‘THE TRAGEDY OF A BURNT GULLET’-by Dr Gamini Goonetilleke

‘THE TRAGEDY OF A BURNT GULLET’-by Dr Gamini Goonetilleke

Source:Drgamini

Let me begin with a short story …

For 42- year old Somalatha, working overseas as a housemaid promised to be that fabled ‘green pasture’. Having slogged as a servant in Colombo households to earn a living, the prospect of going abroad held much appeal. She dreamt of a new country, a new life, a new job, and a new lease to her existence, having suffered much along life’s rocky road. It was with this hope and anticipation that she left Sri Lanka, never expecting that a cruel twist of fate would see her back home in two months rather than two years.

For reasons not known, her employer overseas had forced her to swallow a solution containing acid used to clean the toilet. This cruel act had caused her much pain and she was admitted to the hospital. On recovery from the acute episode, she was not able to swallow any solid food as well as liquids. The acid had burnt her gullet (the passage conveying food from the pharynx/throat to the stomach) and the stomach. Tubes had been inserted into the small bowel to feed her and subsequently sent back to Sri Lanka as she was not in a fit condition to work.

She was admitted to my ward at the Sri Jayawardenapura General Hospital (SJGH) for further treatment. When I saw her for the first time, she was in a poor state of health, in fact, a walking skeleton, dehydrated, anaemic, malnourished, unable to swallow even her saliva and spitting continuously into a plastic cup clutched tightly in her right hand.

Medical investigations carried out revealed that her gullet was like a ‘corroded pipe’ and the passage was completely blocked. Only major reconstructive surgery could give her a new lease of life. There was no alternative and we undertook that major task with an operation for eight (8) hours. After another month in the hospital recuperating from the major surgical procedure, and now able to eat and drink in the usual manner, she went home thanking me and my team profusely for relieving her suffering.

I remember her parting words … “I want to live happily in Sri Lanka, doing a small job that will earn me just enough money to support my family.

The burning of the lower end of the gullet and subsequent narrowing can occur sometimes in those who have a Hiatus Hernia when acid from the stomach enters the gullet over a long time.

This story however does not deal with that problem but relates to my experiences of treating those with forced or self-induced damage/burning of the gullet and the stomach by the ingestion of corrosive substances leading to untold suffering.  

The most distressing symptom of these patients is dysphagia which refers to difficulty in swallowing. They are unable to enjoy the physical pleasures of eating and drinking and are profoundly affected in their activities and the ability to lead a useful life.

The inability to take food leads to dehydration, anaemia, malnutrition with the body wasting away slowly resulting in death.

Why and what do they drink to lead to this unfortunate situation?

Some stories of the suffering victims will give a clue ……and their progress in some after restorative surgery

Rasaji was a GCE Ordinary Level student who sat for the examination but was not successful in getting the expected results. She was depressed and drank sulphuric acid. She burnt her gullet and stomach, and could not swallow any food. A tube had been inserted into her small intestine to feed her as a temporary measure, but in the long term needed major surgery.

Kumari was a poor girl from Anuradhapura. She went abroad for a job as a housemaid in a Middle Eastern country. She felt trapped. There was no one to turn to, no succor. She begged and pleaded that she be sent home after she had finished her contract of service for two years. Kumari had suffered the hardships of a regimented routine of work with hardly any free time. While she slaved day and night, the ‘madam’ did not give her enough to eat. She has suffered much and when repeated pleadings to send her back home to Sri Lanka failed, she brandished a bottle of toilet cleaner and took a few sips.

Writhing in pain, frothing and foaming at the mouth and also vomiting blood she had been taken to hospital only one and a half hours later. She suffered extensive damage to her gullet as a result. After treatment in that hospital, she was sent back to Sri Lanka in bad shape with a tube hanging out of her bellythat was used for feeding. Although the surgery was performed there, her condition had not improved and needed further major surgery.

Kumudu was a Prefect in a school. She was spoken to harshly by the Principal in the presence of the other students. She felt embarrassed and found it hard to face her friends. She came home and drank acetic acid which burnt her gullet.

Rohan was working in Italy. His grandfather who had looked after him during his schooling days died in Sri Lanka. He could not attend the funeral. He was depressed and swallowed a caustic fluid used to clean toilets that burnt the entire gullet. He returned to Sri Lanka in a critical condition, suffered, and died after surgery.

Raja was a soldier in the army attached to a camp in the North. While on vacation he went to a ‘bar’ for a drink with his friends. He came home intoxicated, was thirsty and drank some liquid that was in a bottle and resembled water. But it was not to be. It was a corrosive acid probably aceticacid. The damage was done to the gullet: burns, inability to consume food and drink and immense suffering. Only surgery could help him in the long run.

Sunil was playing cricket with his friends one afternoon. His mother asked him to stop playing and to get ready for his tuition class. He got angry, came home and gulped nitric acid which was in a bottle at home. His father was a jewellery craftsman and they use this acid in that trade. The result was the same as in the others. After much suffering, he was admitted to hospital when his condition had worsened over a few months.

Somapala lost his job as a peon in a private enterprise. With no income to maintain his family, he went into a state of depression. Although under treatment with anti-depressive medications he tried to commit suicide by drinking ‘Harpic’ used to clean toilets. He burnt his gullet and suffered from difficulty in swallowing for months before coming for treatment.

The most interesting story concerns a girl from Mannar. Rajitha Malar was a pretty young girl living in Mannar. The war was raging in the North-East of the country and the Tigers were recruiting the youth, both males and females, into their cadres to fight the war. Rajitha’s parents did not want her to join the Tigers and brought her to Nuwara Eliya and kept her with some relatives. While living there she had a dream that her parents had died in an explosion. Believing the dream to be true she drank sulphuric acid and sustained burns in the gullet and stomach. Later on, she came to know that her parents were still alive. It was too late. The damage was done. From the Base Hospital, Nuwara Eliya she was referred to Sri Jayewardenepura General Hospital for treatment. Surgery was performed on her. She recovered and went back to the North after successful surgery and later joined the ‘Tigers’, not as an armed cadre but as an accounts clerk in the office of the Tamil Eelam Development Organization (TEDO) in the Wanni.

