Indexing Title: HTURINGAN’s Medical Anecdotal Report [04-5]

MAR Title: Child’s play

Date of Medical Observation: July 30, 2004

Narration:

I was leisurely eating lunch at the hospital canteen thinking that with a pre-duty status I have no reason to hurry, there were the usual out-patient consults and minor operations in the afternoon, needless to say the activities were set for the day. Until, a junior resident on duty called me on the cell phone and informed me that a 13-year-old boy sustained a gunshot wound on the thigh after playing with a hand-made gun, with absence of distal pulses and complete femoral fracture, the leg was already swollen and discolored.

They have already referred the patient to the vascular consultant and told them to direct the patient to the operating room and prepare for a vascular graft.  According to the resident, the consultant further instructed that I personally do the case since he already thought me how it was done previously. I recalled that when I was a junior resident we prepared a patient for the same procedure but aborted the plan because the vascular transection is amenable to primary repair. And so in essence I only knew how to do it, but have not done one.

I felt I was caught off guard being the type of person who plans the day ahead. I was mentally unprepared. Realizing this, I focused and planned. I needed two teams one to explore the wound and do damage control, while the other team harvests the saphenous vein from the donor extremity. The two teams should act fast to make the operation work. I called the fourth and fifth years on duty and another pre duty fourth year to complete the two teams. I recited the procedure in my head and we anastomosed the femoral artery using the
saphenous vein graft.

We couldn’t stop smiling after seeing the vein dilate and the distal limb of the femoral artery pulsate. We actually did it. We were even able to do reduction and temporary internal fixation of the femoral fracture. We were grinning, with our blood still full of adrenaline, we called it a day.

Insights (Discovery, Stimulus, REINFORCEMENT):

Lesson learned, no matter how structured you have planned your day, there will always be some circumstances that will arise which you have no control over. One must be flexible enough to be able to adapt to the sudden changes and meet the challenges it bestows.

It is heart warming and at the same time disconcerting to have a mentor trust you to do a procedure without supervision. You gain courage because your mentor believes in your capabilities sometimes more than you do.

And lastly, nothing makes you more alive and inspired as seeing what you have done actually work as it should. All exhaustion vanishes into thin air. And with team work no matter how difficult an operation might seem, the load seems lighter and the task becomes just a child’s play.