Maj Gen Prof HR Harun (LPR)
MBBS (Dha), FCPS (Bd), FRCS (G lasg.), FRCS (Edin.)
Diploma in Urology (London),WHO Fellow
(Urology)
Principal & Head Dept. of Urology
Holy Family Red Crescent Medical
College
Former-Consultant Surgeon General
& Chief Urologist
Bangladesh Armed Forces
Recipient
of Asir Memorial Gold Medal-2015
Recipient
of Idris Lasker Gold Medal-2019
Critical Surgery & Surgeon’s Life
Finding work-life balance is a key issue in most of our lives.
It is particularly difficult but not impossible when you choose medicine as your career path. I decided to become a
surgeon early on in my life because it appealed to me more than any other
specialty. Surgery continues to evolve and shape the way we think about life
and death. It is a profession that is full of risks and challenges, but
nonetheless humble rewards. Each case is a living book that teaches you the
good and bad of life, and induces you to appreciate the unique capacity that
each individual has been endowed with, to help other people. Recently I
operated on one such critical case in Dhaka that left me with profound feelings
in my heart, and so overwhelmed that I was compelled to put this story in
words.
Riad-Al-Hasan, a two-and-a-half-year old boy came as a patient
in my chamber in February 2016. The unfortunate boy, son of a school teacher,
was diagnosed with cancer in both kidneys (Wilms Tumor) in March 2015 (when he
was only one year and four months old). Following biopsy, he was given nine
cycles of chemotherapy according to National Wilims tumor study group, only to
yield poor results. Later he was given ICE chemotherapy till July 2015 but
again without much benefit. On 12 August 2015, his right kidney (with tumor)
was removed (Radical Nephrectomy). Biopsy confirmed the Rhabdoid variety of
Wilms tumor on both his kidneys. From October 2015 to January 2016, he received
VAC & ICE therapy alternately with no improvement in his condition. From
February 2016 till June 2016 he did not receive any other treatment.
Devastated and broken, Riad’s parents moved from door to door of
hospitals for the treatment of his left kidney, but the recommendations were
Radical Nephrectomy Dialysis Transplantation by one group of surgeon and the
other group advised for Nephron-Sparing Surgery but couldn’t proceed as there
was no dialysis facilities in their set up. The parents were shaken at the
advice of such a grave path. Till that point even with a single kidney (with
tumor) Riad maintained normal serum creatinine.
When they came to me for a consultation in February 2016, I
opined that ‘It is an operable case, tumor can be removed preserving the
remaining healthy part of the kidney, - what we call Nephron - Sparing -
Surgery (NSS), of course with risks and challenges”. In the following four
months they checked with multiple hospitals but nobody agreed to do the
surgery.
One day I encountered them in the lift and started fun playing
boxing with the little playful boy in his mother’s lap saying “Dishung –
Dishung” to which he reciprocated with a smile. Since then he named me as the
“Dishung – Dishung Uncle” in his family. His parents later informed me that one
day he asked if he could be operated by his “Dishung – Dishung Uncle”. And
that’s all, the parents came running after me. Despite the complexity of the
surgery, I could not ignore the helplessness of two parents having to watch
their son die on their lap. When they asked me, what I’d do if he were your
grandson, I was left with a loss of words.
I began examining the case in great depth, reviewing all facts
asked for an angiogram, which gave me some courage to proceed. Considering many
legal and medico-legal issues, I discussed the case in a multidisciplinary
medical board and recommendations were - (i) Radical Nephrectomy
Transplantation or (ii) NSS in a specialized centre where facilities for
Paediatric Anaesthetist, Paediatric ICU, Paediatric Nephrologist with dialysis
facilities, and a paediatrician are available, and that the surgery may be
conducted with risk bond, as it is a very high risk patient. Unfortunately we
couldn’t manage such a specialized centre in the private sector.
The parents did not stop pursuing. They begged for their son’s
operation, and one day I gathered all my strength and courage, and decided to
proceed. In the medical profession you may have the highest degree in your
field and all the knowledge in the world, but every time you hold up a scalpel
you know that there is a higher power up there who is the ultimate decider of
life and death. You are only the means through which God’s work is unveiled in
this world. While it is a powerful feeling when you come out of it with a
successful outcome, the uncertainties nonetheless continue to haunt you – Are
you right, or wrong? Can you save the life of the patient? Can you be the reason
for the unbound happiness of two parents today? Or, will you cause the end of a
life, and the death of two parents and their hearts? I was unsure, but I kept
faith and proceeded with full vigor.
