Index Title: RROQUE’s Medical anecdotal Report [04-4]

MAR Title: My “Eureka Bombshell”

Date of Medical Observation: June 16, 2004

Narration:

            I was doing an exploratory laparotomy on a 76-year-old female who had recurrent periods of anorectal bleeding. Patient underwent flexible colonoscopy which revealed a rectal mass about 7-8 centimeters from the anal verge. A biopsy was done and revealed adenocarcinoma. Patient was admitted. With a good preoperative preparation, patient was scheduled for low anterior resection.

            With the plan in mind, I went through the anterior abdominal wall thru a midline incision. I surveyed both lobes of the liver, went down to the para-aortic region and scrutinized the surroundings. I inspected the colon only to find—a bombshell—I found NO MASS! Blood rushed to my face. I saw a flare which flooded the whole room and my heartbeat scuttled into a demolishing halt. “Is this the right patient?” I felt numb with my right hand grappled around the rectosigmoid area. I was conscious without senses but felt a chilly mist ran down my spine. With that instant moment I recognized I was wrong, I have committed an unforgivable mistake. I did not perform my own digital rectal examination—“My Eureka”

            Honestly, I vowed that this will be my last bombed Nagasaki. Forever I will imbibe the bounty harvest of my mistake and rise up from the blunder I have committed.

Insights (Discovery, stimulus, reinforcement):

 Reinforcement

            Spend time and perform my own physical examination despite the available medical and clinical information. Establish my clinical diagnosis and ascertain what is necessary and vital to my planned operation.  

Stimulus

            Even with years of experience, every case is unique and I must appreciate and discover each exceptional nugget of learning it may provide.