The
Grim Reaper
My First Mortality
Dr. Jeffy Guerra
It was a relatively benign Sunday
duty when I assumed my emergency room post. I had my regular chart and bedside
rounds that particular morning. Three patients were endorsed: two cases of
acute appendicitis and a vehicular accident victim.
At the corner of my eyes, I saw a
fairly young-looking man in his early twenties in agonizing pain. His right leg
had a posterior mold and his right foot was completely soaked in blood. I
immediately went to him and extracted a brief history. The patient related that
his right foot was run over by a garbage truck. He sustained a crushing injury
in the right foot with associated multiple metatarsal fractures, including the
distal third of the right tibia. I unwrapped the
affected limb and to my surprise, the right foot was mangled and barely
anatomically recognizable.
The case was then referred to the
orthopedic consultant via telephone. The initial proposed procedure was to
salvage the limb and to debride and ligate bleeders with plan of foot reconstruction on the
succeeding operation.
I was tasked to do the operation.
Intra-operatively, I noticed that the foot was completely crushed and mangled.
The probability of successful limb salvaging procedure was quite low.
The procedure went on smoothly. I
was able to debride the devitalized tissues and ligate the bleeders. Appropriate postoperative care was
given to the patient.
However, on the second postoperative
day, he had sudden onset of difficulty of breathing and episodes of
hypotension. I was informed that my patient was already undergoing
cardio-respiratory arrest in the ward. Without hesitation, I left my
Out-Patient Department post to attend to him. When I arrived, though, he had
already expired.
I asked myself where I had gone
wrong. I gazed down at my first mortality – a 24-year-old male who could have
been somebody, someone I know. Then I shivered at the thought that suddenly hit
me: that young man could have been me.
As I walked out of the room, I felt
devastated. I could not do anything but utter a prayer.
Insights
Referring a case via telephone
should be like providing front row seats to the persons being consulted. You
should be able to describe the case in such detail that it can actually be visualized
clearly. If referrals by mouth alone cannot conjure the image vividly, it is
wise to take advantage of your available resources, as exemplified by modern
communication gadgets. No information is too minor to leave out for it could be
the missing link towards the success of your contemplated management.
From this experience, I have learned
the importance of relaying information completely. Had this been done, another
treatment plan probably could have been instituted, which in turn could have
made a significant difference in the outcome of the patient.
The Kid with Multiple Gunshot Wounds
Dr. Marlou Padua
I consider last October 2, 2004 as one of the most
adrenaline-rushing moments of my life. My co-residents, interns and clerks were
then busy attending to a number of patients when the sound of a man crying for
help alerted each of us. He was carrying a boy whose clothes were soaked in
blood. We attended immediately to the poor boy, got his vital signs and
resuscitated him at once when his vital signs were not very encouraging.
The patient was a six-year-old male
who was apparently the victim of a shooting incident. It happened 30 minutes
prior to consult when the patient and his parents were having a prayer meeting
inside their home. The parents did not notice their son get up from his place
and walk out the door. As he was walking down the stairs, he was accidentally
shot by a man who was then involved in a gun fight.
He was then brought immediately to Ospital ng Maynila.
His presence at the emergency room was truly unforgettable. The boy’s cry was
even more intense as he said, “Mamatay na ako . . .” He sustained a
total of eight gun shot wounds.
I ordered the boy to be directed to
the operating room and I, together with my team did exploratory laparotomy, ligation of
transected vessels, primary repair of liver laceration, resection anastomosis of jejunum and sigmoid, primary repair of
stomach, jejunum, ileum, sigmoid, urinary bladder injuries, ileocolic
resection, ileostomy-colostomy and drainage of
pancreatic injury.
After nine hours of operation, we
were faced with the critical part of sustaining the patient. At the recovery
room, each and everyone’s effort was evident. Every help that I and my team
could provide was given to the child, just to help him get through the grim
situation he was forced to be in, though we knew at that time that only a
miracle was the only hope for the child’s agony.
After a few hours, the little angel
peacefully lost his battle for life.
Insights
What happened to the kid made me ask
a lot of questions. Why did it happen to him of all
people? What were the kid’s parents doing at the time of the incident? All
these questions clouded my mind. I admit I was so angry at the people who were
responsible for what happened. I blamed the man who shot the kid, as well as
his parents, but I knew that nothing could be reversed at that point. For sure,
no one wanted it to happen.
“Death in the Emergency Room
Dr. Tricia Daughterty
My duty in the emergency started unremarkably. I
thought that fateful day would be one of those uneventful duties I’ve had in
the past.
I guess I opened my mouth too soon.
At around ten o’clock that morning, a man was brought
in on a stretcher, He was immobile and unconscious. The patient was apparently
riding a motorcycle prior to being brought to the hospital. He was wearing a
long sleeved jacket and a helmet.
I and a few medical clerks perfunctorily attended to
the patient, just as we had done many times before. We carefully removed the
helmet and saw that there was an open fracture of the mandible at the right
inferior ramus. The patient’s vital signs were taken;
he had stopped breathing and had no pulse.
The patient was dead upon arrival.
It turned out that the patient was a messenger. He
was riding his motorcycle when two private cars hit his vehicle.
Insights
Death in the ER is so common I have become immune to
it. This time, though, it was different. We had to go through his belongings to
find more about his identity. We soon identified him and learned he had a wife
and daughter, both of whom thought he was still at work and would soon be back.
It was my difficult task of having to inform his wife and daughter about his
death.
Being a doctor means being familiar
with death and its repercussions. Although it is our primary task to preserve
life, we must also know the meaning of respecting life when and where it must
end.
First Death
Dr. Chua
I believe that real medical education begins with
clinical clerkship. Seven years ago, I entered my most awaited rotation at that
time, that of Internal Medicine. I had a twenty-year-old renal failure patient
whom I accompanied to renal dialysis centers regularly.
Soon enough, we developed a relationship that
traversed the usual doctor-patient relationship. I ascribe it to friendship.
During one of his subsequent admissions, he developed
generalized weakness and would then have dyspneic
episodes. He was subsequently admitted to the isolation ward where laboratory
work-ups were done to search for an occult source of infection.
Echocardiography (ECG) done revealed an ultrasonographic picture of fluid beneath and surrounding
his heart. This minimal amount of pericardial effusion, as my readings told me,
would not significantly restrict the pumping action of his heart. The
recommended treatment for this complication was dialysis itself.
Over the next couple of days, the patient’s condition
worsened in spite of medications being given. As the one in charge of regularly
monitoring the patient, I detected an interesting aberration: the sounds during
blood pressure measurement would appear and disappear with each breathing cycle
of the patient. I also noticed that the patient had pulsus
paradoxus, his radial pulses would vary depending on
the phase of his respiration. I asked a colleague to verify this unusual
finding and reported it to the resident-in-charge of the patient who casually
brushed it aside.
