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| Sunday, 28 November 2004 |
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Features |  |
| News Business Features Editorial
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Three hours to a miracle by Shanika Sriyananda Saturday November 20. There wasn't anything special about the day, except that after a long spell of rain, the day remained bright and sunny. But there was drama unfolding in the 'Cardiac theatre' of Navaloka Hospital, where Dr. Y.K.M. Lahie, Consultant Cardio-thoracic Surgeon, was about to perform a very rare and complicated heart surgery. The patient, three-year-old Mohammed Milhaj was sitting on his mothers lap with his match stick thin arms around her. Fair and frail, the tiny tot looked pale, with blue tinged lips and red rimmed eyes.
Born with a rare mis-positioning of the heart on the right side, Milhaj was suffering from troublesome complications that left his blood constantly inferior and his health in jeopardy. On this unremarkable Saturday, Dr. Lahie was trying to correct the defect and literally perform a miracle in making life a little bit easy for the little boy. At the theatre, Milhaj garbed in surgical togs was screaming, not so much in pain as in fear. Consultant Anaesthetist Dr. H.D. Waika, his chief assistant, Terrance Fernando, nurses and minor staffers were preparing him for the surgery, technically called 'Bilateral Bidirectional Glenn Shunt'. Preparation
"My son gets very scared when he sees nurses", said his mother Sithy Farusha. Milhaj had been a blue baby at birth, and his 'abnormal' heart had stunted his growth making him weak and feeble and prone to numerous ailments. Doctors in diagnosing his heart condition had ruled surgery as the only option, if he was to survive to adulthood. But Milhaj's father, who does odd jobs to earn a living had not been able to afford the exorbitant cost involved. However, with financial support from the President's Fund and by mortgaging the 10-perches of land they owned for a paltry Rs. 55,000 and selling the little jewellery, Sithy Farusha owned, the family were able to get the funds for the surgery and life for their child. 10.30 a.m.
At 10.30 a.m. Fernando asked the mother to place the little boy on the bed to administer anaesthesia. "Umma...Umma ... ennake payam, kaiya pudichi kongo", (Mother I am scared, hold my hand) he cried holding tight to her hands. The young mother who gripped her son's hand in return was crying and praying to Allah to save him. A young nurse gently rubbed his forehead saying "Putha baya wenna apa. Oyata ridenne ne". It took a few seconds for Milhaj to became fully unconscious, following the injection given by Dr. Waika. All witnesses to the surgery that was about to take place joined the mother in her prayers - one to 'paththini amma' (Buddhists believe that this Goddess takes care of little children) another to Jesus Christ and another to a Hindu God. Milhaj was also given anaesthetic drugs and a combination of antibiotics, pain killers and muscle relaxants to heal the wounds after the surgery. "Monitoring the blood pressure is very important during the surgery", said Dr. Waika inserting two small valves through the right and left thighs and another through the child's neck to measure the exact blood pressure. "These cannulae- the right arterial cannula and left venus cannula and the central venus cannula will help to give any fluids to the patient during the next two days. When the patient recovers, these cannulae will be removed one by one", he said. Several other tubes and cannulae were inserted to the tiny body - from the nose and mouth. 11.15 a.m. After an hour long 'preparation' process Milhaj was taken inside the operating theatre, where he was kept on a warming blanket with 40 degrees Centigrade temperature to maintain the body warmth during the surgery. Then he was fixed to some machines - a multi para metre monitor, artificial blood pressure machine, Carbon Dioxide monitor to check CO2 level and to an artificial heart-lung machine. The tiny body, measuring just 95 centimetres in length and weighing 11 kilos, was covered with several layers of green cloth. Dr. Prasad Chant, while giving instructions to the nursing staff drew some sketches of the heart and explained what they would be doing during the next few minutes. The chest x-ray of Milhaj was displayed on a screen in front of the operating table. Sharp at 11.15 a.m., Dr. Lahie and Resident Surgeon Dr. Prasad Chant cut a four inch opening on the tiny chest, with an electric saw - the surgery had begun. The old radio at the operating theatre was playing "Sulagak wee dura ahase man unawa avidinnata appachchi kohomada man allanne" by Edward Jayakody and Natasha Perera. Every one in the surgical team was looking at the opening trying to catch a glimpse of the functioning of this rare heart formation, which was on the right side of the body. "God should not treat this child like this" said Dr. Lahie. The heart was functioning just like a small turbine and was one tenth the size of an adult's heart. Some valves were only marginally bigger than a strand of hair and it was difficult to see them with the naked eye. While ploughing inside to disconnect the SVP (Superior Vena Cava) that takes the venus blood to the heart, Dr. Lahie explained that the child had been suffering from a very complex congenital heart disease from birth, and had only one chamber called a single ventricle. "The other chamber is poorly developed and due to this condition, the good blood and bad blood are mixed together. That is why the child was very blue. Blood going to the heart is also restricted because the pulmonary artery that takes blood to the lungs is narrow", he said. Meanwhile, another song was on the air but Dr. Lahie asked the nurses to switch off the radio. Milhaj's condition is technically identified as 'Dexro Cardia' and he had two SVPs on both sides, which is also not common. Normally the human heart is on the left side but Milhaj's heart was on the right with other parts on the left. "This is an invasion of normal anatomy", said Dr. Lahie. The team of surgeons had planned in detail the surgery that would correct the defect to a certain extent, but not correct it altogether. However. The surgery would enable him to have a near normal life like other small kids - going to school and playing. 