By Dr George Jacob

Kochi: Doctors worldwide have their hands full with the current pandemic relentlessly continuing to make its presence felt. Besides Covid, there are other diseases that demand doctors’ undivided attention.

These diseases include those categorized as infectious, neoplastic, inflammatory, degenerative, hereditary and traumatic.

Life and lifestyle have undergone drastic changes. Life literally runs on the fast lane, in/on ‘new generation’ automobiles.

These automobiles plying on roads ill-equipped to meet safety standards demanded by them lead to accidents more gory and lethal than those witnessed in yesteryears. Victims of velocity are carried into Emergency Departments of hospitals more frequently these days. Alongside these ‘victims of life on the fast lane,’ victims of violence of assorted kinds too increasingly seek medical care.

As part of a team of doctors working in the ICU of a tertiary care hospital, I was recently involved in the treatment of two injured patients. Wholehearted attempts to treat them successfully ultimately proved exercises in vain. Magnitude of injury sustained by them in entirely different circumstances left us helpless and defeated.

The first patient was a 27-year-old who was stabbed during an altercation at a wedding reception. The knife injured a major blood vessel deep in his pelvis which caused torrential bleed. He was exsanguinated so badly that he collapsed on arrival at the Emergency. After resuscitation, he was straightaway wheeled into the operating theatre.

There was no time to lose, as he was bleeding torrentially. He had to be saved somehow. He was too young to die. His blood pressure and pulse were barely recordable as he was being draped for surgery. Distinct possibility of death on the operating table had been conveyed to his family as consent for operation was obtained.

As feared the patient developed cardiac arrest at induction of anesthesia. He was resuscitated and surgery proceeded with. Chances of his survival depended on how effectively and expediently the injured blood vessel was repaired. The vascular surgeon did his best to do just that. But torrential bleeding and resultant hypotension (low blood pressure) had taken their toll on his body as the surgeon completed the operation.

Hypotension led to renal failure. Both these caused his blood turn acidic. These insults proved too much for him. The young man succumbed before long.

The second patient was a 40-year-old man who met with a road traffic accident. The ‘new-gen’ two-wheeler he rode collided with a car, throwing him off his bike. The high-velocity accident fractured his pelvic bone, and also injured his rectum and the urinary bladder. By the time he arrived at the Emergency, he was in shock due to bleeding caused by the fractured and displaced pelvic bone.

He required emergency operation to fix the fracture and repair injured organs. He was operated by a team of surgeons comprising of the orthopedic surgeon, urologist, gastrointestinal surgeon and vascular surgeon. As usual, the fractured pelvic bone was seen to cause torrential bleeding into the tissues behind the abdomen called retroperitoneum.

In such an eventuality, surgeons are not supposed to foray into the retroperitoneum to arrest bleeding, which usually is an exercise in vain. Akin to searching for a needle in the hay stack. As blood welled up from the retroperitoneum while closing the abdomen, the surgeons called for the interventional radiologist to embolize (block) the bleeding vessel. The bleeding vessel was identified and embolized.

However, bleeding was so rapid and torrential that this patient too was caught in the cascade of bleeding leading to hypotension and organ failure. Despite surgery, embolization of the injured blood vessel, blood transfusion, and high doses of drugs to normalize blood pressure, another young life was lost.

The latter represents mortality and morbidity caused by modern-day ‘life on the fast lane’ on those ‘new-gen’ two-wheelers. These vehicles are so powerful that victims hit by them resemble those mowed by bulldozers. Pedestrians and people traveling in three-wheelers ploughed by these bikes arrive at hospitals with gory injuries with high propensity to kill. Over-Confidence these two-wheelers instill in their riders have them break every rule in the book. Endangering their lives and those of others on the road.

Six two-wheeler riders die every hour on Indian roads. More than a third (37 percent) of those killed in road accidents in 2019 were two-wheeler riders. Many of these reckless riders are found to over-speed with helmets tucked between their thighs or hung from rearview mirrors on powerful new-gen bikes on Indian roads the poor conditions of which are ill-equipped for these ‘hearses’ to ply on.

The other group of people who invite death and injury are those involved in violent brawls using deadly weapons. The present generation seem be short of patience and temper. Audacity with which people attack each other with intent to kill and maim represents inadequacy of law as deterrent. People take to violence over petty reasons and heinous large-scale violence through terrorism, communal and political violence. India recorded 79 murders daily in 2019, making up for 28,918 murders that year.

Both the cases mentioned above succumbed despite being taken to a tertiary care center within reasonable time. Time interval between injury and medical intervention wasn’t long. Magnitude of violence involved was massive to snuff out two young lives. Modern-day healthcare despite rapid advances is increasingly finding it difficult to save lives, most of them young and productive due to the magnitude of trauma suffered.

Law in this country need to be bolstered, at least to serve as efficient deterrent, if not to punish the erring and those who take law into their hands.

Hello, Is anybody listening?

(Doctor George Jacob is a Consultant Surgical gastroenterologist at Lakeshore hospital, Kochi, Kerala)