I recalled I had dealt with two such cases earlier in Central
Hospital. The first was a one-year-old boy, with Wilms tumor in single kidney
in 1997 and the second case was a Physician, with Renal Cell Carcinoma in
single kidney in 2001, his other kidney was removed in 1983 by another surgeon
for the same disease. Both patients are doing well today. They didn’t require
dialysis. The physician patient is doing so well, even with one major calyx of
his left kidney. These past personal experiences gave me so much courage that I
decided to focus my energies on the brighter side of things. Putting all the
recommendations and medico legal issues on one side and my courage and skill to
the other, I picked Riad’s life over death.
As I thought about these trade-offs, a simple facebook post in a
cartoon form caught my attention and came as a blessing in disguise – The post
showed that a lady was sinking in water and screamed for help. People who
passed by simply took pictures and videos of the scenario with their cell
phone, but nobody came to help. And this is a common phenomenon among road
accidents in Dhaka. How sad is the condition of our conscience where we have
become so animalistic that we watch people’s death with so much apathy! Often
times, such situations resurface in our everyday life but in different forms.
And this case was none other than just another of those forms. It hit me
suddenly that given there was no other option than to let the child die, I must
operate. I gathered up the courage to take the full responsibility of the
child’s life on my shoulder regardless of what is to come. I discussed the case
with my long time surgical assistant, OTA Kamal Mollah, a retired master
warrant officer who has been working with me since 1994. He is highly skilled,
knows his job well from knife to laser, and had assisted me in most of my NSS
cases. He recommended me to go forward with the case and provided me with great
encouragement. I created a team at Central Hospital with Prof Loban (Paediatric
Anaesthetist), Prof Habib (Pediatric Nephrologist), Prof AFM Selim (Pediatrician)
and myself, and scheduled the surgery for 27 June 2016 at 3.00pm.
As a treating surgeon I was tensed, as to what will happen!
Every moment there was a question in front of me, am I right or wrong? Again I
put aside all the medico legal issues and chose life, courage and my skills. At
times I was completely puzzled by the dilemma. But my military mind made sure
to make a balanced judgment, and began my day with the primary commitment of
being a surgeon. In the morning I left home taking blessings from my wife, and
focused my mind on the job that was to be done in the evening.
As the hour approached and the patient was anaesthetized, I
examined the mass again and again and watched for its mobility. We then
explored the left kidney intraperitoneally, noticed the mass sitting on the
upper pole like a “turtle” with its head towards the spleen and legs towards
stomach, close to hilum and vessels. Kidney with mass mobilized carefully and
gently, avoiding pressure on the healthy part of kidney. Major vessels were
dissected separately. Then we examined the structures around and decided to
enucleate gently without clamping vessels.
The whole mass enucleated and gently separated from renal
vessels. Surface bleeding was under control and replaced by 200ml fresh blood
transfusion. During the process of enucleation I used ice cold water in a
saline bag connected to saline tube, flowing on the cut surface with force that
made good surface cooling and haemastasis. My father surgeon Prof. Motiur
Rahman entered the OT to watch the operation and infused my team with great
encouragement. The exposed surface was then covered with gelfoam and
perinephric fat. On the table the patient was haemodynamically stable, his
residual kidney produced adequate urine and eventually he made great recovery
from anaesthesia without any perioperative complications.
I cannot narrate the expression of timeless joy and happiness on
the faces of Riad’s parents and relatives as we informed them the success of
his operation. They looked at the tumor in my hand with tearful eyes and
thanked us for all that we have done. I cannot explain in words how excited I
felt regardless of the tiredness in my heart and body, especially during this
month of Ramadan. After a critical surgery like this I usually prefer a glass
of ice cold fresh lemon juice, but as it was close to Ifter time I drove myself
home (without even changing my OT dress – which is rare!), and joined my wife
and her best friend Dr. Kalpana Deb (who is visiting from the U.S.). May Allah
bless us all. Please pray for Riad. I cannot convey the sheer joy I feel in my
heart for this boy and his family.
