Indexing Title: HTURINGAN’s Medical Anecdotal Report [04-7]

MAR Title:  One that hits home

 Date of Medical Observation: September 15, 2002

 Narration:

 I was on the last days of my vacation leave and decided to go with my mom and dad to Philamlife United Nations.  My dad was supposed to get something from the home office and while waiting my mom and I went to shop and eat an early lunch.  When we got back my dad was already waiting for us.  We were about to go when my dad said he left some papers on the top floor, my mom then volunteered to get it for him.  She took a long time so my dad decided to run after her, they had just missed each other.  When my dad got back he was panting from exhaustion.  As we were driving out of the building, he stopped the car and said his chest was about to explode and he is going to die, as we were just in front of Manila Doctors  we asked the security guard  for assistance, he was brought to the emergency room.  I followed after locking the car.

 I recognized the E.R. consultant and some of the nurses greeted me since I took my internship there.  My dad said he felt better, I told him to relax.  The consultant pulled me aside and said he had myocardial infarction.  I told him I assumed that after glancing over the cardiac monitor.  Then he said “you don’t understand it was a massive wall MI, prime your mother, I’m so sorry.”  My mind was whirling, my head was denying the information given to me.  Then he arrested, a code was sounded and he was intubated, and after a few minutes of resuscitation he regained consciousness.  I glanced at my mom in one corner, she was stoic, I guessed she too was denying what she is seeing in front of her.  I called my sister and brother, and told them of our father’s condition.  It was hard for them to take in the gravity of his condition.  He had 2 more arrests at the E.R. and every time he was able to regain consciousness.  He was admitted to the ICU.  There my sister asked a stupid question, “when dad gets home will he still be able to work?”  I said he is not coming home with us, he is dying.  He asked for me, wanting to tell me something, I gave him a paper and he wrote something about the office.  I told him not to worry about anything and try to sleep. 

 After more than 24 hours of vigil I noticed he had no urine output I informed the nurse to inform the IM resident his bladder was already distended and when I checked, the catheter was inflated at the urethra, I took it out and asked for the IM resident once again.  When she came she reprimanded me and said I shouldn’t have taken it out.  She couldn’t insert it.  She called the chief resident of surgery to do the insertion whom I recognized as my former 2nd year resident.  I told him that probably my dad had a stricture from his previous TURPs and acute constriction from the false insertion, still he tried several foley catheters I saw my dad was in pain and I suggested that he do a suprapubic cystostomy just to decompress the bladder.  My suggestion fell on deaf ears, he too said I shouldn’t have removed the foley in the first place, I was exasperated but for my father I tried to hold my temper.  Eventually in the morning the Urosurgeon came, he was surprised to see me and told me why wait in the morning to do a suprapubic.  Before I could speak out the chief resident commented that he actually suggested that.  I couldn't believe it he was lying upfront.  When my senior residents came to visit, I broke down, I told them I felt so useless, I couldn’t help him.  On the third day I told my mom I’ll go home for awhile to take a bath, on the way home I got a call that he arrested again, we went straight back.  When I got to him they were resuscitating for more than 30 minutes.  I saw the faces of the residents and interns, detached, indifferent, bored, wondering why the resuscitation is taking so long.  Finally I told them to stop and said my last goodbye.

 Insights (physical , PSYCOSOCIAL, ethical) ,Discovery, Stimulus, REINFORCEMENT:

It was the hardest MAR I’ve ever done to relive the most painful moment in my life.  To this day I tried to block the events surrounding my father’s death.  It is too raw even now.  I had become a patient’s daughter, not a doctor, not a surgeon.  Feeling the irony of being able to save so many lives except the life of the person I wanted to save the most.  I remember his eyes looking at me, with complete trust on her daughter the doctor, when all I wanted to say was I would have traded places with you if I could but I can’t save you.

 Being on someone else’s shoe made me aware of the mundane things some of us in the field of healing take for granted, how some couldn’t be bothered when a patient’s relative complains about something in the middle of the night, or the decorum one has to assume when answering a code.   How a relative might feel when they are about to lose a loved one and everyone else around them doesn’t seem to care.  How we sometimes take the defensive attitude when confronted.  These are some of the small things I took to heart as I continue my endless learning that medicine sometimes can take the form of a finely woven tapestry, intricate and fragile. I learned never to down play the emotions of others because what seems a common occurrence to you is real and tangible for them, and someday what they went through might hit close to home for you as well.