Most people would already have some idea about Siamese twins and been reminded that there was a previous case in Mauritius in 1992
Dr R Neerunjun Gopee
The recent case of Siamese twins born to a couple at Jawaharlal Nehru Hospital, Rose Belle and currently awaiting surgery at the world-famous Narayana Hrudayalaya Heart Hospital in Bangalore has naturally generated a lot of public interest. By now most people would already have some idea about Siamese twins and been reminded that there was a previous case in Mauritius in 1992 which went to South Africa for operation.
The present episode has reminded me of an incident that took place when I was on call in the Gynaecology & Obstetrics Department at the newly opened SSRN Hospital in the early 1970s. In today’s terms it would probably be labelled as one of ‘fake Siamese twins’, but the specialist who made the diagnosis of Siamese twins was deadly serious – and he had given specific instructions to that effect.
The story is that at that time I was posted to the antenatal ward, and as was customary I accompanied the specialist, Dr Owadally – who had recently come to SSRNH as part of a general transfer exercise – one morning on a ward round. The lady in question was in the last of the four bays towards the far end of the ward. It is true that her abdomen did look rather big.
After I had given a brief history about her admission and so on, the specialist proceeded to examine the patient under the watchful eyes of the very experienced Sister who stood by his side, while I faced him from the opposite side of the bed.
Suddenly, as if he had discovered America, he jerked himself up from the slightly bent position he had assumed for the examination, and loudly made an announcement: ‘This is a case of Siamese twins!’ I met Sister’s eyes and she winked at me, with a sly smile on her face.
‘Now you,’ he said in an imperious, over-confident tone, addressing me, ‘you note down in the file what I am going to say. And I want these instructions followed to the letter, understand!’
And so it was that I wrote down as follows, by the side of the time entered to the minute, I suppose something like 9.22 a.m.
‘Seen by Dr Owadally. Advised: As soon as this lady starts labour pains and is admitted to the Labour Ward, the RMO (Resident Medical Officer) on duty must inform the specialist on call immediately and thereafter every two hours until the patient delivers.’
In those days, there used to be only one specialist in each specialty on call at night, covering the three general hospitals in the island: SSRNH, Civil Hospital and Victoria Hospital.
A few minutes later, as his almighty was walking out of the ward and I sat down in the nursing station to complete my case notes, Sister in a light vein said, equally confidently, ‘Il n’y a aucun Siamese twins de narien Docteur! Il aurait pu demander une radiographie au moins!’ (‘There’s nothing like any Siamese twins here Doctor! He could at least have asked for an XRay!’)
In those days investigations were really basic by today’s standards, there was no ultrasound for example.
As luck would have it, I happened to be on duty a few days later when the nurse in the Labour Ward phoned me at about 4.30 p.m. to say that the lady had been transferred there as she had started to have labour pains. The nurse had seen the instructions that were in the file, and was in a bit of a panic. But I walked calmly to the Ward, recalling Sister’s assurance.
Nevertheless, after checking on the lady, I sat down at the desk with the file open in front of me and requested the telephone operator to connect me to the specialist on call.
A few minutes later there was a curt, loud voice at the other end of the line. ‘Dr Paratian here! Who are you and what is the problem?’, he asked with obvious irritation. Later I realised that he must have been in his private consultation – I recall once in a GMDOA meeting at Victoria Hospital, he had said that ‘private practice is like a prostitute. Like it or not you keep going back!’
‘It’s Dr Gopee here, RMO on call at SSRN Hospital phoning from the Labour Ward. I have a lady with Siamese twins…’ I didn’t get time to finish my sentence when there was something like an explosion that deafened my ears.
‘Siamese twins! Repeat that again, you say Siamese twins! Impossible, impossible!! This has never happened in Mauritius and can never happen!’
I suppose that the words ‘Siamese twins’ must have had the effect of a bombshell on him, for he went on for nearly five minutes, haranguing me on the rarity of the condition, citing worldwide statistics and his experience, along with other things. So much so that I had to hold the phone away from my ears and he had to ask ‘are you still there?’
‘Yes, Dr Paratian, I am here!’
‘Who has made this diagnosis?’ he queried.
‘Well, it’s none other than another specialist here during ward round the other day, also MRCOG London (Member of the Royal College of Obstetricians and Gynaecologists) like you, Dr Owadally. And he has given specific instructions which he has ordered must be strictly followed. I will read them to you.’
‘You are going to call me every two hours young fellow? When I tell you it cannot be Siamese twins…’
‘Yes, Dr Paratian, I am. You and I may know that, but you know how Dr Owadally will give me hell if I do not follow his instructions.’
‘All right, all right, please yourself!’ he ended as he abruptly put the phone down. To say that he was not amused at the prospect of being rung up through the night is to put it mildly. But I had no choice, and at 2.30 a.m. when I called his weary voice said ‘Oh it’s you again! Everything all right?’ Actually at that stage I began to feel a bit sorry for him.
The last call was made at 8.35 the next morning, when the head was ‘crowning’ (presenting at the vaginal orifice), and he exclaimed when I asked him what to do, ‘Do whatever you like my friend, call your specialist, I am leaving for Civil Hospital, I have an elective Caesarian section to do.’
‘I will write that down,’ I quipped, and his final words were ‘You can write anything!’
The lady delivered a normal baby.
Dr Paratian was right about there having been no previous case in Mauritius till then, a fact which I have confirmed with Dr Jugdish Mohith, currently our oldest doctor in the island I think, who had practised in our hospitals from the 1950s and was also Chief Medical Officer and Director of the Mauritius Institute of Health until his retirement a few years ago.
But Dr Paratian was wrong about ‘it’s never going to happen’, because that is always a possibility as the two cases since have shown.
For many years now we have had institutional arrangements with India for the treatment of Mauritian patients with complicated medical conditions, and at considerably lower cost than in the UK or elsewhere. In their wildest of dreams many of our Western Europe-trained doctors may never have imagined that the country whose medical training they would look down upon – through their ignorance – would some day be the preferred destination for treatment of cases belonging to their field! And others too. Supreme irony indeed!
* Published in print edition on 25 January 2019