Being a surgeon is great, and I would do it all over again if I
had to. Every day I am thankful that I chose this career path. Although it is
very difficult, and involves a great deal of risk and challenges, I take pride
in being able to help people - full-heartedly - and making a small contribution
in improving their lives.
My advice to young doctors considering medicine and surgery as a
career, is that – Always remember that if you love what you do, you won’t see
it as work, but instead fun at the hospital on a daily basis. This career may
not provide you with the “best” lifestyle, but it gives you countless blessings
and love. And a life built on blessings is the one to die for.
Pick wisely, but be happy with your decisions. Everything is
possible to balance in life. People have done it time and again, regardless of
their gender or familial background. Many who have come before you in this field
have found a way to balance their personal life and career (despite the sheer
challenges of this profession) and if they have done it, you can do it too!
And finally, family is extremely important. Your contributions
start from your home. So I always try to carve out time for my wife and
children. They are the integral source of joy and fulfillment in my life. If
you don’t carve out time for your personal life, then the hospital can be all
consuming. And so I live by the mantra “A happy life is a happy wife”, and if
momma is not happy then nobody is happy.
I would
like to express my heartfelt gratitude and thanks to my little mother “Navin
Tanveer Harun” who continually inspired me to go for more critical surgeries
and share with others the critical stories of life. Navin is also working hard
to help put to reality the vision we have for our “Harun Health Foundation”.
Please keep us all in your prayers.
Email: harunuro@yahoo.com
https://www.facebook.com/BdUrologist/Mohaiemen MA, Shahidullah, Ruhal Haque AFM,Harun HR,RHABDOMYO SARCOMA – A
Case Report. BAFMJ. Voll – XI, No. 1; 1986. 76 – 80.
Siraj Jinnat KM, Akbar A, Harun HR, Management of Benign Prostatic Hyperplasia (BPH);
A study of 586 cases. BAFMJ, Vol – XIV, No: 1, 1990. 7 – 12.
Harun HR. Report of 30 cases of Testicular Cancer and Review of Recent Experiences.
Vol – XIV, No: 1, BAFMJ, 1990. 91 – 99.
Akbar A, Harun HR. Fracture Penis – A Case Report, Bangladesh Jr of Urology, Vol – 1,
No: 2, 1990. 47 – 49.
Siraj Jinnat KM, Harun HR, The Primary Aldosteronism – Conn’s Syndrome. BAFMJ, Vol –
X, No: 1, 1985. 9 – 11.
Harun H R. Early Experience of Nephron – Sparing Surgery (NSS), Vol. – XII. No: 2,
Bangladesh Jr of Urology, 2004, 52 – 56.
Amin SR, Akbar A, Harun HR, David BT, Addison’s Disease – A Case Report. BAFMJ, Vol.
- XXXV, June 2005, 85 – 88.
Waneed SMS; Harun HR, Shahid, SI. Arif. C. – BMG URETHROPLASTY : Experience of
104 cases of stricture ur`ethra, Accepted for publication in BAFMG, 2013.
Experience of Surceostal Punetune while managing renal stones by pereutaseons
Nephrolithotomy (PCNL), accepted for published in BAFMJ, 2013
Pattern of patients presenting with pelviureteric Junction obstruction in children : study of
30 cases; Vol – 39, Dec 2007, Maj. Md Abdur Rakib, Maj Gen Md Ali Akbar, Col Hrunur
Rashid, Lt Col Md Shahidul Islam, Maj SM Shameem Waheed.
Renal Cell Carcinoma: Presentation & out of Treatment study of 50 cases, Maj. Md Abdur
Rakib, Maj Gen Md Ali Akbar, Col Hrunur Rashid, Lt Col Md Shahidul Islam, Maj SM
Shameem Waheed, Bangladesh Journal of Urology, Vol – XXX VIII, June 2007, No 1.;
Review article – Holmimum Laser in Urology – a review article; MS Islam, H Rashid, S
Waheed, M A Rakib, C M Ashif, Bangladesh Journal of Urology, Vol – 14, July 2011,No.–2.
