Indexing Title: NALUDINOs Medical Anecdotal Report [05-07]

MAR Title: Complacency

Date of Medical Observation: August 8, 2005

Narration:

It was early in the morning, post duty, I was left manning the ER. All my teammates were at the operating room, doing elective operations. I was finalizing our orders for those patients who were still at the ER. It was supposed to be a routine morning, all were benign cases. I was mistaken.

The silence of the emergency room was broken by a group of men, scurrying, trying to look for a stretcher or a wheelchair. When they finally did secure a stretcher, they immediately brought their patient in. When I saw their patient, I realized that this will be an eventful morning.

The patient was in his early 20's, hypotensive, in cardiorespiratory distress Quickly examining the patient, I noticed that he had crepitations on the right hemithorax, with absent breath sounds. Closer examination revealed "paradoxical breathing." This patient had multiple rib fractures, resulting in a flail chest.

I decided right then to insert a chest tube, a procedure which I had done a number of times. As soon as all the materials were prepared, I proceeded to insert the chest tube. When I was about to insert the curved haemostat, something I have done a number of times, I had great difficulty. There I was, beside a patient in distress, having difficulty performing the life saving procedure.

When I was finally able to insert the haemostat and do muscle splitting, I had a hard time inserting the chest tube. Feeling helpless, I immediately called for the assistance of a senior resident. With some effort, she was finally able to insert the chest tube. After evacuating almost 1.3 liters of blood, and after the initial signs of relief from the patient, he suddenly went into shock.

Efforts at resuscitation proved futile and the patient expired.

Insights (Physical, Psychosocial, Ethical) (Discovery, STIMULUS, Reinforcements):

They say that practice makes perfect. The discipline of surgery is based on knowledge and skill. As such, doing the same procedure over and over again coupled with understanding enables us to become better surgeons.

In our quest to become good surgeons, we must avoid the pitfall of thinking we know everything. It was stated earlier that practice makes us better. There are times when practice makes us think we have perfected the procedure and it leads us to complacency. Complacency leads to stagnation. Stagnation leads to errors in judgement. Errors lead to morbidities and mortalities.

Should it take a tragic event to take us out of complacency? I hope not.

Sometimes we are faced with a situation which we cannot handle alone.

We must be man enough to realize this, and ask for the help of those who have more experience. This is both for our sake and the  patient's.