Indexing Title:

RJOSON_s Medical Anecdotal Report [05-1]

MAR Title:

Surgery-induced Disability

Date of Medical Observation: February 6, 2005

Narration:

During my regular Sunday mass at the Saint Andrew Parish Church in Makati City last February 6, 2005, I chanced upon a neighbor whose son had a cystic hygroma on the neck.

Ten years ago, the boy, about 6 months old then, was operated by a pediatric surgeon in a private hospital.  After the operation, I was consulted because of the severe disability resulting from the surgery and the presence of residual-recurrence of the cystic hygroma.  At that time, the boy had a tracheostomy and a nasogastric tube for feeding.  I tried weaning him off from the two tubes but without  success.  I was resigned to the probability that the disabilities  would be permanent and accordingly, I advised the parents on such a prognosis.  At that time, inside me, I was sad for the boy_s  postoperative disabilities.  I told myself a lot of things such as the boy probably should not have been operated on at that early age since the diagnosis was just a cystic hygroma;_ _the surgeon should have avoided nerve injuries that caused the vocal cord paralysis and dysphagia;_ etc. 

Note: these were personal feelings and were not expressed to the parents.

I did not have follow-up information on the boy_s condition until last February 6, 2005, when I chanced upon him, at age 10.  From a  distance, the deformity on the neck was obvious _ there was a depression on one side of the neck that probably resulted from the removal of soft tissues and/or paralysis of the sternocleidomastoid muscle; there was a permanent tilting of the neck towards one side; and there was a tracheostomy tube.  There is no nasogastric tube anymore.  The residual-recurrence that I saw ten years ago did not significantly grow in size.  The boy is going to school and apparently has adjusted well to his disabilities.

Insights (Discovery, Stimulus, REINFORCEMENT) / (Physical, PSYCHOSOCIAL, ETHICAL):

Practicing medicine and surgery is essentially problem-solving and decision-making with the goals of resolving the health problem in such a way and as much as possible, that the patient does not end up dead, with no complications and disabilities and in such a manner that the patient and relatives are satisfied and there is no medicolegal suit.

Surgery is a double-edged treatment tool.  While trying to resolve the patient_s surgical disorder, the surgeon invariably creates a deformity (oftentimes scars, at times, loss of normal tissues).

Sometimes, disability occurs as a result of the treatment.

As surgeons, we should always weigh and balance the advantages and disadvantages of our contemplated procedures.  In medical parlance, we consider the benefit to risk ratio when we decide on something, either for diagnosis or for treatment.

As a medical practitioner, I will not criticize the surgeon who created the disabilities on the boy that I presented. I have to give him the benefit of the doubt that he/she decided and operated with due diligence.  I just pity the boy.   I hope that such incident does not happen to me as a surgeon and to my patients.  I resolve to be vigilant against surgery-induced disability.