12.15 p.m. Meanwhile, Dr. Waika had injected Heparin through a cannula to dilute the blood and prevent blood clots. "There is a tendency for the blood to clot during surgery, especially because this child's blood is very thick due to the mixing. So it is essential to prevent it", said Dr. Waika. Dr. Lahie inserted four cannulae attached to the 'Heart-Lung Machine', which artificially operated the child's heart during the surgery. It was 12.15 pm. when the normal functions of Mihaj's heart was put on hold. Chief Clinical Perfusionist, Vipula Fernando, who operated the machine took over the task of functioning Milhaj's heart. During the rest of the surgery, the functions of Milhal's heart and lungs were carried out by the machine. Then it was time for a short break for the anaesthetic team - Dr. Waika, Fernando and the two nurses. They invited the writer, a witness to the miracle surgery, to have some food at the induction room. " This is how we have our lunch", said Dr. Waika removing the blood-stained gloves and serving wadai and sambol. Being an Indian, he occasionally gets a chance to taste his favourite dishes that remind him of home. "According to Hinduism, one has to be born in a million other lives before being born as a human. So saving a life is a big satisfaction for us", he said. 2.30 p.m. Back in the theatre, Dr. Lahie completed the main part of the surgery - disconnecting the SVP that takes venus blood to Milhaj's heart, and fixed it to the pulmonary artery to facilitate venus blood to go directly to the lungs by-passing the heart. "The surgery is successful", Dr. Lahie, who was now in a very relaxed mood said, while putting some final stitches to tiny nerves with two centimetre long carved needles and absorbable sutures. The very complicated 'Bilateral Bidirectional Glenn Shunt' surgery was fully complete at 2.30 pm, but Dr. Lahie was still searching for a root that was still bleeding. After a few minutes he found the valve underneath the heart and put some sutures to prevent the flow. Dr. Waika had given plasma to the child and a six inches long valve was inserted into the body with one end open outside the body to drain the excessive blood that filled after the surgery. The blood pressure returned to normal and the little turbine like heart, was restored to normalcy. The bluish colour of the boy's body will ease in a few days, the doctors said. Heaving a sigh of relief, after a successful job and in a jovial mood, Dr. Lahie asked "Do you want Power Malt" from the team who had foregone their lunch. "See other professionals have duty time, which doctors, especially surgeons do not have. We cannot just leave the patient and go", he said putting six steel wire switches to fix the bones of the chest. "Treating children is the most satisfying and rewarding job that one can do because they cannot complain about their pain and they are helpless, unlike adults they can smile despite all this. And especially they have a long future ahead them", said Dr. Lahie who performed more than 100 surgeries in children. Recovery Milhaj, who is now recovering, will be discharged soon, heart whole and able to lead a near-normal life. But owing to the sacrifice his mother had to make to find the funds for his surgery, he may have to vacate the dwelling built by his mother from the money saved from her job as a housemaid in the Middle East, if his parents fail to pay the interest for the mortgage. "I do not know how to pay back such a big amount of money and where to live with my son if I loose this house. But I am happy my son is alive", said Sithy Farusha smiling amidst tears. However, little Milhaj will go home soon. But one day he will realise that his life was saved by a team of multi religious people - a Muslim, two Hindus, a Christian and Buddhists. ***** Timely surgery essential - Dr. Lahie Dr. Lahie said that most heart defects among children can be corrected if diagnosed early and treated early. "Most of these children are wait-listed for long years and when they become eligible to undergo surgery most have left the world or are too mature to undergo the surgery", he added. "I have seen lots of children coming for surgery very late", he said adding that a hole in the heart can be corrected very successfully. However, though the surgeries for hole in the heart are available, parents are still ignorant about the facilities and institutions like the President's Fund, where they can obtain financial support. According to Dr. Lahie, there is no specific reason for an increase in heart defects among children. "Infections such as German measles and Rubella during pregnancy, the high intake of unnecessary drugs during pregnancy and marriages between blood relations can result in children being born with heart defects", he added. |
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