HEY, I HAVE TO REMOVE MY APPENDIX!

The theme that I have chosen for the month of April-2018 is #Doctors & Scientists Self Experimented has made me realise the lengths that people can go to prove themselves right. Some of them do it just to boost their ego. I had written about Dr Evan O’ Neill Kane who had operated on himself and removed his appendix earlier in the post titled – BUT FIRST, LET ME REMOVE MY APPENDIX (Click to read). Today I will tell you about a doctor who did the same much later and for reasons quite different, for it was a question of life and death!

Leonid Ivanovich Rogozov was a Russian general practioner who was born on 14^thMarch 1934. He was a part of the sixth Soviet Antarctic Expedition in 1960. He along with his colleagues travelled in the ship Ob which departed on 5^thNovember 1960. After 36 days of sailing, the ship decanted on the Princess Astrid Coast. Their task was to build a new Antarctic polar base. Following nine weeks of activity, on February 1961, the new base called Novolazarevskaya was opened. He was the only doctor stationed there.

By then the polar winter had set in and the sea had frozen over. The ship had sailed back to where it had come from and would not be back for a year leaving the team trapped within the station. Contact with the outside world would not be possible.

On 29^thApril 1961, 27-year-old Rogozov developed fever, nausea, vomiting and weakness. Slowly he started developing pain in the right lower part of his abdomen. Being a surgeon, he quickly realized that he was developing acute appendicitis and started treating himself with antibiotics and fluids.

He wrote in his diary –

It seems that I have appendicitis. I am keeping quiet about it, even smiling. Why frighten my friends? Who could be of help? A polar explorer’s only encounter with medicine is likely to have been in a dentist’s chair.

By the next day his condition progressively deteriorated and by evening he realized that he was developing peritonitis i.e. the infection was going to turn fatal. The nearest Soviet Research station was more than 1600 kms away. There was no aircraft available and no other doctor in the team.

Rogozov wrote again –

I did not sleep at all last night. It hurts like the devil! A snowstorm whipping through my soul, wailing like a hundred jackals. Still no obvious symptoms that perforation is imminent, but an oppressive feeling of foreboding hangs over me . . . This is it . . . I have to think through the only possible way out: to operate on myself . . . It’s almost impossible . . . but I can’t just fold my arms and give up.

I’ve never felt so awful in my entire life. The building is shaking like a small toy in the storm. The guys have found out. They keep coming by to calm me down. And I’m upset with myself—I’ve spoiled everyone’s holiday. Tomorrow is May Day. And now everyone’s running around, preparing the autoclave. We have to sterilise the bedding, because we’re going to operate.

I’m getting worse. I’ve told the guys. Now they’ll start taking everything we don’t need out of the room.

Rogozov had to do the inevitable. He decided to operate on himself. The team members improvised an operation theatre with everything that was available to them. They moved everything out of his room except his bed, two tables and a table lamp. The aerologists Fedor Kabot and Robert Pyzhov flooded the room thoroughly with ultraviolet lighting and sterilized the bed linen and instruments.

Rogozov then fashioned an operating team using the meteorologist Alexndr Atremev, the mechanic Zinovy Teplinsky and the station director Vladislav Gerbovich. He explained the operative steps and their duties to them. Artemev would hand him the instruments, Teplinsky would hold the mirror and adjust the table lamp. Gerbovich was to be the standby just in case one of the assistants had vomiting or fainted. In case Rogozov lost consciousness, he trained his team how to inject him with drugs he had prepared in advance and also to provide him artificial ventilation.

At 2:00 AM on 1^stof May he began the self-surgery. He initially used a local anesthetic to numb the abdominal wall. He then made an incision approximately 10-12 cms in length. The visibility was poor especially in the depth of the wound and so he had to use mirrors and raise his head often. As he opened the layers of the abdomen and entered into the peritoneum, he accidentally injured the caecum which is a part of the large intestine. He sutured the injured part of the intestine and the proceeded to remove his appendix which was highly inflamed. After this, the antibiotic solution was directly introduced into the abdominal cavity. He constantly developed nausea and weakness during the surgery and so had to take constant breaks. The surgery was competed at 4:00 PM.

Gerbovich wrote in his diary that night:

When Rogozov had made the incision and was manipulating his own innards as he removed the appendix, his intestine gurgled, which was highly unpleasant for us; it made one want to turn away, flee, not look—but I kept my head and stayed. Artemev and Teplinsky also held their places, although it later turned out they had both gone quite dizzy and were close to fainting . . . Rogozov himself was calm and focused on his work, but sweat was running down his face and he frequently asked Teplinsky to wipe his forehead . . . The operation ended at 4 am local time. By the end, Rogozov was very pale and obviously tired, but he finished everything off

After the operation the general condition of Rogozov slowly began to improve.  And his temperature began to go back to normal on Day 5.

 

This is what Rogozov wrote –

I didn’t permit myself to think about anything other than the task at hand. It was necessary to steel myself, steel myself firmly and grit my teeth. In the event that I lost consciousness, I’d given Sasha Artemev a syringe and shown him how to give me an injection. I chose a position half sitting. I explained to Zinovy Teplinsky how to hold the mirror. My poor assistants! At the last minute I looked over at them: they stood there in their surgical whites, whiter than white themselves. I was scared too. But when I picked up the needle with the novocaine and gave myself the first injection, somehow I automatically switched into operating mode, and from that point on I didn’t notice anything else.

“I worked without gloves. It was hard to see. The mirror helps, but it also hinders—after all, it’s showing things backwards. I work mainly by touch. The bleeding is quite heavy, but I take my time—I try to work surely. Opening the peritoneum, I injured the blind gut and had to sew it up. Suddenly it flashed through my mind: there are more injuries here and I didn’t notice them . . . I grow weaker and weaker, my head starts to spin. Every 4-5 minutes I rest for 20-25 seconds. Finally, here it is, the cursed appendage! With horror I notice the dark stain at its base. That means just a day longer and it would have burst and . . .

“At the worst moment of removing the appendix I flagged: my heart seized up and noticeably slowed; my hands felt like rubber. Well, I thought, it’s going to end badly. And all that was left was removing the appendix . . .

“And then I realised that, basically, I was already saved.

Rogozov speaking to his friend Yuri Versechagin.
Image Source: www.rarehistoricalphotos.com

More than a year later the Novolazarevskaya team left Antarctica, and on 29 May 1962 their ship docked at Leningrad harbour. Rogozov returned home a national hero. His incredible survival story was spread far and wide.  Just 18 days before performing his operation, fellow Russian, Yuri Gagarin, had become the first man in space, and comparisons were drawn between the two men.

The next day Rogozov returned to his work at the clinic. He worked and taught in the Department of General Surgery of the First Leningrad Medical Institute. He never returned to the Antarctic and died in St Petersburg on 21 September 2000.

Appendectomies are now compulsory for Antarctic explorers from several countries such as Australia. Some in the medical profession have suggested the procedure should be given to any future astronauts leaving the Earth to form a colony on Mars or the Moon.

This post is a part of the #AToZChallenge-2018

I am also linking this post to #MondayMusings hosted by EverydayGyaan.com