Eventually, the patient was brought to the
in-hospital dialysis unit for treatment. In the middle of the procedure, his
breathing became labored, he became delirious and
eventually combative. I tried to ring for an emergency code, bringing most of
the medical staff to the cramped unit. Portable chest x-ray was done and
supportive medications were given.
The patient never left the dialysis alive.
I remember crying in my sleep, for being unable to
save my patient, for not recognizing the importance of my physical findings and
for a lifetime of experiences forever lost by someone so young.
Insignts
Actual learning starts with patient exposure during
clerkship.
Decreased blood pressure and weak
pulse from pooling of blood inside the veins of thorax during inspiration
signifies compression or tamponade of the heart, usually by fluid in the pericardial
sac.
Pear or flask-shaped heart on chest
x-ray signifies a significant amount of fluid accumulated in the pericardial
sac.
That this amount of pericardial
fluid should be treated with pericardiocentesis
The Great Equalizer
Dr. Maria Cecille Leyson
This is the case of a 49-year-old female who was
diagnosed to have breast cancer, left, stage III-B, s/p modified radical
mastectomy.
This patient is not your typical female: dainty,
submissive and weak. She is what, in layman’s terms, a “dyke” or a “lesbian.”
Weighing around 90 kilos, sporting a hair cut more suitable for military
training, she could be mistaken for a man at first glance.
The first time I met her, she seemed to display an
easygoing nature, with a sunny disposition and a formidable but likeable
character. Perhaps it was because of her appearance. There was a masculine air
about her, expressed by the way she looked and the manner with which she
carried herself. She struck me as someone very strong, someone who will face
difficulties in life head on without yielding or falling.
When we first told her about her condition, she was a
little taken aback but a few minutes after, she managed to regain her
composure. She was very keen and asked pertinent questions regarding her
condition. She was very worried about the materials to be used for her
operation. She even joked around while she was lying on the operating table,
prior to being anesthetized for the surgery.
Perhaps this was her way of coping with stress.
It was after her operation that I noticed a very
apparent change in her demeanor. From the start, I have been convinced that she
was a very strong person, far stronger than what was expected of her gender.
But all these opinions of her changed post-operatively. In such a short span of
time, she took a 180° character turn.
It was as if all the fears and apprehensions she had
all along buried beneath a façade of strength and happiness were unwittingly
uncovered.
Insights
Through this patient, I became more
cognizant about the impact of impending death on people. Faced with many
uncertainties about the future, we tend to forget ourselves and indulge on the
emotions that threaten to drown us. We lose our masks in the face of danger. We
become vulnerable to fear of the unknown.
It is through this patient that I
realize once more that despite different guises and appearances, all of us
exhibit similar characters when faced with death. It is really true that death
is the great equalizer.
Being A Surgeon and a
Mother
Dr. Rubi Ann Claire Chan
It was one of those typical mornings as a Surgery
resident when I got to the hospital that day. Lying on Trauma bed 7 was a child
whom at first glance was toxic-looking, weak, dehydrated, pale, tachypneic and very familiar. I went inside the quarters to
put down my bags and went to the emergency room to do my rounds. I immediately
approached the child and found out that it was my very own patient.
He was a one-year-old male who had an imperforate
anus. I did a transverse loop colostomy on him a year ago. He came in septic at
the time, with a five-day undetected imperforate anus. We did not expect him to
go through the operation smoothly. Had he survived the operation,
post-operative care would surely be challenging. I diligently took care of the
fragile human being, making sure he had a good fighting chance to survive.
Despite my fears of the patient not being able to make it, I made every effort
to give some reassurance and support to his parents. At the back of my mind, I
saw him as my very own son and how I would feel had he been in the patient’s
place.
Eventually, after two weeks, the
patient was discharged. On several occasions, I chanced upon him the same
patient at the Pediatrics ward. He came in and out of the hospital due to
either bronchial asthma in acute exacerbation or community acquired pneumonia.
Despite their son’s condition, his parents still managed to smile and greet me
whenever they saw me. In their eyes, though, I saw how drained they were,
physically, mentally, emotionally.
On that fateful day, the patient was
not brought to the hospital for asthma or pneumonia. He had incarcerated
hernia. He was booked for an emergency herniotomy.
While we were hydrating the patient, he went into respiratory distress. He had
another exacerbation. We optimized his condition and directed the patient to
the operating room. We reduced a ten centimeter loop of ileum and concluded the
operation. The patient was extubated and brought to
the recovery room. In less than 30 minutes, the patient became cyanotic and tachypneic. The Pediatric resident reintubated
the patient and ambubagging was done continuously. A
ventilator was secured the following day. Despite efforts to save the patient’s
life, he expired that evening.
I could not help shedding my very own tears as I saw
his parents mourn over the loss of their son. As I was walking towards the
Surgery ward, the thought of my own child passed through my mind. I was so
thankful he was healthy and how I missed him so. I felt the pain that my patient’s
mother was going through. She would never get to comb his hair once more nor
hear his laughter nor feel the warmth of his embrace. Tears once more rolled
down my cheeks and silently, I offered a prayer.
Insights
I always had a soft spot for
pediatric patients long before I had my own child. I gave them a special kind
of attention and care that was motherly in nature. On my second year of
residency training, I became a full-fledged “mom.” True enough, I became more
attached to my pediatric patients, developing a bond with them and their
parents that is unique and special. To put your child’s life in the hands of
someone you hardly know would really entail faith and trust. As a parent
myself, I know how difficult that can be. But as a physician and mother at the
same time, it would be twice as hard. For every pediatric patient I encounter,
the mother in me surfaces. I see myself as his mother. Whatever worries and
pain that their parents are going through, I would feel them too. As much as I
could, I always tried to take care of them as I would want my son’s doctor to
take care of him.
Being a mother helped me a lot in
being able to empathize better with my patients and their relatives. It has
reinforced in me the need to render better quality care and services to my
patients. The ability to build rapport with them made it easier for me as well.
I have become more grateful that I am blessed with a healthy son. I have become
more appreciative of all the little joys and comfort that he gives me.
Coincidence
Dr. Janix de Guzman
A young man in his twenties was brought to the
emergency room by his friends. Fifteen minutes prior to being brought there, he
was with them, happily drinking at his birthday party. Apparently, he just
turned 25. He was allegedly stabbed by an acquaintance for no apparent
reason. He sustained a 2.5 centimeter
stab wound on the posterior axillary line, level of 3rd
intercostals space on the left. The incision site was still actively bleeding.
Patient was stuporous which could probably be due to
excessive alcoholic intake. But his vital signs pointed to a worse scenario. He
was hypotensive, tachycardic
and had shallow, irregular breathing. Immediately, a primary survey was
instituted, following the ABCs of trauma. We checked his airway, assessed his
breathing and circulation, looked for deficits and explored other parts
swiftly. Simultaneously, we went into action for it is our inherent duty to
preserve life. With all the help I could get, my team and I inserted an endotracheal tube to assist the patient in his breathing,
packed the stab site, put two large bored intravenous lines and placed a thoracostomy tube on the left thorax. There was non-stop
action. 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.
