Indexing Title:

        MJCABAHUG’s Medical Anecdotal Report [05-06]

 MAR Title: 

        LORD OF THE RINGS

 Date of Medical Observation:

        June, 2005

 Narration:

       Have you ever asked yourself if how many rings are there supposed to be in a finger? Maybe one, two, five..... No one really knows. What I am about to share with you is a FIRST ( and probably the last ) in the history of Ospital ng Maynila.      

      It was just like any other Sunday duty. I was manning the Emergency Room and patients come by the strokes. It was around 11 a.m.  when a man approached me and said, "Doc, magpapa-admit po ako".

     At first glance, I noticed that there was nothing wrong with him. I asked him, "Bakit, ano po ang problema?" He did not reply and instead, he placed his right hand on the table and slowly removed the towel that was covering it. "Dahil po dito", he then said.

    What I saw was a very swollen 4th digit. So I told him to occupy one of the beds and will attend to him once I'm done with the other patients. Thoughts were running in my mind what could have possibly happen to his finger.

    After a while, I went to him. Again, I asked, "Ano po ba ang problema?" And again, I got no reply. but it was obvious that he was grimacing in pain. I took his right hand and examined it. On closer examination, I saw two rings stucked up in his 4th finger.

    And so I asked, "Kailan pa ho ito?" " Mahigit tatlong linggo na po", he said. Upon hearing that, something in me tells that I should get angry with him, but I chose not to. It's because I'm more concerned with his problem ....How to remove those rings?

     At that time, the only thing I could think of was to use a "steel saw". which I asked the relatives to buy. After a few hours, it arrived. I told my junior co-resident to prepare the materials in what may seem a very long procedure.

     Before starting, I thought it was prudent that I give him some analgesic to lessen the pain he was bearing. It was 1:30 p.m. and I started my quest. It was some sort of an "extra challenge" for me. Because of the swelling, it was really difficult to strike the saw, specially when the patient groans every time I made a move.

     But with confidence and determination, I was able to find a way. After some time, the first ring was history. Now, it's time for the second ring. I just did the same maneuver and successfully removed it. But as I was removing the 2nd ring, I felt something hard close to it.

     I thought it was already the bone, but it was not. So I decided to ask the patient, "Ilan po ba talaga ang singsing niyo dito?" He did not immediately reply and so I asked him again. He then answered, "Apat po" I got the surprise of my life and could not get the idea how it happened.

     It means that there are 2 more rings waiting for me. I hope he was joking, but as I checked it, there were really 2 more rings deeply embedded in that swollen finger. They say patience is a virtue, but at that time, i was losing it. There was nothing I can do but to remove them.

     Luckily, I was able to find a way out with not much difficulty. It was 4 pm and my challenge seems had no end. I decided to check his left hand and what I saw were 5 rings in the same finger.

     I noticed that it was beginning to swell and so I told him, "Sir, tatanggalin ko na itong mga singsing sa kaliwang kamay niyo bago mahuli pa ang lahat." All he can do was to give me a nod.

     And so I removed them all. After that, I gave all the rings to him. It was around 5 pm and I made my orders for him to be admitted so that I can observe his 4th finger.

     After 2 days, the patient absconded and was no where to be found.  He was gone together with his precious rings.  

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

     Surprises do come in one's life. Some are pleasant while others maybe not. In a residency training, surprises almost come everyday. It test your abilities and decision-making and sometimes your PATIENCE.

      I must admit that what I experienced was a FIRST for me. Being in that situation, I could only think of what's best for the patient.

      I could have easily blamed him or got angry but my conscience tells me that he is still a PATIENT. And it is my duty to do whatever I can to help him.

      Rings being stucked up in a finger is a common scenario I find at the ER (but not like the one I just narrated). We can deal with those simple cases but if it is like the one I encountered, we should be ready for it.