In my 35 odd years of practice as a surgeon, I have treated many cases of stabbing. I have observed a distinct pattern in these cases. Which could be categorized into two types.
1. The intention of the stabber is only to frighten the victim and not kill him.
2. The stabber intents are homicidal and he makes sure that he delivers a potentially mortal blow.
Rewind to 1985, I was working in a Mission Hospital as a junior doctor. Wet behind the ear plain MBBS. A patient presented in the out patient department with a painful swelling in the right buttock. His story was that on Holi day (when most people are inebriated or stoned or both) he got into an altercation with a stranger. This progressed into a fisticuffs. He was getting the upper hand until the opponent pulled out an equalizer, a gupti. A gupti is a traditional Indian dagger, it has a long and slender blade which tapers to a sharp point. It’s akin to the Italian stiletto and it is normally carried in a wooden sheath disguising it as a swagger stick or a walking stick. Now the tables were turned in favor of the opponent and my patient decided to beat a hasty retreat. Perhaps recalling the old adage, “He who fights and runs away lives to fight another day!” His opponent chased him and managed to stick a length of the gupti into the victim’s retreating left buttock before giving up the chase. The only obvious external injury was a small puncture wound on his left buttock. This was sutured by a friendly neighborhood general practitioner. The next day he had pain which radiating down on the back of the left leg and also a swelling around the sutured area which was growing in size. When the pain became intolerable he decided to visit the Mission Hospital for a second opinion.
Now at that time I was a mere MBBS with limited experience, I showed the case to the Surgeon. He noticed that the swelling was pulsating and on listening with his stethoscope over the swelling he could hear the sound of turbulent flow of blood which is called a bruit. The diagnosis was a pseudo aneurysm as a result bleeding in the depth of the buttock from a punctured large blood vessel. An aneurysm is an abnormal dilatation of a blood vessel, whereas a pseudo aneurysm mimics an aneurysm, but it’s as a result of injury to the wall of a vessel. Blood flows out into the surrounding tissue and creates a false dilation of the vessel. In retrospect I have to doff my hat off for the surgeon for being observant and making an accurate diagnosis, in absence of any diagnostic tools. Those were the days when an x-ray was the only diagnostic tool. The case could have been misdiagnosed as an abcess as a result of infection from the puncture wound. In which case the treatment is an incision and drainage. Incising over the pseudo aneurysm would have resulted in a torrential haemorrhage and even death due to exsanguination. The surgeon had recently completed his degree and was enthusiastic. He planned exploring and staunching the bleed.
The case was posted for surgery. An incision along the iliac crest or the border of the bone shaping the buttock and divided gluteal muscles or the muscles comprising the buttock. A whole lot of clots were encountered which were cleared. Then torrential bleeding from a blood vessel lying deep to the bone was encountered. The gupti had managed to pierce the three gluteal muscles in the inner and inferior quadrant and injured a vessel emerging from the sciatic notch, a recess in the pelvic bone through which blood vessels and nerves emerge. Try as we could but we were unable to catch the bleeder as it retracted behind the sciatic notch. Meanwhile the patient went into shock due to loss of blood. The assistance of a senior surgeon was sought, the senior decided to approach the bleed from the abdomen. So the gluteal region was packed and the patient repositioned and the lower abdomen opened. There the bleeder was caught just near the sciatic nerve, a main motor nerve supplying the leg and tied. It was far from an easy job but in the end the patient survived to fight another day with two surgical scars, one on his buttock and the other on his abdomen. He also had a foot drop, or a weakness in the foot due to some fibres of the sciatic nerve getting caught in the ligature. A small price to pay. Quoting Bailey and Love, “A living problem is better than a dead cert.”
Looking back it doesn’t seem like the attacker intended to kill the victim, he chose a well padded area which in most circumstances would have required nothing more then stitches and maximum hit the iliac bone. However he struck just a little lower and that made the difference.
