GOOD MORNING DOCTOR Prof. John Kurakar (a heart touching experience of cancer treatment) authored by Prof. John Kurakar CHAPTER 6 UNDERGOING A MAJOR SURGERY

 

                       GOOD MORNING DOCTOR

Prof. John Kurakar

(a heart touching experience of cancer treatment) authored by Prof. John Kurakar

CHAPTER 6

UNDERGOING A MAJOR SURGERY

 

I arrived at Amrita Hospital in Idappally after a CT scan at Kottiyam Hospital revealed a tumor in my colon, which was diagnosed as colorectal cancer. Colorectal cancer is one of the most prevalent cancers today. Its development is influenced by changes in lifestyle and dietary habits. Key factors contributing to colorectal cancer include a high-fat diet, consumption of processed meats, a sedentary lifestyle, obesity, smoking, and alcohol use.Colorectal cancer is more common in men than in women and typically occurs in individuals over middle age. The primary symptom is usually changes in bowel habits, such as blood in the stool, along with other signs like loss of appetite, weight loss, fatigue, nausea, and vomiting. This cancer is most commonly found in people over the age of 50. As the cancer progresses, it can cause the colon to become completely obstructed, leading to severe abdominal pain and persistent constipation, along with vomiting.During a colonoscopy, the colon can be examined in detail, and if any obstructions or tumors are detected, a biopsy can be taken for further analysis. This test is crucial for diagnosing colorectal cancer accurately. Once cancer is confirmed, staging is the next step, which determines how extensively the cancer has spread in the body. An MRI scan helps assess the extent of the cancer's invasion into nearby tissues. Additionally, advanced technology such as PET scans can provide a comprehensive view of how far the cancer has spread throughout the body with a single scan.

The symptoms of colorectal cancer often resemble those of benign conditions, leading many patients to choose various treatments before accurate tests are conducted. As a result, colorectal cancer is frequently diagnosed at stages three or four. The primary treatments for colorectal cancer are surgery, chemotherapy, and radiation therapy. In the early stage, surgery alone can often completely cure the disease. Effective surgical intervention plays a crucial role in removing the cancer entirely. A modern surgical technique called Total Mesorectal Excision (TME) is used, which involves removing not only the rectum but also the surrounding mesorectum to address potential spread. The decision for post-surgery treatment is based on pathology results, which help determine the risk of recurrence. Factors in the pathology report influence whether additional treatments like chemotherapy, radiation, or immunotherapy are necessary. If the cancer is in a condition where surgery is not feasible, radiation therapy and chemotherapy can help shrink the tumor, allowing for a more effective surgical intervention later on, ultimately leading to successful treatment.

Even if colorectal cancer has reached stage four, it is still possible to manage and treat the disease effectively with the combination of surgery, chemotherapy, and radiation therapy. Colorectal cancer, which is also known as colon cancer, rectal cancer, or bowel cancer, can be diagnosed at various stages. Tumors that occur in the anal area are referred to as anal cancer. In India, approximately 150,000 new cases of anal cancer are reported each year.Surgical procedures involving the anal area are complex and require a high level of expertise. Laparoscopic surgical techniques are employed in the treatment of colorectal cancer, enabling minimally invasive surgery. Tumors often start as polyps on the wall of the rectum, which can appear in a grape-like shape. Early detection of the disease is crucial. Regular cancer screening for those over middle age can significantly improve the chances of early diagnosis and successful treatment.When performing surgery for colorectal cancer, the affected portion of the colon or rectum is typically removed. After removal, the remaining part of the colon is usually reattached to the rectum. However, due to the anatomical constraints of the pelvis, which is a narrow and complex area, open surgery can present significant challenges. The difficulty arises from the need to maneuver within the restricted space of the pelvis to perform precise surgical tasks.

