Index Title: RROQUE’s Medical anecdotal Report [04-6]

MAR Title: “Time to refer”

Date of Observation: September 4, 2004

Narration:

Two surgeries, one after another was the experience of L.C. a 25-year-old male who underwent Explor laparotomy for suspected perforated gastric ulcer. History has it; he underwent gastrojejunostomy for a duodenal mass which intra-operatively was an enlarged lymph node. He came back months after, when he suffered severe abdominal pain with generalized tenderness. The second operation was done for a perforated viscus from a marginal ulcer, to which a debridement of the perforation site and primary repair with omental patching was done. Patient was discharged and surprisingly, his grimacing face was yet again obvious, in his third visit at the Emergency Room.  He endured another hollow viscus perforation. Finally I stopped by his bedside and asked myself sympathetically “What is the problem of this patient?” “Was the past two surgeries not enough for him?” I called M.G. the consultant in charge and relayed to him my findings and my own diagnosis. I prepared the patient for the third operation and only to find another perforated marginal ulcer about 2 centimeters from the previous perforation. With the proper supervision of my consultant, the operation went smoothly. The next 5 days, his familiar grimace was gone; instead I saw a radiant, beaming smile I will never forget as long as I would live.

Insights (physical, PSYCHOSOCIAL, ethical) / (Discovery, stimulus, REINFORCEMENT):

 L.C. has helped me realize my own humility. Though I was in no doubt of my diagnosis, my plan and proper surgical execution was imperative. The best evaluator of my maturity in decision making was neither the length of years I spent learning, nor the number of operations I had; but the experience and wisdom my teacher has and will try to follow.

Realization and authentic acceptance of ones’ immaturity is a virtue.

Two operations are enough to shatter my alter ego and humbly admit “I cannot do it myself.”

It was time to refer.