Army Commander's recovery was amazing - Dr. Abayajeewa

INTERVIEW: Dr. Kirthi Abayajeewa was the chief surgeon who performed the surgery on Army Commander Lt. Gen. Sarath Fonseka after he was brought to the National Hospital Accident Service Unit with severe injuries following a suicide bomb attack.

After a four-hour surgery Dr. Abayajeewa and his team succeeded in saving the Commander's life proving the capability and proficiency of Sri Lankan doctors.

Here for the first time Dr. Abayajeewa, in an interview with staff reporter Lakmini Rodrigo, reveals his experiences at the surgery which led him to achieve a great victory in Sri Lankan medical history.

Q: What was your observation when you first saw the Army Commander in a critical stage?

A: I was at home when I first heard about the blast. I didn't believe it when a colleague called me up with the news, but I came to the hospital right away.

At about 1.30 p.m. about seven victims of the blast, were rushed to the hospital. We took the worst injured for the operation first. I didn't know it was the Army Commander then.

Usually when an injured person is brought to the accident service we assess him first. If there's no hope of life then we categorise him as black.

Those with severe injuries but could be resuscitated to life are categorised as red. The Army Commander was given `red', and as soon as we started the operation I knew that his life could be saved.

Q: What was the Commander's health condition when he was brought to the Accident Service?

A: He was very badly injured but not unconscious at that moment. He was aware of the surroundings. But he had external injuries in the abdomen, thorax and neck. Among them the abdominal injuries were the worst. Fortunately, he had no fatal injuries like injuries, to the heart or the great vessels.

Q: What was the initial treatment and pre-operative care given to the Army Commander?

A: We took him to the Accident Service ICU instantly and gave him a brief pre-operative treatment. Here we tried to bring the patient's blood pressure and other body functions to normal levels because such an injury could bring the pressure down.

But I should say that the Army Commander was relatively stable at the moment and did not have any other diseases which might have affected the surgery.

After nearly half an hour of pre-operative care in the ICU we decided to take him to the theatre as we realised that he needed emergency care.

Q: Can you describe your experience while performing the surgery and the post-operative care?

A: Once we took him to the theatre he was put under general anaesthesia in which his whole body was anaesthetized. Two other surgeons and I started performing the surgery. Several senior surgeons arrived afterwards and coordinated. Later on another senior surgeon of the National Hospital joined the surgery that lasted for about four hours.

It was only half way through the surgery that I got to know that we were operating the Army Commander. After the surgery he was taken to the Accident Service ICU where he stayed for the next 10 days.

Consultant anaesthetist Dr. Aluthge was in charge of his post-operative treatment. He was given the necessary supportive care at the ICU, that is nutritional fluids, antibiotics and analgesics.

Q: Did it put any extra pressure on you when you realised that it was the Army Commander that you were operating?

A: Not exactly. Our intention was to save a patient's life whoever it was. We carry out the surgery with positive thoughts and do our best. Who the patient is doesn't really matter.

Q: How would you assess his recovery?

A: Pretty good. For the first two days it was slow and gradual. But after that it was amazing. He was able to talk in about two days. In about five days he was able to talk well, sit up on bed and even eat food. By the time he left to the Army Hospital he was able to walk.

Q: Who were the other doctors involved in the surgery?

A: Dr. Gamini Abeysinghe, Dr. Jayasuriya, Dr. Liyanarachchi and myself were directly involved in the surgery. Consultant anaesthetist Dr. Suneetha Ranasinghe, Senior surgeon Dr. Narendra Pinto, Dr. Lal Silva, Dr. Semaka Jayasekara, Dr. Sarath Kumara Kollure, Dr. Rohana Vithana, Dr. Chandima Amarasena, Dr. Waruna Karunarathne and Dr. Ajith Karunarathne were present at the operation.

Q: Did the National Hospital Accident Service have all the equipment and facilities needed to perform such an immediate and major surgery?

A: We have a disaster management plan. So as soon as the emergency occurred it was put into action coordinated by accident service director Dr. Anil Jasinghe.

We normally have adequate facilities to handle five to six critical patients in a given time. But if the number of casualties are higher we mobilise our staff to designated areas of assembly and mobilise the theatres. We have relatively good facilities and equipment, but still have some requirements as well.

The National Hospital Accident Service is one of the few 'Level 1' trauma centres in the whole world, and it is the best place to bring such a casualty.

Q: The Army Commander is a VVIP. The National Hospital Accident Service would be the place any such person would be brought in after meeting with an accident. Are you ready to take up this kind of challenges?

A: Yes. No other hospital could handle trauma as we do. As I said being a Level 1 trauma centre we have the best and most dedicated staff, that is doctors, nurses, anaesthetists and any others, three theatres which are open 24 hours and a lot more facilities. We are open 24 hours a day and on all 365 days a year. So yes, we are ready to take up any challenge.

Q: How was the atmosphere at the hospital when the Commander was brought in? How did you and other hospital staff manage amid the high security provided at the moment?

A: It was difficult. We even had a hard time getting into the hospital with our bags. But security was essential at the moment and we cooperated with them.

The accident service staff is used to coping with such high security situations, so it was no big deal.

Q: Have you operated on any other VIPs before?

A: Yes. I have operated on many politicians and surgeons.

Q: In your career as a trauma surgeon, where exactly would you place this challenge?

A: It was a big challenge all-right. He was critically injured at the moment. But the accident service has developed greatly over the past couple of years, that the life of any patient admitted under the Army Commander's condition could be saved.

Q: What are the facilities or equipment the accident service needs to enhance the efficacy of their service?

A: We need more nursing staff. And also we need some high-tech equipment like a CT scan dedicated to the Accident Service.

Q: What is your assessment of the Commander's recovery?

A: He is going to be perfectly all-right. No residual injuries or after effects. In a few days he would be able to perform his duties as before.