 

In cases where reattachment is not feasible, a new external opening, known as a stoma, is often created. This procedure involves pulling a portion of the colon through an opening in the abdominal wall to create an artificial exit for waste. This new opening is called a colostomy. Instead of the natural rectal passage, the waste is collected in a plastic bag attached to the stoma. This bag must be worn continuously to collect and manage waste.The limitations of traditional surgery for colorectal cancer are overcome by the laparoscopic surgical technique. This minimally invasive method allows for surgery in confined areas by using a TV screen to view the site in detail, ensuring precision and accuracy. With laparoscopic surgery, the "purse-string" technique can be employed, which maintains continuity from the large intestine to the new external opening, enabling the patient to have normal bowel movements. This approach requires a high level of skill and experience from the surgeon to ensure successful outcomes.

Upon arriving at Amrita Hospital, the first specialist I encountered was Dr. S. Sudhindran from the Gastrosurgery department. Dr.Sudhindran is a renowned Gastrosurgeon both within Kerala and beyond.Dr. S. Sudhindran serves as the Clinical Professor and Chief Transplant Surgeon in the Department of Gastrointestinal Surgery and Solid Organ Transplantation at Amrita Institute of Medical Sciences, Kochi. He is recognized as the first liver transplant surgeon in Kerala and is highly regarded for his expertise in liver transplants, having performed over 820 liver transplants, predominantly live donor procedures. His skills also extend to pancreas and small bowel transplants.Dr.Sudhindran completed his MBBS and MS degrees from Trivandrum Medical College and further trained in vascular surgery and solid organ transplantation in the UK. He worked as a Clinical Fellow in Transplantation at Addenbrooke's Hospital, Cambridge. With over a hundred publications, he has made significant contributions to his field. On February 15, 2020, he was honored with the "Distinguished Alumnus Award" by Trivandrum Medical College for his leadership, exceptional service to his alma mater, and his broader contributions to society.

After reviewing the CT scan and biopsy reports, Dr.Sudhindran confirmed that I had colorectal cancer. He indicated that a major surgery would be required and mentioned that prior to the surgery, a combination of radiation and chemotherapy would be necessary. He emphasized that these treatments were the only viable options for saving my life. The type of surgery recommended is known as APR (Abdominoperineal Resection), which involves the creation of a colostomy. The radiation and chemotherapy treatments are managed by Dr. Haridas M. Nair and Dr. Pavithran. Dr. Haridas M. Nair is the Clinical Assistant Professor in the Department of Radiation Oncology. Hearing this was both distressing and disheartening, but I understood the gravity of the situation and the necessity of these treatments as explained by the doctors.Your summary of the surgical procedure and the role of intensive care units (ICUs) is clear and well-articulated.Dr.Sudhindran was supported during the surgery by Dr. Vijay Ganeshan, Dr. Binoy, Dr. Rahul, and Dr. Dinesh Balakrishnan. The operation commenced at 8 AM on March 22 and was completed around 10 PM. While the surgery was ongoing, my wife Molly, daughter Dr. Manju Kurakkar, and son Manu Kurakkar anxiously waited outside the operating theater. At 10:30 PM, as I was being moved to the ICU under anesthesia, my family watched with tearful eyes.Major hospitals are equipped with sophisticated intensive care systems, including the Intensive Care Unit (ICU), the Intensive Treatment Unit (ITU), and the Critical Care Unit (CCU). Patients who lose the ability to breathe on their own often require mechanical ventilation in the ICU. These units provide crucial care for patients with severe or life-threatening conditions, ensuring continuous monitoring and the use of life-support equipment and medications to maintain essential bodily functions.

Intensive Care Units (ICUs) are managed by highly trained physicians, nurses, and respiratory therapists who specialize in treating critically ill patients. The ICU is distinct from general hospital wards due to its high staff-to-patient ratio and access to advanced medical resources and equipment not typically available elsewhere. Common conditions treated in the ICU include Acute Respiratory Distress Syndrome (ARDS) and septic shock.Typical ICU equipment includes mechanical ventilators for breathing support, which can be delivered via endotracheal or tracheostomy tubes; cardiac monitors for tracking heart conditions; and various devices for continuous monitoring of bodily functions. The ICU is also equipped with a range of tools such as intravenous lines, feeding tubes, nasogastric tubes, suction pumps, drains, catheters, and syringe pumps. Pain management and induced sedation are essential components, and various analgesics and sedatives are utilized to alleviate discomfort.

