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Ulcerative Colitis: Predicament of a Surgeon
Dr.Rathin Datta FRCS (England, Edinburgh & Glasgow).FFIMS (Athens)
Ulcerative Colitis: Predicament of a Surgeon
PHOTO : Skyline of London, U.K.

He said "Doctor, Please, when I go next, don’t bring me back."
It was in end of 1963, Chief was on holiday, we juniors were running his out patient clinic, I was the Registrar of Surgery, second in command in the colorectal dept. of a large General Hospital, near Manchester, in North of England. In came Mr Michael Douglas, a tall (6ft plus) very handsome man with his Fiancee who was also a tall very pretty lady.My chief had briefed me about him.

'So you are Mr Michael Douglus? I have heard about you, Mr Wilks the consultant surgeon had told me about you'. 'Really'? he asked. Rather pleased, he added 'but Kirk Dauglas is not my father, we belong to the same clan in Wales. (Just to remind the older readers, Kirk Douglas was a Hollywood star, whom we adored, we worshiped him in our younger days). Michael was a university professor of Organic chemistry in the university.A very popular teacher; also teacher I/C of the dramatics in the university; Evelyn was also a professor in the university.

Michael was suffering from Ulcerative Colitis, a fairly deadly disease, common in the west, not so common in our country...It is a form of inflammatory bowel disease (IBD), is an idiopathic (cause not nown), recurrent inflammatory disease of the large bowel ie colon, invariably affecting the rectum., characterized by prolonged bloody diarrhoea during acute stages, [called the flares] pain in abdomen and anaemia. Due to constant blood loss from the ulcers. Very annoying disease which comes and goes.In the '60s the theory of including this disease in the group "Auto Immune disease" was on. {Biological agents like infiximib and Adalimabab [Humira] not known then are now a days commonly used.}

Colonoscopy and biopsy confirms the diagnosis.Long term Amino salicylates ie sulfasalazine and masalazine and occasional steroid controls and are  often resorted to.The new group of Immuno suppressive drugs ie Azathioprine were just in the horizon but were not in free use.,we were contemplating to try them on Mike.

Problem arises when toxic megacolon sets in, when surgery is indicated means-total removal of colon and rectum. With better drugs being available, the number of surgeries needed were coming down.The acute attacks were known as "Flares", dreaded and our attempt was aimed at preventing the 'Flares', for which our dieticians worked overtime.Proper dieting was what was aimed at. Michael (&Evelyn) were our regular visitors, once a month, mainly to consult the dietician who kept a strict hold on the diet. They also became very friendly with  the doctors specially me , the Registrar. Once he rang and invited me for drink, dance and dinner.The place was a posh restaurant in the elite area of the city. [I knew it practiced colour bar] I was hesitant and he guessed the reason.’Just flash your Round Tabler' badge and come in. He knew I was a Round Table member (and in line for entering the Rotary Club). It was his birth day party. We enjoyed.

Later the pair were regular visitor in our hospital parties which were quite frequent.They would wed soon.
Remembered my teacher in the Medical college, Principal-professor in Surgery, Prof. B.N.Banerjee: "never get emotionally involved with your patients, your mind gets clouded while taking hard
decisions-whether it is preoperative or intraoprative." I broke my promise to my teacher. Michael became my best friend.I would be the Best man in their wedding.So we became Mike, Eve & Rathin.
It was summer of 1964, they went to Majorca, an island, off Spanish coast.After a fortnight, he was brought in with high fever and severe pain in abdomen and with a very toxic look.
I was away during the week end, that being my week-end off, off to Bisley, Surrey near London for my Rifle shooting training at the NRA (National Rifle Shooting association of UK).Rifle shooting was my hobby, I was addicted to it .

While the other residents on their week-end offs , would dash for Blackpool or the North wales shores with their girl or boy friends in tow, I would take off in my sports car Mini Cooper, the fastest car then available in Britain to cover the Manchester to London (,then the newly built M1 highway was the craze , the Cooper made the 200 miles in 2 hours flat.Friends used to joke –"Dr. Datta is married to Surgery and with his two girls is leaving for the week-end, meaning my Cooper and the Barretta rifle."
I was still addressed as doctor Datta, having not cleared three FRCS exams, an FRCS is addressed as Mister). On return on Monday morning, as I was entering the ward, I saw Evelyn, sitting quietly outside the ward. "Dr.Rathin! Michael is very sick" said Evelyn.

I rushed in, grim-faced Mr.Wilks, the chief was there. He told me- Mr Dauglas is in .I think he has toxic pancolitis.Colonoscopy was terrible - it was very friable, bled like hell. He was naughty during the holidays in the Spanish island, broke all discipline, in eating and drinking during his holidays.
Probably radical proctcolectomy is the 
answer, i.e total removal of whole colon and rectum.Next day we went in with heavy antibiotic and steroid cover and blood transfusion gadzets. The Consultant Surgeon

Mr. John Wilks was with the knife, myself as the first assistant.  Abdomen was opened with a long incision,to expose the whole colon in one field.The sight was frightening as the colon was severely inflamed ,as if on fire ,swollen and friable,bled profusely at the slightest touch.It was Mr.Wilks skill and the boldness that succeded .Ultimately the colon was removed,an ileostomy was done and the wound closed in layers. Duly, as expected after such surgical onslaught, patient went into surgical shock, but was revived by the anaesthetist’s team. They handed over the patient to us, now stable in the evening i.e 10 hour after starting the surgery, and  after about 5 to 6 hours, in the ITU.

We had just sat for our dinner, when the alarm bell rang –emergency in the ITU!! ,it announced. Instantly we knew it was Mike. We sprinted and as we were nearing the bed he was breathing his last.The endo trachel tube was inserted, pt was flooded with oxygen, cardiac massage brought back the heart beats. The endotracheal Tube was taken out when Mike opened his eyes, smiled and spoke" Doctors! why did you bring me back ,I was with my mom & dad ,we were so happy, they were just on the other side of a meadow,I went to hug my Mom, when you pulled me back. Please doctor; promise me when I go next you would not call me back".  I lied “what pulling back are you talking about Mike? I have done nothing of that kind."

"Don't lie to your best friend buddy,I had left my body and was sitting on the window sill ,watching when you came running in, passed that tube down my gullet,it did not hurt as I had left that body. I went out through the window, my mom was waiting for me, Pa was a step away when you pulled me back. Please do not do it again when I go next.  I looked at Eve, she nodded, just do as he wishes.After couple of hours the heart was stopping   again i.e. the heart rate was dropping, electro cardiogram started to show irregularity. I looked at Eve; with her eyes she said 'no don't'. We stood our heads bent, did the routine minimum. Mike's last word was 'thanks Doc'.

I always pondered if as the leader of the surgical team.  I did the right thing in not trying my best to revive the patient .Morally we were bound to fight till the last moment or as a friend allowed him to
pass away quietly undisturbed ,honouring his last wishes.I am still confused. My apology to my respected Professor of Surgery. After about a year I went through the Fellowship exams, cleared all
three and I flew back to India.

(Acknowledgment: Master Amit Datta for secretarial help)
[It is a true story, no names changed]

 

Dr. Rathin Datta, FRCS (England, Edinburgh & Glasgow).FFIMS (Athens) 

Surgeon & Sports Medicine Specialist

Padmashree Awardee, winner of the Bangladesh Liberation war honour 

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