Caring and Curing

Dr. Yalwa is a young lady doctor from Nigeria.  She first attended a specialist hospital 2 years ago for the treatment of a small tumour in the right atrium of her heart.  That was a simple enough operation, she recovered well and although the treating hospital and surgeon realised that it wasn't a heart tumour that was taken out of the heart (the tumour was from the liver), she went back home pretty well very quickly.

The problem recurred soon and her belly started swelling, her weight came down, appetite became poor and repeat investigations now showed a huge tumour in her liver one again entering the heart.  It was very large and was encroaching  vital areas of the liver, heart and blood vessels and most liver surgeons would dare not operate upon her.  She communicated with senior liver surgeons in the UK and couldn't workout the formalities of getting treated there.   She took appointments from Nigeria and one fine day landed up in Delhi and was admitted to my hospital.  

Dr. Suresh Singhvi (one of her Liver Surgeons from UK) and I together operate upon such unusual and most complicated problems that affect the heart and the liver together. Initially we studied her history, examination findings, data, scans, and all relevant information separately.  Both of us separately decided that she was more or less inoperable, her tumour was surgically incurable.  

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It was magical when we sat down together and sought to find a solution.  I could readily operate upon areas not approachable by the liver team and Suresh could operate the rest.  We conducted more tests before finally fixing a date for Dr. Yalwa's (@lubaba47) surgery who by then had been named Dr. Lubo by the two of us.  

The complexity of her surgery arose from various factors, huge liver tumour replacing more than 70% of her entire liver, (can one safely take that much out, can she survive with the remainder); tumour spread to the largest vein in the body, tumour invading the diaphragm, tumour spread to the heart and invasion of the right atrium.  Equally importantly she had already had a heart operation; this makes the heart physically stuck to the breastbone as well as other surrounding tissues.  All in all a very complicated and challenging operation indeed.  

The two surgical teams worked alongside two anaesthetic and two nursing teams and the entire operating theatre environment remained charged for over 11 hours.  Arguably this was one of the most challenging operations where we removed more than 70% of the liver, portions of the IVC (great vein), diaphragm (partition between the belly and heart), portion of the right atrium (heart muscle) and the tumour within.  Then we repaired all that was divided, then stopped the bleeding and so on and on.  I believe it was close to midnight when we all came out exhausted from the operating theatre and talked to Dr. Yalwa's husband.

His only exclaim was: I knew we were doing the right thing and I know she will be fine.  A short while later all his extended family back in Nigeria were thanking the surgeons.  The best part was that she made an uneventful recovery as if she had overcome a mild flu.  

Later reports confirmed that we could expect a cure.   She is back to caring for and curing patients back in Nigeria.

Posted on February 9, 2014 .