Our final decision was to operate on
the patient and to control the continuous bleeding inside. I talked to the
relatives about the patient’s condition and the plan. Because there was really not much we could do
about it, they consented to have the operation. Patient was brought to the
operating room as fast as possible. After we opened his left thorax, he went
into arrest. After having evacuated 2.5 to 3 liters of blood and having noted
active bleeding on the upper lobe of his left lung, we clamped the left hilum and did an intrathoracic
cardiac massage. But despite everything, he succumbed to death due to
transected left pulmonary vessels and right bronchus. The hardest part was informing
the relatives that he would not be celebrating his birthday ever again.
Insights
Life in the emergency room is full
of action, suspense, drama. I had the chance to be in this situation and the
experience overwhelmed me. Given the option, I would rather not be in the same
position again. But do we really have a choice? Instead of avoiding what we can
not avoid, it is better to be prepared. Always keep in mind the ABC’s of
emergency and trauma. Decision-making plays a big difference. Know when to seek
help. And equally important, be wary of relatives or somebody concerned and
find time to talk. Even a short conversation matters. They will surely
appreciate it.
With
that, I invoke the prayer of St. Francis, “…grant that I may not so much to
seek to be consoled as to console…”
Family Ties
When You Lose Someone Close to You
Dr. Oliver Leyson
It was around four in the afternoon when I received a
text message from my sister asking me if I was on duty, I told her I was at
home. She was suffering from a severe attack of asthma. I told her to go to the
nearest hospital right away.
I thought she would then go to the nearest hospital
after instructing her to do so.
At around nine o’ clock in the morning, I was
surprised when I saw my mother at the out-patient department. She asked me if I
could attend to my sister who was still at home. I immediately went to her
house and was shocked to see her in severe dyspnea
and unable to stand. Suddenly, she became cyanotic and apneic.
I tried talking to her while injecting an ampule of
hydrocortisone which I brought with me when she suddenly lost consciousness.
She had no pulse and no spontaneous respiration. My mind went blank. I performed
mouth-to-mouth resuscitation and chest compression. I was finally able to lift
her to the car while my father drove us to the nearest hospital from our place
while attempting resuscitation. At the hospital, cardiopulmonary resuscitation
was continued for 45 minutes, to no avail. She was pronounced dead on arrival
due to status asthmaticus. I later learned that she
took approximately 30 nebules and her attack had been
twelve hours long before I was able to get to her.
Insights
When someone close to you is your patient, it is very
easy to lose your sense of composure and objectivity. You realize your own
limitation as a doctor and as a human being. As a doctor, we can only do as
much in a given situation. We are not God who is all omnipotent, omniscient and
omnipresent.
One That Hit Home
Dr. Hazel Turingan
On the last day of my vacation leave, I decided to go
with my parents to Philam Life at
I recognized the ER consultant and
some of the nurses since I took my internship there. My father 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 MI.
Prime your mother. I’m so sorry.”
My mind was whirling. My head was
denying the information given to me. Then, a few minutes after, he went into cardiorespiratory arrest. A code was sounded and he was intubated. After a
few minutes of resuscitation, he regained consciousness. I glanced at my mother
in one corner. She was stoic. I guess she was also denying what she was seeing
in front of her. I called up my sister and brother and told them about our
father’s condition. It was hard for them to take the gravity of his condition.
He had two more arrests at the emergency room. And every time, he was able to regain
consciousness. He was admitted to the intensive care unit. There, my sister asked a stupid question,
“When dad gets home, will he still be able to work?” I said he was not coming
home with us. He was already dying. He asked for me, wanting to tell me
something. I gave him a piece of paper and he wrote something about the office.
I told him not to worry about anything and to try to sleep.
After more than 24 hours of vigil, I
noticed he had no urine output. Upon checking, I asked the nurse to inform the
IM resident that his bladder was already distended and that 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 father had a stricture from his previous TURPs and acute constriction from the false insertion. Still,
he tried several foley catheters. I saw my father in
pain so I suggested that he do a suprapubic cystotomy just to decompress the bladder. My suggestion
fell on deaf ears. He too said I shouldn’t have removed the catheter in the
first place. I was exasperated but for my father, I tried to hold my temper.
The following morning, the Urosurgeon came. He was
surprised to see me and told me suprapubic cystotomy should have been done earlier. Before I could
speak, the chief resident commented that he actually suggested that. I couldn’t
believe he was lying blatantly. When my senior residents came to visit, I broke
down. I told them I felt so useless. I could not help him. On the third day, I
told my mother I had to go home for awhile to take a bath. On the way home, I
got a call that he arrested again so we went back. When I arrived, they were
resuscitating him for more than 30 minutes. I saw the faces of the residents
and interns: detached, indifferent, bored. Finally, I
told them to stop and said my last goodbye.
Insights
Up to now, I am still blocking the events surrounding
my father’s death. It is too raw. I had become a patient’s daughter, not a
doctor or a surgeon. I felt 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 wanted to trade places with him If I could not save him.
Being on someone else’s shoes made
me aware of the mundane things some of us in the field of medicine take for
granted, how some could not 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 while everyone else around them doesn’t seem to care, how we
sometimes take the defensive attitude when confronted. These are just 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 a
and fragile. I learned never to downplay 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.
All in a Day’s Work
The Ground Shaking Appendectomy
Dr. Jeffy Guerra
September 22, 2004 was a date to be remembered in my
training as a surgeon. An early morning’s quake caused jitters. I was about to
finish an appendectomy when the nurses, together with the rest of the operating
room staff, left the operating suite in a rush when they felt the first jolt of
an earthquake. Needless to say, the tremor was strong enough to shake the whole
room and rattle everyone’s nerves, including mine. I was shocked, as if my
world stopped altogether. I looked around and realized that my assists and
anesthesiologist were frightened. We simply stared at each other, uncertain of
what to do. We were all at a loss: should we run and try to save ourselves or
stay by the patient’s side and watch each other die?
I was in the middle of deep thought regarding the
life and death dilemma when the patient suddenly turned to me and said, “Doktor, ‘wag niyo po ako iwan.
Hindi tayo pababayaan
ng Diyos.”
I immediately regained my senses. I felt braver and
confident in having to take charge of the situation. The faint voice inspired
me to act rationally. So I then instructed the nursing aide to secure a
stretcher and transfer the patient should the earthquake continue. I was about
to close the fascia while waiting for the stretcher when the tremor decreased
in intensity and eventually stopped.
I could not help but look up and
utter a small prayer.