Some years later she sought my advice regarding marriage since she has had major surgery. The boy was from the Wanni; a Tiger of course. I said she must get on with her life forgetting the past, have a successful married life and produce ‘Tiger Cubs’ as well. However, on 27 July 2007, I heard the sad news. She had died three days before her wedding following a snake bite. What a twist of fate for this unfortunate girl!

Nineteen-year-old Indika, was following a course in electronics at the German Technical College. He was experimenting at home with his friend. This ‘friend’ had introduced Ferric Chloride, which is used in making electronic circuit boards, to a bottle of water without his knowledge. Indika felt thirsty and gulped half a bottle of water contaminated with the corrosive. A few hours later he started vomiting and was rushed to the Provincial Hospital. It was only later that he realized that he had been poisoned by his friend who by then had disappeared from the scene never to be found again. He underwent at least ten operations over a period of two years at the hospital, without much improvement.

(Barium Meal – The patient is asked to drink a contrast medium called barium sulphate and X rays are taken to visualize the stomach)

He was later referred to my unit at SJGH. We found that half of his stomach had been burnt and that part had to be removed. He recovered from this operation, but returned six months later, now complaining that he could not swallow. This was due to the narrowing of the gullet caused by the corrosive. Further major surgery had to be done to overcome this serious problem, without which he would die of malnutrition.

He recovered from this too and went home a happy man able to eat and drink. About a month later, he came to my clinic once again with a beaming smile to inform me that he had found employment. I was happy, but only for a short time. Where was he employed? I got a shock of my life when I heard it. It is unbelievable but true. Indika a young boy, 22 years of age, 5 feet tall and weighing only 30 Kg and having had multiple major surgical operations had been recruited to the Sri Lanka Army as a Corporal to fight terrorism. I could only warn him of the dangers he would have to face during the training, and true to my word, while performing strenuous exercise he vomited blood and collapsed only to be hospitalised once again. However, following my appeal, Indika was promptly discharged from the Army.

For Wimalawathie, the agony of starvation began as a twenty-three-year-old very much in love with a young man in the neighbourhood. Her parents were unhappy about the affair and there was much unpleasantness at home. In her foolishness and anger she “drank acid”.  The condition that developed was much worse than what she had to endure at home.  Although it was a small gulp, it left her gullet burnt dooming her to a liquid diet and that too only a few sips at a time. It was only thirty-three years later that she sought treatment when she had to struggle to swallow even her liquid diet.

For Rohini, it was an argument with her boyfriend over a ‘silly matter’ which is not uncommon when immature people are in love. The boyfriend left her and Rohini now depressed with a broken love affair and on the spur of the moment came home and drank acetic acid which burnt her “insides”. Unable to take food and drink, a tube had been inserted through the nose to the stomach (nasogastric tube) to feed her. This was a temporary measure and she too required major restorative surgery.

Rohini recovered after major surgery. My advice to her on discharge was to lookout for a new ‘boyfriend’. Indeed she was successful, married and now lives happily with her husband and two kids.

‘FOR ME THESE WERE

THE JOYS OF HEALING’

“I couldn’t swallow”, “I couldn’t eat”, “I couldn’t drink”, “I was vomiting all the time ………… were some of the symptoms they had come with but they were all referring to the main problem of difficulty in swallowing. Some had been written off. Others had tubes sticking out of their nose or belly for feeding, but only liquids.

A few complained that they had exhausted all their financial resources trying various forms of treatment. Others were still in a state of depression ‘fed-up of living’ and still having a suicidal tendency.

While in some cases it was accidental, others were emotional and quick to react to commit suicide. However what was most distressing was to see those suffering after the forced feeding of a corrosive liquid, a problem faced by housemaids working in the Middle Eastern countries. The damage had been done and they were suffering both physically and mentally. No doubt they needed of care and compassion in addition to physical and mental healing.

The corrosive substances ingested included: acetic acid, sulphuric acid, nitric acid, caustic liquids, hydrochloric acid (Harpic), etc.

Sadly most of them were young. What we have seen in the surgical ward were those who had survived the acute phase. They were left with serious burns of, the oesophagus (gullet), the stomach, and even the larynx (vocal cords).

None of them were in a fit condition for immediate surgery and various issues had to be dealt with before surgery. They were in fear and anxious not knowing what their fate would turn out to be. That was natural. Irrespective of the circumstances that lead to this condition of a ‘burnt gullet’ everyone required sympathy and a humane approach. That was a priority! 

This is where small things matter the most and these small things can be given without    any additional cost and include …….. compassion, love, kindness and a gentle touch   

The leader of the team should always show the way and the rest of the team members will follow…

Many methods of treatment have been advocated for these patients and this includes non- surgical and surgical techniques. Surgery entails removing the diseased part and replacing it with another part of the digestive tract. Such surgery requires expertise and calls bravery and daring on the part of the surgeon…

More about these techniques in my next story explained in a way that will be easy to understand…

Dear Reader, If you haven’t read my earlier story, you can read by clicking this following link : “The Bomb explosion in Gampaha town – 1989′

You also might be interested in watching some of our other photo gallery links are given here : ‘WAR FRONT – 1’ – ‘WAR FRONT – 2’ / ‘PHOTO GALLERY – PICTORIAL JOURNEY OF SURGERY’ / ‘MY LIFE’ / ‘SPORTS’