Indexing Title: RCHAN’s Medical Anectodal Report [04-8]

MAR Title: Blood Compact

Date of Medical Observation: June 2000

Narration:

            Like most medical anecdotal reports, mine was set at the emergency room. After all,you can spend a few minutes there just looking at an x-ray plate of a patient with an injured foot and VOILA! An anecdote would just come into play while doing so. So anyway, it was on one of those tumultuous tours of duty when patients just keep pouring in and out of the emergency room in streams, flocks of fives, groups of tens and the least would be handcuffed by twos. Being a first year resident back then, you could just curse these people under your breath, but as they say “PATIENCE IS A VIRTUE…” so you gotta do what you gotta do.  As I was stamping my trodat on a pile of medical certificates, rushing into the emergency room was a man probably in his forties carrying what looked like a boy in his teens with his shirt drenched in blood. The man kept on shouting, “DIYOS KO PO, TULUNGAN NYO AKO NABARIL ANG ANAK KO!”  We then brought the patient to the Trauma-ER and attended to him.

            The young man, who we later learned was only sixteen, was apparently standing in front of their house when he was hit by a stray bullet. He had a gunshot wound on the left upper quadrant with no point of exit. He came in pale with cold clammy extremities. He had a blood pressure of 60/40 and was tachycardic at 110. We did initial resuscitative measures and brought the patient at once to the operating room.

As we were riding the elevator on our way up, the patient’s distraught father in between sobs then told us, “DOC KAYO NA PO BAHALA SA ANAK KO PERO KAHIT ANO PA PO ANG MANGYARI, DI KO PO PASASALINAN NG DUGO ANG ANAK KO. SAKSI PO KAMI NI JEHOVAH…” For a minute there, I pinched myself believing I was just half-awake and half-asleep and what the father said was just a waking dream. I asked him what he had told me was true. He gave me a nod and lowered his eyes in despair. We tried to convince him otherwise but to no avail. We could not do anything but to let him sign a waiver stating his stand against transfusing any form of blood or blood products to his son and that the doctors and the hospital will not be held liable for the outcome of his decision.

We opened up the patient and found a liter of hemoperitoneum. He had multiple colonic perforations and a lacerated left kidney.  During the course of his operation no blood was transfused. Crystalloids and dextran were the only sources of volume replacement in the patient. He was practically bleeding intravenous fluids! We made do with what was available and concluded the operation. The patient lost 4 liters of blood. He was as pale as paper when we brought him to the recovery room.

We called the father and talked to him about what we saw intraoperatively. We again stressed the need for replacement of the blood loss but again, we were turned down. With tears in his eyes the father told us, “Ganyan po talaga doc e. Tanggap ko na po na mawawala na ang anak ko. Sana po maintindihan nyo ang kalagayan namin. Ibinibigay ko na po sya sa Diyos Ama.”

His son expired soon after that.

INSIGHTS: (DISCOVERY, stimulus, REINFORCEMENT) (physical, PSYCHOSOCIAL, ETHICAL)

            As physicians, we try our best to save lives. We exert every effort to exhaust all means in treating our patients. But then there are situations that we are brought in the middle of our crossroads, where our decisions are matters of life and death, where our backs are put against the wall. Take a simple case of a lacerated wound that a patient would not want sutured. We would advise the patient against it but once he confirms his stand, we would dare not argue anymore, unless the wound is bleeding significantly. We would let him sign a waiver that we will not be held responsible for whatever happens to him in choosing not to be sutured. What more in this case? Where a patient’s faith is prioritized over resuscitating the patient? It doesn’t hurt not to try to convince the patient or the relatives to bend their rules or traditions once in a while to give way to what is more appropriate for the patient’s well-being. If they insist on what they decided upon, then we should always respect it. And to prevent any medico legal suit, we should make sure everything is clarified and discussed and the consequences or complications are presented. They should be written on paper and duly signed by the relatives. It should contain assurance that the doctors and the hospital will not be held liable for the outcome of their decisions,