Insights
This particular incident made me realize my duties
and responsibilities as a doctor more. No matter what happens in the operating
room, such as in this case, our first priority should always be the patient.
Sometimes, we will be made to choose
between ourselves and others, or to choose between self-preservation and social
responsibility. During the incident, I was at the crossroads between choosing
to save myself or the patient.
As I look back, as surgeons and
captains of our ship, we should always be able to take charge of any untoward
circumstances. We should take command of it and sail them safely to the shore.
I never expected that I would be
facing this situation so early in my career. Each time we work on a patient,
inside the operating room, we should bear in mind that the patient’s life is in
our hands; that for the time being, we are responsible for whatever would
happen to him.
One Fine Day
Dr. Rommel De
It all began when I assumed a
“post-duty” status. Since it was Thursday morning, all the residents were
expected to attend the weekly conference. Being a second-year “post-duty”
resident, however, I was excused from the conference and was instead assigned
to man the emergency room.
It was a relatively benign morning.
Patients began to come in one by one. While waiting for a text message or a
phone call from my co-residents, I attended to my patients. I started to notice
that the number of patients was starting to go up. So I doubled my pace and
acted a bit faster.
It was about eleven o’ clock in the
morning and still, patients kept coming in. Cases ranged from relatively simple
medico-legal cases to various types of trauma.
It was around this time that an
85-year-old female came in. Apparently, she fell from the stairs. Although her
entire face was drenched in blood, there was no apparent lesion that would
explain the pertinent finding. As we were examining her, another patient, this
time a vehicular accident victim, was wheeled in.
He was hit on the abdominal area. On
examination, we considered a blunt abdominal trauma. Para-clinical diagnostic
procedures were done to confirm the diagnosis. As these examinations were
carried out, new batches of patients came in. Of course, I had to attend to
each of their needs and to take time in explaining their conditions.
As for the patient with the
suspected abdominal trauma, chest radiology upright showed no pneumoperitoneum. Abdominal ultrasonography
revealed no fluid in the peritoneum. I talked to the relatives of the patient
and explained that we would have to observe the patient temporarily in order to
know if he would develop signs that would warrant an immediate operation.
As if the toxicity in the emergency
wasn’t enough, two bone fracture cases were still waiting to be attended to.
It was already six o’ clock in the
afternoon when I finished all the work. I rested for a while, took a shower and
prepared to go home. When I was about to leave the emergency room, the mother
of the patient with blunt abdominal trauma approached me and asked me if I was
going home.
I told her I was dead-tired and was
indeed going home. She replied, “Paano na po ang
anak ko? Sa
iyo lang po ako kumukuha
ng lakas ng loob!”
With that very simple comment, I
felt that all the day’s pressures were very much worth it. I felt very much appreciated
and needed. My heart swelled immensely.
I smiled and patted her shoulder
comfortingly. I sat down beside her and told her that her son was going to be
just fine.
Insights
There are times when our work will
really drain us physically, mentally and emotionally.
During these times, our patience is
being tested. But no matter how tired we are, we should always be humane and
compassionate. We should not lose the essence of a real Healer: compassion and
care for our patients.
Baptism of Fire
Dr. Rubi Ann Claire Chan
Who could ever forget? Everybody all over the world
was so excited a few days before celebrating New Year. Who wouldn’t be? It was
the turn of the millennium! If it were even the turn of the century, people
would still make it a big deal.
Other than being a much-awaited
event all over the world, it was also one of the most spine-tingling and
nerve-racking duties that Surgery residents dreaded that year. The usual New
Year’s celebration every year would never be complete without tons of
medico-legal patients, firecracker injury patients, trauma patients. But that
New Year’s Day was special so we expected it to be more toxic or even thrice
over. The hospital was prepared for the event, too. All the medical supplies
were suddenly made available and seemed to be endless that New Year’s Eve.
I was just an incoming first year
resident then. All incoming first year Surgery residents were
on call on New Year’s Eve. We were to be bonafide
residents of the Departemnt of Surgery of Ospital ng Maynila
on January 1, 2000. What a way to start the training!
New Year’s Eve was quite benign that
day. Three or four patients came in with minor firecracker injuries. We even
had the time to prepare media noche that
evening with the clerks and interns.
As the night was coming to an end, a
stretcher-borne four-year-old female was wheeled in. She was the victim of a
vehicular accident. She was apparently run over by a scooter, the tire marks
very much visible across her abdomen. We did the necessary procedures for the
patient. She was referred to our Pediatric surgery consultant who advised us to
observe the patient. If she showed signs of significant blunt injury, we would
open her up. After a few hours, she already had an acute abdomen. We prepared the
patient for an operation. It was past eleven o’ clock in the evening when we
finally brought the patient to the operating room. As expected, we celebrated
the millennium New Year there. When the clock struck twelve that midnight, we
all stared outside the glass windows of the operating room. There were
magnificent fireworks across the sky. It was a sight to behold. It could have
been more spectacular if were to see it while standing along Roxas Boulevard.But we could not
and so we had to be content with a few glances through the glass windows. After
a three-hour battle for dear life, the patient died on the table. Two liters of
hemoperitoneum was evacuated. She had an avulsed
spleen and left kidney and a ruptured duodenum. All of a sudden, the millennium
celebration did not have any reason for most of us to celebrate anymore.
Insights
I came to the reality that from that
day henceforth, it was the start of my career as a general Surgery resident. I
told myself, “Ok, this is it!”
I knew that what transpired would pale in comparison
with the trials I would be facing in the net five years. That day, I realized
that training in Surgery is not a bed of roses. I had to prepare myself for
this emotionally, physically, mentally and spiritually. Looking back, I can say
I have come a long way. I have matured through the years and evolved as well.
Indeed, more challenges came my way and I have braved them all.
The
life of a surgeon is unpredictable. Schedules are erratic. No one can choose
the time that he/she will operate on an emergency patient. There would be times
when he would not be able to celebrate holidays and special occasions because
of the call of duty. No matter how exhausted and drained we may be from work,
if he Is called upon to attend to a patient in need,
he should do so. There would also be a lot of instances where he would have to
give up many things like his free time for his family. That’s the reality all
surgeons must live with.
Mother’s Fear
Dr. Martin Cabahug
I was on duty at the emergency room one Saturday
morning. A despondent-looking patient came in for a scheduled breast surgery.
Three weeks ago, she sought consult at the
out-patient department due to a two by two centimeter, non-movable, hard,
non-tender mass on the upper outer quadrant of the right breast. No lymph nodes
were noted. Fine needle aspiration biopsy was done and histopathologic
report revealed invasive ductal carcinoma. Patient
was then advised to undergo an operation.
While finishing the admitting
orders, I cracked a joke to break the ice but she remained unresponsive. I
asked her why she seemed so sad. Suddenly, she burst into tears. She began
talking about her life, her fear of death and her apprehensions on leaving her
two children behind.
