Indexing Title: CLEYSONs Medical Anecdotal Report [04-4]

MAR Title:  It‘s all in GOD’s time

Date of Medical Observation: May 2002

 Narration:                               

On one fine evening, I received a telephone call from a doctor from another hospital institution. He was transferring a 65-years-old male, a Manila resident, with an impression of Fournier’s gangrene. I referred the case to my senior resident and he permitted the transfer. I told the doctor that the transfer has been approved and I asked him some pertinent data about the patient.

When the said patient was wheeled in, a foul, overpowering odor swept through the room. The information that I gathered from the physician was an underestimation of what the patient was.  He has the picture of a very sick patient. On doing the physical examination, we noted a blackish discoloration running from his anal area up to his left scrotal area. On further assessment, I found out that the patient has an obstructing annular rectal mass, about three centimeter from the anal verge, in which the referring doctor failed to emphasize.  We optimized the patient’s condition and directed him to the operating room to undergo colostomy and debridement.

At the operating room, we did the colostomy first and noted that the carcinoma was filling up the pelvic area. After which, we prepared for the debridement. I thought it was just like any other debridement but my young mind was wrong. On my first incision, the smell around the room became more pungent and a pasty, grainy, blackish material came out of the incision. It has a perfect representation of the residue seen at bottom of the canals around the squatter’s area. As we go along our operation we noted that the substance spreads through the subcutaneous tissues from his genital area, to his thighs and buttocks.  When we decided to stop and I saw what was left of the patient, I thought that he would not live long…But he survived a full course of chemotherapy as well as full course radiotherapy. 

And he breathed his last breath last April of this year!    

Insights (discovery, stimulus, REINFORCEMENT)

A complete physical examination is the doctors’ best aid in the diagnosis of a certain disease. We should not forget to perform simple assessment just like the digital rectal exam, for it maybe the only key to the mystery of the disease.

As a surgeon we have seen a lot of patients at the edge of their existence. We sometimes estimate the period on how much further a patient will live. We sometimes utter the words -- “He will not live long!” Malapit na siyang kunin ni lord!.

But this patient bestows clarity to my mind and my heart, that I have no right to estimate how long he will live his life, and that there is really one greater being, a higher power that holds and control our lives. And He and only He have the right to say “My son, it is time, come with me!”