The recommended nurse-to-patient ratio in an ICU is typically 1 nurse for every 2 patients.While I was in the ICU, I woke up at 4 AM feeling completely numb and heavy. My body felt like it was paralyzed, with a sensation as though both legs were encased in plaster. I could barely move and experienced an overwhelming sense of heaviness. The ICU was filled with distressing sounds; I could hear faint, agonized cries such as "Mommy, mommy" and "Oh, oh" piercing through the environment.I felt as though my throat was parched and cried out for a drink of water, but no one seemed to hear me. I noticed nurses attending to other patients in pain, moving from one bed to another. When I called out again for a bit of water, several nurses hurried to my side. They gently offered me a sip of water, which provided some relief. I then lay back, eyes closed, amidst the mournful sounds of the ICU and the constant beeping of life support equipment. Each patient had a screen mounted above their head, and various life support devices were connected to their arms, legs, and body to monitor and sustain vital functions.

In the ICU, my blood pressure was recorded on the screen every five minutes. Some patients had ventilators with oxygen support, while others had oxygen masks. The atmosphere in the ICU was tense, filled with the sounds of distress and alarm signals.I pondered my way out of the ICU, feeling completely immobilized as life support devices were attached to my arms, legs, and neck. Despite my inability to move even a little, my mind wandered aimlessly. I drifted in and out of consciousness, with countless images and memories flashing through my mind. Doctors and the operating theater appeared intermittently in my thoughts, like fleeting glimpses of a vivid, disjointed dream.I dreamt that Molly, Manju, and Manu were all by my side. When I woke from the anesthesia, I was unsure whether it was a dream or reality, but to my surprise, my daughter, Dr. Manju Kurakkar, was indeed standing beside me. I was astonished that my dream had become reality. Manju stayed with me for a while, talking and offering comfort. Shortly after, my son Manu Kurakkar arrived at the ICU and shared details from the previous day. Later, Molly joined us and recounted the difficulties of the operation day. Hearing about the distress my family had experienced added to my own sorrow. After Molly left the ICU, I lay there for a while, deeply affected. Before 7 AM, Dr.Sudhindran came to see me. He informed me that the surgery had been very successful, lasting over ten hours. Due to the colon cancer, the rectum had to be removed. He explained that the surgery was laparoscopic, involving the use of a camera inserted through small incisions in the lower abdomen for observation. After one day of ICU monitoring, I was moved to a hospital room. I received antibiotics and pain management injections three times a day. The pain persisted for several days, but the doctors reassured me that after about 20 days, the outer wound would begin to heal. The next day, they informed me that I could be discharged.

The following day, complications arose as an infection developed in my abdomen. It was suspected that the infection might have been a result of the 25 rounds of radiation therapy I had undergone prior to the surgery. Despite efforts to manage the infection and promote healing, the gastroenterology department was unable to address the issue effectively and referred me to the plastic surgery department for further treatment.April 9, 2022, marked my 70th birthday. Given the pain and distress I was experiencing, the idea of celebrating seemed almost impossible. The day passed in anguish, and I had little inclination to acknowledge the occasion. However, at around 9 PM that evening, Dr. Vijay Ganeshan, along with his team and the hospital staff, unexpectedly arrived in my room with a grand birthday cake. The sight of them and the cake was surreal, leaving me in a state of disbelief. Dr. Vijay explained that the celebration was a gesture of his deep affection and concern for me. He had brought the cake during a break in the operating theater, turning what seemed like a grim situation into a heartwarming celebration. This unexpected gesture was one of the happiest moments of my 70 years. Throughout my hospital stay, Dr. Vijay and I developed a relationship akin to that of a father and son. Additionally, Sister Merlin from the gastroenterology department, who treated me with the utmost kindness and care, became like a beloved daughter to me.