I tried to comfort her. I began
casually talking about breast cancer. Although she seemed momentarily stopped,
the sad look on her face was still there. I advised her to pray. I even
promised her I would pray for her, for her to have courage and strength to
fight this personal battle.
Four days after our talk, while
doing my morning rounds, I noticed this patient with a happy expression on her
face. She turned to me and suddenly said, “Maraming salamat po,
Doc MJ.” I paused and wondered who this patient was. Then I realized this was
the same patient I admitted at the emergency room with the sad face.”
Insights
Most cases of breast cancer are diagnosed in their
late stages. This is because most women are unaware about basic facts on breast
cancer.
As surgeons, we have a social
responsibility to educate patients about their diseases.
Patient with Generalized Peritonitis
Dr. Janix de Guzman
A 26-year-old female was brought to the emergency
room last June 26, 2004. She had been complaining of abdominal pain for four
days. On physical examination, her abdomen was distended, soft, tender on the
right lower quadrant and had hypoactive bowel sounds. Our primary consideration
then was acute appendicitis.
With a past history of giving birth a month ago, we
referred the patient to the Department of Obstetrics and Gynecology (OB-Gyn), thinking of an obstetrical or gynecological problem
as our secondary diagnosis. However, our patient was eventually cleared. With
persistent and progressing right lower quadrant pain, she was eventually
operated on.
Upon opening through a right lower quadrant
transverse incision, purulent discharge was noted intraperitoneally
on all quadrants. The appendix was grossly normal. The right fallopian tube and
fimbriae were inflamed while the opening of the left
fallopian tube was closed with absent fimbriae.
Uterus was contracted to its normal size. Again, she was referred to OB-Gyn. However, the residents were adamant that the right
fallopian tube was normal.
Left alone, with no idea as to where the source of
infection was coming from, I weighed my options, to do or not to do formal
exploration. Not doing a formal exploration meant sticking with my previous
impression that it was a pelvic inflammatory disease contradicting the findings
of “experts.” However, doing a formal exploration would entail creating another
incision in order for me to have a clear exposure of all the quadrants of the
abdomen. It has also the advantage of easier peritoneal lavage
for the difficult areas in the abdomen.
After checking the condition of my patient with the
anesthesiologist, I proceeded with the formal exploration. Except for the
purulent non-foul smelling discharge on all the quadrants and the equivocal
findings on the adnexae, all the intraperitoneal
organs were grossly normal.
Insights
Clearly, this patient had a very unusual health
problem. I had to humbly accept my limitations so I sought the help of my
colleagues. However, being the attending physician, the burden still fell on my
shoulders and the final decision still rested upon me.
Have I done an unnecessary
operation?
With this question in mind, I was
reminded of an adage: It’s the things that you had not done that give you
heartaches at the end of the day.” With this, I pray: “Lord, grant me the
serenity to accept the things that I can not change, the courage to change the
things that I can and the wisdom to know the difference.”
Breaking a Tradition
Dr. Maria Cecille Leyson
One peaceful evening, a sixteen-year-old male who
looked ashen-pale entered the emergency room.
He was shaking and holding his crotch. I noticed immediately that it was
bleeding. On examination, a six-centimeter incised wound at the dorsal aspect
of his penile shaft with hematoma was continuously
bleeding. As I was controlling the bleeders, I asked him what happened. He
hesitated at first; then, with candor, he said that he incised his penis using
a Gillette blade.
He said that his friends found out
that he was not yet circumcised. Since then, they started tormenting him and called
him names like, “Boy Supot”
or “Boy Duwag.”
Some of his peers insinuated that he might be thrown out of their inner circle
or “barkadahan.”
because of his “shameful” condition
The patient was humiliated. He felt
like a social outcast. He tried to go to a doctor and have his penis
circumcised but he was too embarrassed to do so because he was already sixteen.
Confused and determined, he then
decided to mutilate himself.
Insights
By telling these to our children, we
become instruments in continuing a tradition that has no beneficial effects
based on evidence-based medicine.
Campaigns dissuading the practice of
circumcision will provide our countrymen scientifically-proven facts regarding
circumcision. We have to stress that it really does not provide any added
beneficial effects.
Surgical Surprises
Dr. Jeffy Guerra
It was just another ordinary duty day when I was
called upon to operate on a 32-year-old male presenting with classical signs
and symptoms of acute appendicitis. Having done quite a number of
appendectomies in the past, I was pretty confident on how I would go about the
procedure, thinking I had adequate knowledge about the case based on my
readings and experiences.
At the operating room, the procedure
started uneventfully. Everything was well until I had completely opened up the
abdomen. Instead of a pathologic appendix, what lay in front of me was a
ruptured cecal diverticulitis
plastered with omentum. For a fleeting moment, I was
in a state of panic. I felt dizzy in disbelief. I tried to focus, recalling
everything I knew as a young surgeon-in-training. But it was difficult, having
to psyche myself for something other than a mere inflamed appendix.
There I was, trapped in my own
quicksand. Recovering from my initial mental paralysis, I did the next best
thing. I referred to my senior who immediately came to my rescue, allowing me
to get back on track. Step by step, he discussed with me the pathology of the
disease and the surgical procedure of choice.
We debrided
the perforation and did primary repair. The rest of the operation went on
smoothly. At long last, the operation ended successfully.
Insights
Surgery is just like a football game. The choice of
offensive strategy is based on the kind of defenses you think your team is up
against. But no matter how good the game plan is, no one can predict how the
game will go. Faced with an unforeseen situation, a good team captain should be
able to recreate another game plan from which he shall redirect his team to
take the challenge that lies ahead. In surgery, each new case that you see may
require you to take on a management process differently from what you initially
contemplated. It is ideal to be prepared for anything all the time because you
can never always predict what you will see on the operating room table. The beauty
of this discipline is not merely perfecting your operative skills, but more
importantly skewed on surgical decision-making. Unlike in other specialty where
treatment plan is “de-kahon”
or “cook book medicine.”
Child’s Play
Dr. Hazel Turingan
I was leisurely eating my lunch at the hospital
canteen thinking that being on a pre-duty status, I
had no reason to hurry. There were the usual out-patient consults and minor
operations scheduled in the afternoon. Needless to say, the activities were set
for the day, until, a junior resident on duty called me on my cell phone and
informed me that a thirteen-year-old boy sustained a gunshot wound on the thigh
after playing with a hand-made gun, with absence of distal pulses and complete
femoral fracture, leg already swollen and discolored. They have already
referred the patient to the vascular consultant who in turn told them to direct
the patient to the operating room and prepare for a vascular graft. According
to the resident, the consultant further instructed them that I personally do
the operation since he already taught me how it was done previously. I recalled
that when I was a junior resident, we prepared a patient for the same procedure
but aborted the plan because the vascular transaction is amenable to primary
repair. In essence, I only knew how it was done but never actually done it
myself.
