterile sheets (drapes) around the area of operation. He then gave an injection of local anaesthetic agent around the penis to numb the area and started the operation.

As the staff nurse was assisting both as scrub nurse and assistant surgeon, Dr. Tarun Kumar Chaturji, placed some instruments on his friend's thigh for quick and easy access to them during operation.

As Dr. Chaturji neared the end of the operation he started to stitch the remaining cut end of the penile skin together. As he took a stitch near the fraenulum of the penis, his friend gave a loud yell and jerked his body of the table.

The fraenulum is very sensitive to pain and difficult to anesthetise with local anaesthesia. Also with the passage of the time, the effect of the local anaesthetic had become less. These factors combined to cause severe pain to the friend.

Due to the sharp jerking of the friend, the instruments lying on his thigh went upwards, sailing towards the roof as if launched by a rocket-launcher.

According to Newton's law of Gravity, what must go up must come down. The instruments which included a surgical knife with sharp blade come down with equal velocity.

Unfortunately the surgical knife came down sharp end first and its tip first pierced the surgical drapes, then Dr. Tarun Kumar Chaturji's friend skin, his subcutaneous fat, the thigh fascia and finally pierced his femoral artery.

For Non-Medicos: The Femoral artery is the main blood vessel carrying oxygenated blood from the heart to the lower thigh, leg and foot. Damage to it can lead to gangrene of the lower limb.

Now a jet of red arterial blood spurted towards the roof from the wound in the femoral artery.

Fortunately, Dr. Tarun Kumar Chaturji, showing quick reflexes and presence of mind immediately pressed a sterile gauze dressing over the bleeding wound, stopping the bleeding. While maintaining pressure with his hand over the wound, Dr. Chaturji reluctantly asked the nursing staff to call for help.

Dr. Tarun Kumar Chaturji's unit consultant came and saw what was happening, others doctors working in the emergency department also came. Finally the CTVS vascular surgeon was called to repair the artery with anaesthetist to give general anaesthesia for the operation.

So what started as an operation in secrecy turned out to be an open day and Dr. Tarun Kumar Chaturji, his friend and his operation became the talk of AIIMS, New Delhi, for days to come.

Remember Dr. N. K. Dewanda's Law of Medical Secrecy: The more you want an operation to remain secret, more is the chance that due to some complication or other it will become public.

Tip: Never keep any instruments, especially sharp instruments on the patient's body. They may fall down and injure the patient or the operative team members. This is also not desirable from a sterility point of view.

Tip: Most bleeding can be easily controlled by applying pressure with sterile gauze, etc. Don't release the pressure until competent help arrives.

Tip: In a tricky situation, no matter how embarrassing, never hesitate to call for help.

Tip: If some complications develops, it is better to let someone more experienced or qualified to handle it. Dr. Tarun Kumar Chaturji resisted the urge to repair the bleeding vessel on his own.

(Based on true incident)
— ND
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DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Practice should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost. 

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