Indexing Title: JMDEGUZMAN’s Medical Anecdotal Report [04-8]

 MAR Title: Coincidence

 Date of Medical Observation: October 2004

 Narration:

           A young man in his early twenties was brought in by friends. Fifteen minutes ago he was with them happily drinking in a birthday party. He just turned 25. By sudden turn of events, he was apparently stabbed by an acquaintance for some reason or the other. He sustained a 2.5cm stab wound on the posterior axillary line, level of 3rd intercostal space on the left. The stab site was still actively bleeding.

Patient was stuporous caused maybe by too much alcohol intake? But his vital signs pointed otherwise; a much worse scenario. He was hypotensive, tachycardic, and has shallow, gasping breathing. Immediately a primary survey was instituted following the ABC’s of trauma. We checked his airway, assessed the breathing and circulation, looked for deficits, and explore other parts swiftly.

Simultaneously, we went into action for it is our inherent duty to value life and will always try our best to save one. With all the help I could get, me and my team inserted endotracheal tube to assist the patient in his breathing, packed the stab site, put two large bore intravenous lines, and placed thoracostomy tube on left thorax.

That was non-stop action and it did not end there. The closed tube thoracostomy output told more, a continuous active flow of more than a liter of blood was noted associated with a deteriorating condition, alarmed us.

Final decision: patient needed to be opened and must control whatever was bleeding inside. I talked to the relatives about the patient condition and the plan, we do not have the best of chance but it’s the most that we could do, they conceded. Patient was brought to the operating room as fast as we could.

Just as soon as we had opened the left thorax, he went into arrest. After evacuating 2.5 to 3 liters of hemothorax and noted an active bleeding on upper lobe of left lung, we clamped the left hilum and we did an intrathoracic cardiac massage.

But despite everything he succumbed to death due to transected left pulmonary vessels and bronchus right on the table. The hardest part was, informing the relatives that patient died on the day of his birthday.

Insights (Discovery, Stimulus, Reinforcements) (Physical, Psychosocial, Ethical)

Life in the emergency room is full of action, suspense, drama, and sometimes comes in a package. I had the chance to be in this situation and the experience overwhelmed me. Given the option I will not like to be put in the same position again. But do we really have the choice?

Instead of avoiding what we can not avoid, it is better to be prepared. Keep always in mind the ABC’s of emergency and trauma. Decision-making plays a big difference it either makes or breaks. Know when to seek help.

And equally important, be wary of the relatives or somebody concerned and find time to talk. Even a short conversation matters and they will surely appreciate it. I know it is kind of hard for a surgeon coming out in the operating room to tell the relatives “sorry, that’s the best that we can do” but I had to do it.

With that, I invoke the prayer of St. Francis, “grant that I may not so much seek to be consoled as to console”.