Being the type of person who plans
the day ahead, I was caught off-guard. I was mentally unprepared. Realizing
this, I focused and planned. I needed two teams: one to explore the wound and
do damage control, while the other team to harvest the saphenous
vein from the donor extremity. The two teams should act fast to make the
operation work. I called the fourth and fifth years on duty and another
pre-duty fourth year to complete the two teams. I recited the procedure in my
head and we anastomosed the femoral artery using saphenous vein graft.
We couldn’t stop smiling after
seeing the vein dilate and the distal limb of the femoral artery pulsate. We
actually did it. We were even able to do reduction and temporary internal
fixation of the femoral fracture. We were grinning and with our blood still
high with adrenaline, we called it a day.
Insights
No matter how structured you are, no matter how you
have planned your day ahead, there will always be some uncontrollable
circumstances. One must be flexible enough to be able to adapt to the sudden
changes and meet the challenges they bestow.
It is heart-warming and a little
disconcerting to have a mentor to trust you to a do a procedure without
supervision. You gain courage because your mentor believes in your capabilities
more than you actually do.
Lastly, nothing makes you more alive
and inspired as seeing what you have done work as it should. All exhaustion
vanishes into thin air. No matter how difficult an operation might seem, team work lessens the load a lot such that the task is but
a child’s play.
Holistic Surgeon
By Dr. Hazel Turingan
Last 2003, I operated on a patient with breast cancer
stage III-A. I learned that she has a strong family history of breast cancer.
Two siblings have the same disease and one already passed away. For a long
time, she was in denial about her condition, refusing to accept that she was
also afflicted with breast cancer like her sisters.
Because of her sisters’ conditions,
she was very knowledgeable about breast cancer. When she decided to have her
operation done, her resistance dissolved and she complied with utmost obedience
to treatment. She underwent chemotherapy for six months after the operation
with diligent follow-up. For a year, I was in touch with her and her daughters.
Three months ago, she came back with
bone pains and a bony elevation on the head of her left clavicle. Chest x-ray
and bone scan were both negative. Two months later, she returned with pulmonary
and bone metastases that were earlier undetected. She was then referred to a
surgical oncologist and was again put on chemotherapy.
She and her daughters still came to
visit me and update me regarding her condition.
Later, one of her daughters came back and told me about her
deteriorating condition. I told her to get her mother’s affairs in order as she
may not have the luxury of time. I told her to make the best out of her
mother’s remaining days.
A few weeks ago, I received a
message from her that her mother expired with the whole family on her side.
Again, the patient’s daughters came to visit me and expressed their gratitude
for giving their mother the care and concern they felt I gave not just as a
doctor but also just like a real daughter to their mother, as well.
Insights
Although we were taught in med school to empathize
with our patients and maintain a certain degree of detachment as doctors,
sometimes we transcend the delineation between a doctor-patient relationship
and a human relationship where strong bonds are formed and no restrictions are
made.
For terminal patients who undergo
the process of denial, anger, guilt and eventually, acceptance in the course of
their illness, surgeons must realize where their role as a doctor ends and
where their role as a friend begins.
Building
Blocks of Character
Treat Your Patients As
You Would Treat Your Own Relatives
Dr. Nolan Aludino
A 54-year-old female entered the emergency room,
complaining of right lower abdominal quadrant pain. She was diagnosed with
acute appendicitis and was subsequently booked for appendectomy. I was the one
assigned to operate on her.
The operation went on smoothly. It
turned out she had perforated appendix with localized peritonitis.
When the patient was brought back to
Surgery ward, I visited her regularly, hoping to build rapport. In one
instance, I noted that the patient spoke in my vernacular language. I was
intrigued so I asked him and his companions where they hailed from.
It turned out that my patient was my mother’s cousin.
Insights
The medical adage, “Treat your patients as you would
treat your own relatives” holds true in this case. Spend time building a good
professional relationship with your patient. Not only would it help avoid legal
suits, it would also help uplift your spirit, knowing you helped lift a person
physically and spiritually.
Athena’s Daughter
Dr. Trisha Daughterty
One of the greatest legacies of Greek civilization to
scientific thought is the power of observation. Rather than attribute diseases
as manifestations of God’s wrath, Hippocrates used astute observations and
examinations to diagnose and to treat patients, casting away magical thinking
that so clouded so many minds in the past. Indeed, no amount of philosophizing
can equate attending closely to a patient, discovering in the process what is
really happening within him.
This I realized more one morning
when I reported for duty at the emergency room. The air reeked so strongly of
rancid odor. Almost all beds were occupied. The residents were tired and the
clerks buzzed around like bees. There were many patients, one of whom caught my
attention.
She was a sixteen-year-old female
who came in due to abdominal pain. At first glance, she seemed to be another
case of acute appendicitis. On subsequent evaluations, however, it seemed lees
likely and a gynecologic pathology looked more logical. She was then referred
to the Department of Obstetrics and Gynecology for clearance but the findings
were inconclusive and noncommittal. An ultrasound was warranted. I told myself
it was no big deal. I would just have to perform the necessary exam.
In the midst of deep thought, I
received a phone call from a consultant who apparently held a high position in
the same hospital. My sixteen-year-old patient, it seemed, was what our
hospital euphemistically call a “CO,” which in simple terms means that the
patient was a VIP, that she probably had special connections in the hospital.
The consultant scolded me for the
delayed and inappropriate management and questioned my diagnosis even without
having performed a physical examination himself.
To add insult to injury, another
so-called CO called me rudely and ordered me to bring the sixteen-year-old
patient immediately to the operating room and perform appendectomy. I told him
that according to our history and physical examination, the patient did not
appear to have a surgical abdomen.
Eventually, an ultrasound was done
and revealed normal findings. Eventually, the consultant’s whims were followed
so an appendectomy was subsequently done. It turned out to be a gangrenous
appendix. The consultants were right, after all.
Insights
I may be young and too dreamy-eyed for this
profession. Hubris may be my cup of tea. But it bruises my spirit to learn that
those claiming to be gods of modern medicine can easily trample upon the basic
principles of science to serve their own personal interest. Reminiscent of the
oracles of Delphi whose power they attribute Olympian gods and goddesses who
claim to know everything and decide on matters based on gut feel, these VIPs
have tasted some power, thus making them eligible to decide on patient care,
even without a glimpse of my patient’s skin.
As a true daughter of Athena,
Goddess of Wisdom, the tradition lives in my spirit. Medical training has
taught me that a careful history and
physical examination is essential to diagnose a disease with high sensitivity
and specificity. As long as I am able to examine a patient thoroughly, I know I
am on the right track, that nobody, even one who purports to know more I do,
can trample me if my foundation is firm enough.
Indeed, the greatest legacy of Greek
science is the power of observation. As long as the fire burns within me, I
shall uphold that paradigm. No amount of coercion from so-called experts can
force me to do something that I do not believe in.
