Impaled man survives to tell his tale

He was in agony but fully conscious and even held the three iron rods tightly while they were being sawed to a shorter length, so that he could be loaded onto the 110 Emergency Service ambulance for the ride to the Accident and Orthopaedic Service of the National Hospital in Colombo.

There was only a little blood but he knew that he was seriously injured, all the while thinking that his life would soon be over.

An incredible escape: The plastered Gunarathne recovering at the National Hospital and (below) his state before the operation on Aug 6.

The operation in progress

For, he had been impaled by three 16 mm iron rods 20’ long on that fateful morning of August 6, which had been like any other working day for him as long as he could remember.

However, when the Sunday Times met him last Wednesday in Ward 72, the only clue that he had been the victim of a serious accident at a construction site at Wellawatte were the large plasters all over his body and the slight pant once in a way when he spoke.

Dostharalata pin sidda wenna oney, says father of three, D.M. Gunarathne, 52, with his eyes moist with emotion and gratitude for the team, headed by Casualty Surgeon Dr. Wasantha Wijenayake, whose skills snatched him from the brink of death.

Gunarathne, a mason who had been working for about one year at the Wellawatte site where a five-storey building is being put up, recalls with horror the split second before his life changed.

“We had to send bundles of iron rods to the level of the fifth floor. I tied five of them together with a binding wire, attached the bundle to a hook in the electrically-operated hoist cable and sent the bundle up with a lift-haul,” says Gunarathne. As he peered up to send the second bundle up, he saw the binding wire give-way and the iron rods crashing down, literally on his head. “I tried to step away, but three went through my body,” he says.

It was the Colombo Municipal Council--Fire Brigade’s 110 Emergency Service that sawed the rods shorter and rushed him to the Accident and Orthopaedic Service. Brought to the Resuscitation Room around 8.30 a.m., the team of doctors under the guidance of Dr. Wijenayake went into action and quickly assessed the injuries.

“Two rods had pierced the right side of the chest, gone through the upper torso on the same side and come out from the buttocks,” says Dr. Wijenayake, adding that the third had got embedded above the right knee and emerged just below the knee. “The patient was very frightened and shocked.”

Administering anaesthesia in the Resuscitation Room itself, the doctors realized that they could not wheel Gunarathne into the operating theatre because the rods jutting out were still too long. Not even the Accident Service’s workshop had equipment to cut the rods and the team immediately sought the assistance of 110. “They came with a compressor-air cutter and did the needful,” says Dr. Wijenayake, pointing out that they had to be extremely careful not to shake the rods while doing so, to prevent further injury. It was in the Resuscitation Room that they pulled out the rod embedded in Gunarathne’s knee.

Soon after, they moved him to the operating theatre and the arduous three-and-a-half procedure began with many a “technical improvisation” by Dr. Wijenayake, his three Registrars of Surgery Dr. Sanjeewa Seneviratne, Dr. Janaka Ekanayake and Dr. Jeewantha Rathnayake, the anaesthetist and other theatre staff.

Taking time off his busy schedule, Dr. Wijenayake detailed the step-by-step procedure of this operation, although he says with humility that any surgeon could do it, but acknowledges that it is a “rare operation”.

The first step was to insert an “inter-coastal drainage tube” into the right chest cavity of the patient to ensure that the right lung could be ventilated without a problem.

Then the team had to deal with the two rods in the chest. “The first one had gone through the sub-cutaneous layer of the skin, injuring two ribs and come out through the buttocks,” says Dr. Wijenayake, who slit the skin up to the embedded rod, from the chest as well as the buttocks, leaving a bridge of skin in-between and then pulled out the rod.

The second rod in the chest was the difficult one, “the real challenge”, concedes Dr. Wijenayake, for it had damaged several vital organs, entering the right hemi-thorax (the cavity in which the lung is located), piercing the right-side of the diaphragm, going through the right lobe of the liver and gall bladder, entering the right side of the large bowel, traversing the entire length of the ascending colon, coming out through the caecum, then piercing the pelvic muscle, going through the pelvic bone and finally emerging through the buttocks after creating a hole there as well.

Thinking on his feet, Dr. Wijenayake, as soon as he opened up the abdomen had decided to remove the gall-bladder along with the affected part of the large bowel, with part of the rod in it. “This is called a hemi-colectomy,” he says, explaining why this procedure was needed – whereas the small intestine is mostly sterile, the big bowel has many bacteria and is full of faeces. “We needed to prevent the liver, a vital organ in digestion, from getting contaminated with these bacteria.”

The surgical team, holding the part of the bowel now cut off from the rest of the digestive system aloft, had pushed the faeces to one side and the rod to the other, thoroughly washing the rod with an antiseptic-saline solution to disinfect it.

Dr. Wasantha Wijenayake	Dr. Sanjeewa Seneviratne	Dr. Janaka Ekanayake	Dr. Jeewantha Rathnayake

Pulling it out from the top through the chest would have infected the liver with faeces and so the team decided to pull it out through the buttocks because the rod would have already contaminated the bottom part with faeces when it went through in the first place, he says.

And that’s what the team did. Referring to the “biggest problem” that they faced, Dr. Wijenayake says it was to ensure that the wounds along the right-side of Gunarathne’s body would not fester.

As thirteen days after this Operation Marvel, Gunarathne sits up and tells us that he is not in pain except for a few niggles here and there, the surgical team that laboured over his body to repair the destructive pathway of those iron rods can rest assured that it is a job well done.

Don’t pull out anything that’s embedded

In any accident or incident, where a foreign object (like the iron rods in Gunarathne’s case, or a stick or a knife) gets embedded in a person’s body, no one should attempt to pull it out, advises Dr. Wijenayake, as it could cause severe and sometimes irreparable internal injury and massive haemorrhaging.

Rush the person to hospital without moving or shaking him too much, he says, explaining that if Gunarathne’s friends, in good faith, attempted to pull out the rods, they would have severely damaged his liver and other organs.