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Governor's death throws up several questions

By J. Ajeth Kumar

THIRUVANANTHAPURAM, FEB. 25. The demise of the Governor of Kerala, Sikander Bakht, at the Medical College Hospital here on February 23 has thrown up several questions in the medical circles.

There are at least a few medical professionals who feel that it could have been averted, had adequate preparations been made for the surgery that the Governor had to undergo and a little more care and caution exercised during the post-operative period.

The Governor had first gone to the Medical College Hospital on February 18 with severe abdominal pain and he was subjected to an Ultra Sound scan. As the pain persisted he was rushed to the hospital the next day.

It was a major emergency surgery that was performed on him late in the night on the same day, to remove a gangrene in the small intestine. Higher-ups in the Medical College had earlier clarified that the surgery was absolutely necessary as the gangrenewas threatening to perforate the intestine. It was later on found that the infection had spread from the walls of the stomach to the lungs, resulting in pneumonia.

However, the doctors believe that it was not bacterial pneumonia but aspiration pneumonia, which usually turns out to be fatal in nine out of ten cases. In normal conditions, bacterial pneumonia sets in only five days after the surgery is conducted. In this case, the symptoms developed within 48 hours of the surgery, which is unusual in patients devoid of a history of bronchitis.

Whether the setting in of aspiration pneumonia was not detected was not certain. The fact that antibiotics were prescribed points to the failure in this regard, since they are not effective in the case of aspiration pneumonia. It is also felt that the presence of over a litre of fluid, that also included orange juice in the stomach, could have resulted in the lungs getting damaged, causing aspiration pneumonia.

Why adequate preparations, including the cleaning up of the stomach and intestines, at least six hours before the surgery was conducted, is the most important question raised by the doctors who feel that things would have been different otherwise.

Besides an ultra sound scan, the Governor was made to undergo a CT scan just before the operation. The gastrograffin liquid administered for obtaining a better result in the scan had also not been removed from within, as evident from its presence in large quantities in the stomach. This also could have contributed to the occurrence of aspiration pneumonia, it is believed.

It has also been observed that a patient developing aspiration pneumonia should not have been put on ventilator.

The Medical College, Thiruvananthapuram, is the only institution of its kind in the government sector to have an independent Department of Surgical Gastroenterology. However, it is said that the gastroenterology surgeons were not informed, consulted or involved sufficiently early while preparing the patient for the major operation, even though a general surgeon was competent enough to conduct similar surgeries.

Meanwhile, the surgeon who conducted the operation has been forbidden from talking to mediapersons. The Superintendent of the hospital also did not comment, because he "was denied permission by the Minister for Health and the Secretary, Department of Health, to do so".

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