Sharing Your Blessings
Dr. Jeffy Guerra
It was around eleven in the evening of August 2004
when I received a phone call from another hospital, referring a
fourteen-year-old male diagnosed with acute appendicitis. I extracted a brief
history from the referring physician. More or less, I agreed with her
diagnosis. I then informed my senior resident about the case and decided to
accept the referral.
After two hours, the patient came
in. He was in severe pain that he couldn’t even walk. I examined his abdomen
and noted that there was direct tenderness and muscle guarding on the right
lower quadrant. He was then booked for an emergency appendectomy. I prepared
the patient pre-operatively and talked to the parents regarding their son’s
condition. I also discovered that they were not from
I then tried to explain to them that
they needed to buy the necessary anesthetics and OR needs. However, they
pleaded that I provide the anesthetics since they did not have enough money to
spend.
I tried to look for ways to help
them secure the OR needs. I even approached the Senior House Officer and
anesthesiologist but unfortunately, no anesthetics were available at that time.
When I got back, I was surprised to
learn that the medical clerks shelled out some money in order to buy the
anesthetics. I gave my share and eventually, the patient was successfully
operated on.
On the first post-operative day, I
came to visit him and I was truly touched when he gave me a piece of candy and
said, “Salamat po, Kuya.”
It took a long time before the words
stopped ringing in my ears.
Insights
Brushing elbows with financially incapable patients
is not very uncommon nowadays.
Moreover, I have this philosophy
that working on a 37-hour duty as part of my training is a kind of service in
itself to the less fortunate. I believed it was already good enough. This
belief changed radically when I encountered this patient.
In this world where it is no longer
practical to be kind and generous, we sometimes think twice before actually
doing something for someone we barely even know, especially when we are bounded
by our own physical and financial limitations. Sharing the expenses of a
patient is never really a requirement to be regarded as a good doctor but having
done just that once in my training, words could not convey how rewarding it
feels that I had actually done more than what was expected of me.
This experience also made me realize
that even with the challenges and problems I have to deal with everyday, I am
still more fortunate than most. And for this, I am thankful that despite all my
shortcomings, God still paves the way to use me as an instrument to help others
unconditionally, not just a doctor treating the sick but as a human being
extending a hand to a brother in need.
Good Samaritan
Dr. Roderick Mujer
Driving to work from my place in
One morning, however, I woke up ten
minutes later than usual. I was quite worried because I was set to do an
important errand for the department early that day. So I breezed through my
morning rituals to meet my daily 30-minute drive to Ospital
ng Maynila.
Everything was fine until I turned
to
Although I was quite reluctant to
get out of my car, worried that I was losing precious time, I knew I had to get
out and help. So I squeezed my way through the crowd and walked over to the
injured man. I saw that he was badly hurt but very much alive. Up close, I
could not help but feel sorry for him. I felt angry at the driver who had the nerve
to leave him like that. Being a doctor, I knew what to do in such emergency
cases, so after checking and quickly assessing his status, I volunteered to
take him to the nearest hospital. I could have just dropped him at the
emergency room but the receiving doctors asked me if I could stay for a while
so they could get some information from me.
While helping with the history, a
middle-aged woman came up to me. To my surprise, she took my hand and asked me
if I was the good-hearted young man who helped her husband. Apparently, she was
the wife of the hit-and-run victim. I told her not to worry because the doctors
would take care of her husband and would soon be fine. She squeezed my hand and
told me that if it were not for me, she would have lost him for good. She also
thanked me for being the angel that God sent from heaven. She smiled at me
through the tears. I was so touched by what she said that I smiled back.
When the time has come for me to
leave, I realized how late I was. I hurried to my car and drove to OMMC. Upon
arrival, I was informed of having a Sunday duty as a sanction for my being
late. I uttered an excuse and apologized to my seniors. But as I walked away
from them, I knew that I started my day right and that would be one Sunday duty
I would be very glad to serve.
Insights
To most people, a doctor is synonymous to a healer.
He is usually referred to as that one individual who can make miracles happen.
He treats the sick and saves those who are dying.
As privileged as I feel that I am
one of those few whom the society looks up to, I realize that all the prestige
comes with great responsibility, not limited by time and place. I realize that
a real doctor does not limit himself within the confines of the hospital or
clinic where he works but rather, should spread himself enough to maximize his
role in the society. Truly, it is a lifetime commitment and sacrifice, all for
service and higher good.
What made me bring the patient to
the hospital when I knew I was running late for work was my conscience telling
me to live up to my title. Leaving a person to die when I could have done
something to save his life so I could carry on with my hospital
responsibilities would never make me more of a doctor than I already am. On the
contrary, it would just make me less as a person had I opted to do so.
Quest for Character
Dr. Maria Amado Pingul
It was five o’ clock in the morning. I came down to
the emergency room after finishing a long operation. I sat down on the bench to
catch my breath when the phone rang. I answered it and the voice on the other
end said that our patient in the intensive care unit had a blood pressure of palpatory 40. That patient was endorsed the day before and
was in a guarded state of sepsis. I figured that she was already in septic
shock. I told the nurse I would be attending to the patient immediately.
When I entered the intensive care
unit, I saw that patient was hooked to an ambu-bag. I
listened for heart and breath sounds but there were
none. I signaled to the medical clerks to start cardiopulmonary resuscitation,
after which I gave the emergency medicines.
After 40 minutes of cardiopulmonary
resuscitation, I pronounced the death of the patient. I sat down behind the
nurses’ station and wrote entries to his chart. It was then that I noticed a
sign on the table with the prayer, “Dear Lord, please give me strength to face
the day ahead. Please bring me courage as I approach each hurting bed. Please
give me wisdom in every word I speak. Please give me patience as I comfort the
sick and weak. Please give me assurance as the day slips into night that I have
done the best I can and that I have done what is right.”
As I wrote, “post-mortem care please,” I asked myself, did we do the right thing for
this patient?
Insights
The person who wrote the prayer was asking for the
following characteristics: courage, patience, peace of mind, strength.
Building character is not being
taught in medical school, nor can it be learned from medical books but each
physician is expected by society to have courage, peace, patience and strength.
Each of us, both doctors and
non-doctors, went through different experiences that molded us into the person
we are now. But because we have different experiences, the depth and level of
character vary from person to person.
We
all continue to go through the journey into ourselves, our characters. Every trying moment, every difficulty, every
trial is an opportunity to develop our characters.
Stress Test
Dr. Maria Amado Pingul
It was the night before our RITE (Residents’
In-Training Exam), which all Surgery residents in the Philippines are required
to take each year, in preparation for the Board of Surgery examination after
graduation. This exam gauges how much theoretical knowledge a Surgery resident
has; moreover, it compares the ranking of each resident taking the examination.
