This is not a particularly nice experience to share. But as a surgeon who faced multiple cases, it becomes imperative to share most of the incidents. This was a case of a young 34 year old man having a rectal cancer all along believing that it was piles.
One day I received a telephone call and the voice said, that he had got admitted to a famous hospital for piles surgery. Since the surgery was postponed for some reason and since he was ready for the surgery, could I operate on him almost immediately? I was kind of perplexed because without knowing what his case history was, I could not commit anything. I asked him to come over.
This young man walked into my cabin the same day. He introduced himself and narrated that he was supposed to get operated that day in the hospital that was famous for Piles surgery in Chennai. Since the surgeon had an emergency call that day, he could not be operated. He had all his reports from that hospital and literally forced me to operate on him. He quoted that he is starving from morning as asked by the surgeon and he is ready to go under the knife the very moment.
I firmly said that I would at least do a physical examination to confirm the reports and then probably talk about surgery. The patient refused to sit down as he said that he had enormous pain and he does not feel comfortable sitting down. Moreover he insisted that he had all investigation done and he had relevant papers for the same. I now had a strong reason that I need to do a physical examination on him and only then talk to him about the surgery. He agreed.
I strongly believe that Surgeons have the duty to touch the patients in all good earnest to get a first-hand experience of what the ailment is all about. The pattern of touch near the reported area and the pattern of pain manifesting as a result of the touch is one of the golden rule in diagnosis. In this case, I had to put my gloves on and put my fingers inside the patient’s anal region to get a feel of what the piles condition is like, called Digital Rectal Examination in medical terms. To my dismay I found a sizeable rectal mass inside. I suspected a tumor and I asked him to do a biopsy. I refused to do a piles and instead advised him only a biopsy.
The biopsy report confirmed my worst fear. Yes, the young man suffered from rectal cancer. The further worst part was he was in his advanced, stage-4 level of cancer and the cancer cells have migrated to the bone tissues. Sadly, the patient just lived for two more years.
My Requests – If you have a bleeding rectum along with pain and it has manifested suddenly without you having suffered constipation, the probability can be of rectal cancer. Do not conclude that it can be only piles or fissures yourself. Either way, it is always better to consult a gastro surgeon to rule out all possibilities. Early detection can help you get better treatment.
On the part of surgeons, they should put their fingers inside the anal passage to understand the nature of ailments. I would like to remind a quote from a famous book, “Bailey and Love” which says – “If you don’t put your finger, put your foot”. I sincerely hope am being listened to.
