Surgery saved man stabbed in liver

For one man, the pageantry of Batabano this year quickly dissolved into a struggle for survival.

A 29-year-old man, who asked to remain anonymous, spoke to the Cayman Compass this week about an ordeal that nearly took his life. He was stabbed in the liver while visiting a food vendor at the end of Batabano, and it took an odyssey between two local hospitals to save his life.

The man was ultimately saved by an operation conducted by Dr. Deepak Varma, a senior consultant in gastrointestinal and bariatric surgery at Health City Cayman Islands, but before that happened, he had run to George Town Police Station to get help. From there, he was taken to Cayman Islands Hospital, where he was diagnosed and given preliminary treatment.

“My instinct told me to run to the safest place,” he said Tuesday when reached by phone. “The adrenaline was pumping, so there was no pain when I was running to the police station.”

The doctors at Cayman Islands Hospital discovered that the patient was bleeding internally, which triggered a call to Health City to see if there was a surgeon on call who could handle a liver injury. Then, after making the call, they shuttled the patient 18 miles to Health City’s waiting trauma centre.

“We started this trauma care centre last December,” said Dr. Binoy Chattuparambil, the clinical director and chief cardiac surgeon at Health City. “The whole reason was that anybody on the island who has an emergency like this will need urgent care where time is precious. It can be a brain injury or a heart injury, a lung, liver or bone. We need the entire specialty tree in any hospital. There’s no point in having a liver surgeon when someone needs neurosurgery. And it has to be 24/7.”

The patient made it to Health City, was stabilised by the emergency room physician, and within an hour, he was on his way to the operating theatre, where Dr. Varma and a staff of seven nurses and doctors were ready.

“The first thing we do is see where the bleeding is,” Dr. Varma said. “We put pressure on it, packed it and it stopped. From the operating theatre, he received some blood transfusions and he was stabilised once the bleeding stopped. Then we stitched the bleeding spot. There was a big wound on the liver. It was very deep and just bleeding profusely. We had to suture the bleeding points and repair the laceration.”

For the patient, there was not much fear or anxiety. He was in pain by this point, but he did not really know that he was in critical condition. He said on Tuesday this week that he did not remember much about the procedure except for staring up at the white lights on the ceiling and being told to count as the anaesthesia took hold.

But for the medical staff, there was an intense recognition of the severity of the situation. The surgery took 90 minutes, said Dr. Varma, and the liver’s proximity to the heart meant that every minute mattered.

“The liver has three blood supplies; one that comes from the intestine, another where the good blood goes through the artery, and another where blood is taken out through the liver into the heart,” he said. “The liver is very close to the heart, and it’s very close to the major blood vessels in the abdomen. If there’s an injury on the liver, it will bleed profusely. Within hours, the patient can die.”

“If he had continued to bleed for a couple of hours more, he’d go into shock,” added Dr. Chattuparambil. “The next stage is the other organs will shut down and he will die. And there’s no liver surgeons on the island or in the region. The only other option for him would be to go to the United States. And he wouldn’t survive that time. The air ambulance getting organised takes six to eight hours.”

The patient, an active athlete who loves to play basketball, spent seven days in the hospital before being discharged. He said he is still recovering nearly two months later, and he’s still not able to run at full speed. But his liver is fully functioning, and Dr. Varma said that the organ is able to heal itself.

“The good thing about the liver is that even if you remove 60%, the rest of the liver will grow to make-up for the functionality,” he said. “There’s a story in Greek mythology. Prometheus. The eagle ate the liver every day and the liver would grow [back]. The same thing is found in modern science.”

The patient said Tuesday that he is well aware that the alternative to surgery meant a flight out to Miami, and he acknowledged that he may not have made it if that had come to pass.

“I can’t thank them enough,” he said of the staff at Health City. “Every time I go up there, I ask for Dr. Deepak and I go see him and say hello to him. … My family was very grateful.”