Fast forward to 15th August 1990, when I was doing my MS in Ludhiana. We had just finished our ward rounds and were enjoying a post round chai and charcha in the tea shop on the campus. Then suddenly all the hell broke loose! All the surgical residents, super speciality residents and consultants were paged to the casualty. This is normally happens when there is a mass casualty, where everyone is paged. When we reached the casualty we discovered it was a ‘Tale of two Technicians’. One technician was a microbiology technician and the other an ECG technician. The microbiology technician was going around with the ECG technician’s sister who was a nursing staff in the hospital. But when it came to tying the knot, the microbiology technician backed out. The sister attempted suicide unsuccessfully by overdosing with diazepam, a sleeping pill. Only to wake up after a prolonged sleep into this world. The ECG technician swore vengeance and chose today as both were on call. He accosted the microbiology technician in the hospital corridor and some verbal altercation took place. Then he produced a knife and stabbed him only once but accurately just below the left nipple at the 4th inter costal space. Being an ECG technician he was aware that the apex of heart was at that point. More accurately the left ventricle of the heart which pumps the blood through the body. Luckily for the microbiology technician it happened in the hospital premises and there were onlookers who immediately brought him to the casualty, which was just a stones throw away. And since it was morning most residents and consultants were available as they were conducting their morning rounds. Providentially the Professor of Cardiothoracic Surgery was there in the casualty. He immediately took a scalpel made an incision through the left 4th intercostal space, ask two of us to retract the ribs while he sucked out all the blood and clots. The lung collapsed and after sucking the blood the heart could be seen spurting blood. He took a single stitch with catgut on the puncture and controlled the bleeding. This gave us all a breather and we rushed the patient to the operative theatre for definitive surgery.
A week and 22 blood transfusions later the patient was back on his feet, being literally snatched from the jaws of death. The ECG technician was absconding and when the law finally caught up with him he was let out on bail as the case was of a grievous injury and not homicide. Last heard he was plying his trade in a corporate hospital in Delhi. As an ECG technician of course and not an assassin.
This attacker had all the intentions of killing the victim with a stab of such surgical precision. But it was not his time!
Fast forward again to 2011, my mother had established a residential charitable school for the rehabilitation of street children. There were two brothers studying there whose father was a professional burglar. He was also physically abusive to his wife. The wife appealed to my mother to protect her against the violence. My mother feeling sorry for her allowed her to stay in our house. All of a sudden we noticed things beginning to disappear from the house. The pump of the dessert cooler and other small things around the house. The husband would also intermittently appear at our gate and would meet his wife. She would refuse to return with him.
We have an old chowkidar or watchman, he has been with us for many years and functions more as a scarecrow rather than a serious deterrent. But as a person he is a good so we forgive the times he comes drunk. Life is difficult for these people after all they hold two jobs one in the day time as a construction worker and night as a watchman. He is also very fond of animals so our Labrador was always at his side. He used to feed all the strays in the locality so they were hanging around the gate. There was a stray dog couple who he was very fond of and even named them Maruti and Madhuri. They were inseparable one brown and the other black. They could be seen constantly playing with each other. People say that watchmen feed the strays so that they bark and warn them about intrusions.
One July evening at around 9 pm I heard a ruckus at the gate and I stepped out into the verandah to investigate. I was horrified to see our chowkidar getting mercilessly stabbed by the lady’s husband. To escape from the assailant the chowkidar ran to the lawn in front of the the verandah. The assailant chased him. I could not remain a mute spectator and I did a very dangerous thing, I vaulted over the railing of the verandah and landed in between the two. He could have very easily stabbed me but he didn’t, he backed off. Trying to reason as to why I got spared, maybe because of my superior size or because of my superior placement in life. He presumed he could get away by stabbing a humble chowkidar but stabbing me may have had larger repercussions. So he ran to the back of the house and tried to escape by climbing the tree at the back. I followed him to the back and also tried to search for a suitable weapon, even a stick would do. I appreciate the chowkidar who also came behind me and backed me up despite being injured. The husband after climbing the tree discovered it’s a long jump over the wall and descended, he had his head shaven and a bandana tied on his head. He was hissing like an animal and had blood shot eyes, possibly stoned. I wisely decided to give him space to run out from the gate rather than trying to tackle him. Now I could concentrate on the Chowkidar’s injuries, surprisingly they were only slashes around the neck. I took him to one of the hospitals I am attached and sutured them under local anaesthesia. We then went to the Police station and filed an FIR. The police caught the husband and incarcerated him for a day or two then let him go. The stabbing was intended to scare us and it had it’s intended effect. We decided it was wise to tell the lady to return to her village. Her sons finished school and the school helped the younger boy get trained as an AC technician. He is employed and earning and his mother lives with him. Recently he had kidney stones and I arranged his surgery. As for the father they don’t where he is, he could be dead. The Chowkidar is still with us and immediately after this incident I could hear him scolding the dogs for not coming to his aid or barking and remaining mute spectators.
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