She couldn’t swallow due to the narrowing of the gullet following an attempt at suicide by swallowing Acetic acid
Dr Gamini Goonetilleke (Right) with Lalitha (Left) and her family
In the Book of Psalms, lines 107:14 says, “He brought them out of darkness and gloom, and broke their bonds asunder,” which reminds this writer of Dr. Gamini Goonetilleke. The Daily Mirror met this person- a surgeon- and there was much he had to say during his interview with us. Dr. Goonetilleke is a person who values his patients more than anything else. He sat with us during one evening and he walked us through one of his thought-provoking and nerve-racking experiences as a surgeon. Lalitha, his patient, was in a desperate situation where she had swallowed food with difficulty for eight years. If not for this doctor she might have suffered her entire life.
Narrowing of the 'gullet' after acid ingestion
Lalitha is a 29-year-old spinster, the only child in the family living with her mother Somawathie, who is a rubber tapper earning a daily wage. Following an argument, Lalitha attempted suicide by swallowing Acetic acid (referred to as rubber acid by those in that occupation and usually kept in their homes. It is used to coagulate latex). This life-threatening incident took place in May 1990 at their home in Ingiriya. She collapsed with acute chest pains and was rushed to the nearby District Hospital.
Following initial treatment she was sent to a hospital with better facilities; located farther away. There she spent the next two months with her mother by her side. She couldn’t swallow at that point, therefore, a general hospital’s thoracic unit was recommended to her. Her gullet had narrowed and strictured, according to the diagnosis. Lalitha said that efforts had been made on 48 occasions to widen the constricted gullet, so that she could swallow during meals. Talking about surgery, this operation is known as oesophagoscopy and oesophageal dilatation (gullet), according to Dr Gamini. “I remember that she had to endure general anesthesia each time, and the treatment took place over the course of eight years. Every time she had some symptom alleviation it never amounted to a full resolution of her issue. When she was sent to my Unit at the Sri Jayewardenapura General Hospital (SJGH) from that hospital and I first saw her it was October 1998. The patent was 37 years old then. When she was admitted to the ward her physique was withering and she appeared sick. The biggest issue Lalitha faced was that she had trouble in swallowing and could only consume liquids, and even then, just a trickle at a time. She was slowly, but steadily losing body mass, which was a very pitiful scenario,” he recalled.
This writer questioned Dr. Goonetilleke in order to get him to explore and explain the scenario in much simpler terms. Acetic acid burns the gullet when it is swallowed (the passage that takes food from the throat to the stomach). The immediate aftermath includes shock and severe chest discomfort. The gullet eventually narrows after the initial burn lesion heals as a result of the scar tissue contracting. It becomes challenging to swallow food and liquids due to the constriction of the gullet. If extensive reconstructive surgery is not performed to remove the burned gullet and replace it with another section of the gullet that wouldn’t allow her to take food in a satisfying manner. This condition may eventually bring death to the patient due to dehydration, anemia, and starvation,” he explained.
The typical path was entirely obstructed, making it unthinkable to control Lalitha by feeding her with healthy food. Even when attempting to insert a tube (a nasogastric tube) through her nose and into her stomach the procedure proved to be too much of a challenge. As a result, we needed to find another solution,”
- Dr. Goonetilleke
“The typical path was entirely obstructed, making it unthinkable to control Lalitha by feeding her with healthy food. Even when attempting to insert a tube (a nasogastric tube) through her nose and into her stomach the procedure proved to be too much of a challenge. As a result, we needed to find another solution. A short surgical operation was performed on her, during which a tube was placed into a small intestinal loop. It’s known as a Jejunostomy.
This made it possible for us to give her liquids strong in protein and energy to make up for her dietary inadequacies. She went through this process for three months before being ready, both physically and mentally, to have major surgery,” he said.
According to Dr. Goonetilleke, Lalitha underwent a major surgical procedure that lasted 8 hours. The gullet that was burnt and scarred was completely removed following an approach using the neck and the abdomen- where the gullet is situated -without opening up the chest. This procedure is referred to as “Transhiatal Blunt Oesophagectomy” (TBO). Next, a segment of the large bowel with its blood supply was prepared. This segment was taken through the chest and placed in the normal site of the gullet and was used to bridge the gap. This was connected at the top end to the Pharynx (throat) and at the bottom end to the stomach. This will now act as the conduit to convey food from the pharynx to the stomach. Lalitha survived and returned home happy and was able to swallow food and drink once again. She was advised to attend the clinic on a regular basis, but she defaulted on many occasions for various socio-economic reasons.
Lalitha, speaking to Daily Mirror, said that if not for Dr. Goonetilleke , she would not have been able to see the light of day. “Eight years after the operation I met Chathupala, a 61-year-old rubber tapper. One year later I gave birth to Kumuditha, my only son. I was functioning normally after the surgery performed with the ‘Godly hands’ of Dr. Goonetilleke. I had no intention of living further when I could not eat, I lost all hope and my only hope was death. It is only due to Dr. Goonetilleke that I saw a ray of hope and regained my appetite for living,” Lalitha said.
It was following that episode that Dr. Goonetilleke reappears in her life. Dr. Goonetilleke with a radiant smile said, “To my surprise she appeared at the clinic one-day carrying baby Kumuditha. “She was well, but the reason for her visiting the clinic was to obtain some financial assistance from me to buy milk for her baby boy and some vitamins for her. Lalitha used to visit my clinic whenever she was in a desperate financial need. Chatupala had no permanent job and used to earn Rs 300 a day on and off. That was barely sufficient for their sustenance; especially with the couple having to nurture a small child,” he said.
Dr. Goonetilleke retired from service in October 2014 and afterwards she couldn’t find him at the clinic anymore. Lalitha had lost all hopes in life although she managed to survive in order to bring up her son.
“Three years later Lalitha returned to the SJGH ward where she had received treatment in a desperate attempt to seek help. The workers knew Lalitha well, and she got my phone number from one of them. Lalitha was able to get in touch with me once again as a result. I realised that those calls were coming to me from the Almighty up there and could not be ignored,” the doctor said humbly.
Dr. Goonetilleke said that he had visited her residence in Handapangoda on the Meepe- Ingiriya road; which is about 40 km from the heart of Colombo. “It was a sad plight at first sight. In fact, the construction of the house was incomplete, and the inside was so dark resembling a dungeon. They were certainly living in darkness. I spoke with them regarding their problems. They were faced with plenty of problems and all of them were connected to poverty and the lack of a regular income,” the doctor said.
Dr. Goonetilleke with the help of his friends and other donors has done a tremendous meritorious job to improve the lives of Lalitha’s family.
Lalitha, with tears in her eyes, said that all the requirements for her son are fulfilled by Dr. Goonetilleke. She said that the doctor had bought all the equipment that was needed by Kumuditha to pursue online education during the COVID pandemic.
Lalitha and her son used to walk two Km daily to reach the main road to get a bus to school. A school van was arranged to take the boy to school. Additional classes in English, Mathematics and Information Technology were also arranged so that Kumuditha would receive a sound education. Every month Lalitha receives Rs 15,000 and on some months sometimes more to cover their daily expenses, including the purchasing of medicines.
Dr. Goonetilleke, being pensive for a moment, said “After each telephone conversation the parting words are “Sir we are happy now, May God Bless you and your family. When are you coming to see us again”.