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

 MAR Title: The Series

 Date of Medical Observation: September 2004

 Narration:

            I never thought my journey on my training to be smooth and straight. Surely, there will be bumps and turns like a road. Even in a highway such as ours, just when you have gained speed a roadblock slows you down, be wary though it might cause you to spill. I found myself in a similar situation the last time I handled the case of I.O., a fifty-five-year old male. It was not only a single turn but multiple turns; still I look at it in a positive way for I have learned a lot. Thank God I was still in control of myself and did not totally lose my way.

            I operated on I.O. for the first time a month ago closing his colostomy for the past eight months after he sustained an apparent colonic injury due to multiple stab wound in the abdomen. Originally I was supposed to assist but the surgeon had an important thing to do hence the assistant became the surgeon. I therefore had to establish rapport, and so informed the relatives. The full procedure and possible complications though were explained post-operatively. A week after, just when I thought I was in the right track when I discovered a wound dehiscence on the previous colostomy site. I had to re-operate, my findings intra-operatively, beside the necrotic tissues on the fascia that might have caused the dehiscence there were also necrotic areas on my bowel anastomosis that caused gallops of heartbeats. Further investigation, we noted anastomotic breakdown but no gross fecal spillage. We decided to do formal laparotomy, adhesiolysis, and resection to freshen out the edges then anastomosis on the involved part of the left colon. We were hopeful. But the journey was not yet over. Less than a week passed, fecal material coming out from the anus thought I’d be glad; but alas! gross fecal material also coming out from previous colostomy site. Here we go again, a colo-cutaneous fistula! For the third time, we operated on the patient. With a gross fecal spillage intra-peritoneally localized at the left quadrant of the abdomen, area of anastomosis due to another breakdown of anastomosis, we decided to do end-colostomy. The options were previously discussed and consent secured. My patient condition gradually improved in the ward and he was eventually discharged after almost a month, alive and with a sigh of relief. However, he had to contend of having a colostomy (he came and went home with it). Despite the turns of events, as we part, he still managed to smile and say “thank you”. I could only reply, “thank GOD”.

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

Establishing a patient’s trust towards the attending physician is a must in any patient-doctor relationship. It does not only build confidence on the part of the physician but creates respect with each other. This is what we called rapport. How I did it? Let me count some ways; when I do my rounds I pay attention to my patients. I just do not talk but also listens, being a doctor you must be good at both. Conversation is better than talking alone. I still do the dirty works even now. Changing a wound dressing is not a big thing but creates a great impression that you really care. Explaining patient condition clearly and giving him the option.

My treatment goals for this patient took sudden turns but I was able to withstand the pressure of explaining through patient management process as each problem arose.

The series of complications that had happened on my patient made me open my eyes as a trainee. With such experience, be humble to accept mistakes, gracious to have learned from it and promise to yourself not to do it again.