In my 35 odd years of practice I have treated many cases of stabbing and they seem to follow a certain pattern. I categorize stabbing into two types.
1. The stabber wishes to frighten the victim and not kill him.
2. The stabber has full intentions of finishing off his victim and makes sure he delivers a mortal blow.
Way back in 1985 I was working in a Mission Hospital and a patient presented in the out patient department with a painful swelling in the right gluteal region. 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 fisticuff, he was getting the better of the situation 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 and my patient decided to beat a hasty retreat, following the old adage, “He who fights and runs away lives to fight another day!” His opponent was chasing him and managed to stick the gupti into his right buttock before giving up the chase. He had a small puncture wound on his buttock which was sutured by a neighborhood GP. The next day he had pain which radiating down on the back of the 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. 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 of 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. The surgeon was freshly passed and enthusiastic. He planned exploring and staunching the bleed. We posted the case for surgery made an incision along the iliac crest and divided gluteal muscles. We then encountered whole lot of clots which when cleared we encountered torrential bleeding. 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. 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 and tied, though it was far from an easy job. In the end the patient survived to tell and retell the tale with two surgical scars, one on his posterior and the other anterior. 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. 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 a mass casualty comes then 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 coincidentally was a Sister. A nursing staff in the hospital. When it came to tying the knot, the microbiology technician backed out. The Sister attempted suicide unsuccessfully by overdosing with Diazepam. 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 there where onlookers who immediately brought him to the casualty which just a stones throw away. Since it was morning most residents and consultants were available as they were conducting their morning rounds. The heart had got punctured the patient had bled profusely internally and was in shock. 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. He identified the puncture in the ventricle and took a single stitch with catgut on the puncture. This stopped the bleeding and gave us all a breather. The patient was then shifted to the operation 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 obviously absconding 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 as an ECG technician of course not assassin, in a corporate hospital in Delhi.
This attacker had all the intentions of killing the victim with such a surgical stab.
Fast forward again to 2011, my mother established a residential charitable school for the rehabilitation of street children. There
were two brothers studying there whose father was a professional burglar. The mother of the boys came to my mother seeking protection against domestic violence. My mother feeling sorry for her allowed her to stay in our house. Suddenly we noticed things beginning to dissappear 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 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 was hissing like an animal and had blood shot eyes. 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 which I sutured 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 which it definitely did. 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.