AS Asmita Katkar (35) battled for her life on Tuesday after being pulled out from the debris of a collapsed road overbridge in Andheri, a team of over 15 doctors at the municipal Dr RN Cooper hospital conducted multiple surgeries over a span of 14 hours, not only salvaging her left hand but also stabilising her medical parameters by Wednesday.
Employed as a domestic help, Asmita had suffered an intracranial bleed, a crushed face and multiple minor injuries. She was unresponsive when taken to the government hospital at 9.29 am, two hours after the collapse. The neurosurgery, plastic surgery, ENT, anaesthesia, orthopaedics, and general surgery departments operated on her from 12.30 pm Tuesday till 3 am Wednesday.
At 8 am on Tuesday, a message was sent to all doctors at Cooper hospital to expect mass casualties. At that point, head of the ENT department Dr Shashikant Mhashal had left home from Sion but was stuck in traffic. “At Milan subway I finally left my cab and took a lift from a biker to reach the hospital,” he said. Between 9.15 am and 9.29 am, all five injured were admitted. While others were stabilised, Katkar had a broken jaw and a damaged airway. Her left hand was dangling from the elbow. Doctors tried to insert an air tube intra-orally but the bleeding from her jaw made that impossible. “It was a miracle she was surviving, fighting to breathe, even two hours after the accident. We conducted a tracheostomy to create an airway to breathe,” said Dr Vinod Gite, assistant professor in ENT. Gite has earlier worked in KEM hospital.
As Gite and Mhashal, with nine and 12 years of experience, respectively, conducted the tracheostomy, a team of eight doctors from anaesthesia department inserted a central line to stabilise her while orthopaedics started cleaning her wounds. By 10.30 am, the first CT scan was conducted. Her neurological status did not seem critical. The intracranial bleeding had not affected other regions of the brain, neurosurgeon Dr Shraddha Maheshwari, assistant professor in neurosurgery, said. So, doctors focussed on salvaging her hand and reconstructing her face.
Mhashal and Gite sutured her right cheek and did a basic surgery to realign her jaw. “In my experience, survival is minimal. But in her case, she was brought at the right time,” Gite said. Meanwhile, the head of plastic surgery Dr Nitin Ghag started operating on her left hand. “Her hand was hanging, the nerve, tendons and muscles were damaged. I had to use blood vessels from the thigh and reattach her hand,” he said. The surgery stretched for six hours, until 7 pm. Sister-in-law Anuradha Katkar said before surgery the doctors had warned that an infection from the hand could affect the brain if the hand was not amputated on time. “We thought she had lost her hand. She washes utensils to earn a living.”
By evening, the orthopaedics team realigned the bone in the hand and blood had started flowing again. “We need time to assess whether nerve sensations will return,” Ghag added. By dusk, Katkar’s brain injury had started swelling following multiple surgeries. “We noticed her clinical status had deteriorated,” neurosurgeon Maheshwari said. Maheshwari has been working with BMC hospitals for six years. She took a bold decision, to conduct a craniotomy.
Associate professor of anaesthesia Dr Harpreet Kaur said the challenge was to keep Katkar stabilised on the ventilator to maintain blood pressure. “The blood loss was huge. It was important to balance her vitals amidst all surgeries.” Kaur, with an experience of nine years, previously worked with Nair hospital. “In government hospitals, we are always prepared for emergencies,” she said.
By 9.30 pm, decompression surgery on the brain began. “We removed a portion of skull bone. The skull had restricted the swelling due to the injury,” Maheshwari said. During the surgery that lasted till 3 am, Katkar’s parameters worsened. “… But we managed to stabilise her,” Maheshwari says. The next 48 hours remain critical for Katkar as she remains on ventilator support. If her hand starts turning black, it may indicate need for amputation. On Wednesday, an anti-gangrene injection was administered. If she survives for next 48 hours, doctors hope for a normal recovery.
“There will be deficits, but we are trying to bring her as close to her previous self as possible,” said plastic surgeon Ghag.
Husband Luv Katkar, a housekeeping worker in Vile Parle, has not left her side since Tuesday. “She moved her legs a little bit today,” he says. Their son Siddhesh refuses to return home without his mother. In their Juhu chawl, he runs from one house to another to play with neighbours. “We have told him she is in the dawakhana (hospital), but he keeps asking if she is alive,” Sarojini, Katkar’s mother-in-law said.