If I fail this examination, it would mean non-promotion in my residency
training. So this coming exam was an added source of anxiety for an already
toxic night since I was on duty at the emergency room.
On the average, the trauma emergency
room usually has about 60 to 70 patients per duty. That night, though, we had
111 patients. Probably because it was Saturday and a “pay day” weekend, there
were lots of medico-legal cases, probably borne out of drinking sessions.
At four o’ clock in the morning, a
two-year-old boy was referred by the Pediatrics Department because of a bulging
mass on the right inguinal area, which was associated with vomiting. When I
read the referral sheet, my heart was pounding. I crossed my fingers and hoped
that it was not incarcerated. So I went to examine the patient and as my worst
fear went, the hernia was indeed incarcerated. During this time, I wished that
it would go back to its original position spontaneously. I even tried to push
it in but the patient was in deep, agonizing pain. There was no way the hernia
would reduce spontaneously.
I referred the patient to my senior
resident and soon, the patient was directed to the operating room. I prepared
the patient for operation, secured an informed consent and gathered his OR
needs.
I thanked God that the patient’s
terminal ileum which seemed incarcerated at first was viable. The operation
went well and we finished at around six o’ clock in the morning.
At 7:45 a.m., the traffic around UST
was very heavy. There was a college entrance examination in the said university
so there were more vehicles than usual. The stress of being late for the exam
was so high it was almost unbearable. I took a left turn on a “no-left turn”
street, honked my horn loudly as I sped by, took the
risk of getting caught by traffic enforcers. Needless to say, it was a big
gamble.
At 8:10 a.m., I was seated inside
the examination room at UST. I felt very tired, hungry and dizzy. I stayed
still and recollected my thoughts. I recalled the Bible verse, “Be still and
know that I am God.” Psalm 46:10. I asked the Lord for strength to be able to
keep me awake through the entire three-hour exam.
Insights
Life brings us different types of stress at different
times. As a government Surgery resident, I usually encounter so much stress
especially when at the emergency room.
I believe that one has to learn how
to deal with stress. In my case, I handle stress by surrendering my weaknesses
to a strong and awesome God whom nothing is impossible. These life challenges
actually make me stronger as a person.
There are lots of things or events
that we do not have control over. Most
of the time, we do not get what we want. Hence, life becomes even more
stressful. But there is something we can do and that is by controlling how we
react over circumstances.
My
Dr. Redomir Roque
I was doing an exploratory laparotomy
on a 76-year-old female who had recurrent periods of anorectal
bleeding. Patient had undergone flexible colonoscopy which revealed a rectal
mass, about seven to eight centimeters from the anal verge. A biopsy was done
and revealed adenocarcinoma. Patient was subsequently
admitted. With a good preoperative preparation, patient was subsequently
admitted. With good preoperative preparation, patient was scheduled for low
anterior resection.
With a concrete plan in mind, I went
through the anterior abdominal wall through a midline incision. I surveyed both
lobes of the liver, went down to the para-aortic
region and scrutinized the surroundings. I inspected the colon only to find a
very shocking discovery . . . there was no mass! Blood rushed to my face. I saw
a flare which flooded the whole room and my heart skipped a beat. Is this the right patient?
I felt numb when my right hand
grappled around the rectosigmoid area. I was
conscious but felt paralyzed. I felt a chilly mist run down my spine. I
suddenly realized I had been wrong. I have committed an unforgivable mistake. I
failed to do a digital rectal examination which was a basic and logical
procedure when considering anorectal lesions.
From then on, I vowed it would be my
last faux pas. I will forever remember this blunder and vow to resurrect myself
next time.
Insights
I should spend more time in
performing my own physical examination despite available medical and clinical
information. I should establish my clinical diagnosis and ascertain what is
necessary and vital to my planned operation.
Even with years of experience, every
case is unique. As such, I must appreciate and discover each nugget of learning
it may provide.
Valentine’s Day
Dr. Hazel Turingan
I was diagnosed with a congenital heart disease,
technically called a Wolff Parkinson White Syndrome. Simply put, it has
something to do with the electrical conduction of the heart, which determines
the rate to which the heart should beat. Aberrant fibers within the heart
overpower the normal pacemaker or the SA node. Thus, I suffered from supraventricular tachycardia (SVT) from as long as I could
remember and became a frequent visitor to different ICUs, something I learned
to hate.
Heart rate going over 270 beats a
minute could not enable the heart to adequately pump and deliver enough blood
to my body, as well as to my brain. We all know in the medical field what that
could do. What triggers the SVT, according to experts, could be anything from
getting tired to as simple as getting startled. From experience, it always
happens when I least expect it. Except for attacks I get once or twice a year,
I have led my life as normally as the girl next door. The thing that never
failed to amaze me was that I usually forget about WPW and SVT until I get the
next attack which would remind me I am not normal as I wanted to be. But as my
father taught me earlier on, mind should take precedence over matter. So I went
to pursue Medicine and never thought that my condition would deter me from my
achieving my goals.
After getting accepted in my
residency training, I was told that I needed to sign a waiver that would give
absolution to the hospital to whatever happens to me since Surgery is
strenuous. This was a novelty to me since I went through school, medicine,
clerkship and internship without my physical condition becoming an issue. But I
accepted and signed, knowing that I can be a Surgery resident and be as good in
my chosen field as any of my colleagues. Things went on smoothly without a
hitch until I reached my third year, when my physical condition became bothersome.
In 2001, after frequent attacks, my
work was affected with my absences. With medications only given to arrest the
attacks, I sought consult once more. I was given a different answer this time, I was offered to undergo a cardiac ablation an
alternative to open heart surgery. With cardiac catheters inserted in my
femoral and jugulars, the team proceeded to identify the aberrant fibers and
ablate them one by one. After what seemed to be an eternity, exactly on Valentine’s day, I was told that I now have the heart that I
always wanted. I could now do things that I thought I would never get to do
like run, climb, jump, and as my senior residents teased me without end, make
love and have a baby without killing myself. I was given a month to recuperate
but I cut my sick leave short and went back to work after two weeks.
Then all of a sudden I unbelievably
had what felt like another attack only slower this time and not so painful but
definitely an SVT, then another. I went back to my doctors and after several
more tests they confirmed it was SVT, a slower one, going 160 to 170 beats per
minute that was not apparent when I underwent the procedure because it was
hidden by the faster one. I did not get my wish after all but nothing changed
really, I’m still me.
Insights
I grew up learning that here are
limitations to what I can do physically. But thanks to my father, I also
learned that those I can do, I can do with everything I’ve got and excel if I
put my heart into it. This included wanting to become a surgeon and hopefully
in a month’s time, I would have done what some people thought was impossible
and crazy, finish my residency training still with WPW. It was not a bed of
roses. I tire fast and had to work twice as hard. All things of worth do not
fall into place easily.
This I have accepted with all my
heart.