Indexing Title: JGGuerra’s Medical Anecdotal Report (05-03)

MAR Title: The Making of A Surgeon II

Date of Observation: March, 2005

Narration:

It’s been quite a while when me and my wife had our last romantic date. Oftentimes we were both preoccupied with our respective works that we sometimes forget to chill out. Until one Sunday afternoon, we had an opportunity to sneak out and go on a date. We were both excited, as if it was our very first date. We already planned the whole dating thing, I promised her a good movie and a fine dinning. I never thought something unexpected would happen.

Halfway through the movie, my mobile phone beeps. Initially, I did not mind the alert. Then another beep, and another and another… Disappointedly, I excused myself and headed to the CR to check the series of text messages. To my surprise, it read, "Your patient ten-year-old female SP Appendectomy, at the ER, with two days abdominal pain, distension and high grade fever. My hand was shaking badly as if I had coffee nerves. Initially I asked myself, is it postoperative obstruction, adhesion, or retained abscess? Such questions were boggling in my mind that needs to be answered. I hurriedly went back to my wife and asked her whether she wanted to finish the movie or see my patient at the hospital. Without hesitation, she told me, "let’s see your patient first, our date can wait." I kissed my wife and we headed to the hospital.

At the Emergency Room, I noticed a wasted patient, gasping for breath. When she recognized me, I saw a smile on her face. She uttered, " Dr. Guerra, tulungan mo po ako." I reassured her and the family that we will do our best to attend to her needs. On history and physical examination, pattern recognition of the disease was pointing out to intraabdominal abscess. There was a palpable mass on the pelvic area. We started to hydrate the patient, and prepared her preoperatively for Exploratory Laparotomy. I informed the service consultant and agreed on the contemplated procedure.

At the operating room, I was staring blankly at my patient. Suddenly, my co-resident tapped me on my shoulder and said, "OK lang yan, cheer up". We are all puzzled on what to expect out there. Upon opening up the abdomen, we noticed adhesions of the ileum with pockets of abscess in between. We tried to evacuate the abscess and wash the abdomen. We proceeded with the exploration and to my shock, I found a stump blowout. The thing I don’t want to see in my patient. My heart pounded like a jackhammer, cold sweats were dripping heavily all over my body soaking my scrub suit. My God, where did I go wrong? We revised the stump and did the rest of the procedure. The operation went on smoothly.

Post operatively, the recovery was not that stormy. Presently, my patient is on the verge of full recovery. What an experience.

INSIGHT (Physical, Psychosocial, Ethical)(Discovery, Stimulus, Reinforcement)

It is boldly inevitable to finish Residency training without encountering operative challenges and complications. It is of great importance how a trainee will deal with such problems. A young surgeon on training may either respond positively or negatively. Negative in the sense that one’s confidence might crash down to the ground in one blink of an eye. This behavior is more or less acceptable initially, however, on the positive side, we must not let this problems affect our subsequent operations. Instead, we must view this as a learning experience that will help us not to commit the same mistake again.

During our life as a surgeon, we will meet problems pre-operatively, intra-operatively and post-operatively. These problems make us a fine tuned surgeon in terms of surgical skill and decision making. We are being prepared to combat further problems when we go out on our own.

I fully agree when my mentor told me and I quote, " A surgeon who says that he has never come across a complication is neither telling a lie or has not done enough operations to experience one.