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

MAR Title: “Surgical Surprises”

 Date of Observation: April 2004

Narration:

            It was just another ordinary duty day when I was called upon to operate on a 32-year-old male presenting with classical signs and symptoms of Acute Appendicitis. Having done quite a number of appendectomies in the past, I was pretty confident on how I would go about the procedure, thinking I had adequate knowledge about the case based on my readings and experiences.

 At the Operating Room, the procedure started uneventfully.  Everything was well until I had completely opened up the abdomen.  Instead of a pathologic appendix, what lay in front of me was a ruptured cecal diverticulitis plastered with omentum.  For a short moment, I was in a state of panic.  It felt like the rest of the world has left me for a second.  I tried to focus, recalling everything I know as a young surgeon-in-training.  But it was difficult, having failed to psych myself for something other than a mere inflamed appendix.  There I was, trapped in my own quicksand.  Recovering, I did the next best thing.  I referred to my senior who came to my rescue, allowing me to get back to track. Step by step, he discussed with me the pathology of the disease and the surgical procedure of choice as well as how to deal with such problem. We debrided the perforation and did primary repair. The rest of the operation went on smoothly. At long last, the operation has ended successfully.

Insights (Discovery, Stimulus, Reinforcement):

Discovery:        

            Surgery is just like a football game.  The choice of offensive strategy is based on the kind of defenses you think your team is up against.  But no matter how good the game plan is, no one can really predict how the game will go.  Faced with an unforeseen situation, a good team captain should be able to recreate another game plan from which he shall redirect his team to take the challenge that lies ahead.  In surgery, each new case that you see may require you to take on a management process differently from what you initially contemplated.  It is ideal to be prepared for anything all the time because you can never always predict what you will see on the operating room table. The beauty of this discipline is not merely perfecting your operative skills, but more importantly skewed on surgical decision making. Unlike in other specialty in which treatment plan is “de kahon”.

Reinforcement:

            Unpredictability sets Surgery apart from other medical disciplines.  It never runs out of surprises.  What best prepares you for this is not limiting yourself to just one game plan.  This should not be difficult given you know an adequate amount about your field and given you got the skills to complement your knowledge.  You should never be contented with what you know and what you can do even if you think you have learned enough from reading and practice.  There should be a never ending quest for knowledge.  It is also wise to continually challenge yourself in perfecting your skills as you go on.  With the right attitude, excellence and competence in your craft, perfection can be achieved over time.