Indexing Title: OLEYSON’s Medical Anecdotal Report [04-3]

MAR Title: Lucky!

Date of Medical Observation:  June 1, 2004

Narration:

 A one year old female was referred to Surgery department for Closed Tube Thoracostomy insertion a month ago by Pediatric department with an initial impression of massive pleural effusion on her left lung. Pre-operative diagnosis then was the same with a 90% degree of certainty.  Thoracostomy tube insertion was performed producing a milky white output. The patient was diagnosed to have chylothorax so we decided to refer the patient to the service consultant in charge. Due to lack of facility, consultant advised to have the patient be transferred at Philippine General hospital for immediate operation. However, we learned that there was no vacancy at the PGH to accommodate transfer of the patient a week after. We made several follow ups but still no to avail.

Unfortunately, the patient stayed for a month in the Pediatric ward. Constant monitoring of Closed Tube Thoracostomy was done and daily output was recorded.  On a particular day, we noticed a sudden decreased in output on the CTT bottle then her chest x-ray showed expanded lungs and has no signs of chylothorax!  The patient unintentionally removed the CTT but to our surprise, there was no adverse effect on her.  We immediately informed our service consultant of the development of the patient.  He dropped by and checked the patient after which, he still advised us to effect the transfer to another hospital to prevent high mortality and morbidity rate if the chylothorax recurs.

Insights (Discovery, Stimulus, Reinforcement)

Sometimes no matter how good our argument is, there are patients who respond differently to our expectations, as we seek greater understanding of the disease.  We must know and accept the boundaries and limitations of our knowledge and learn that some good things happens when least the unexpected.