INDEXING TITLE: RSMUJER’s Medical Anecdotal Report [05-07]

MAR Title:  Surgeon’s virtue 

Date of Medical Observation: July, 2005  

Narration:

One afternoon, a very thin, pale pregnant woman in twenties was referred by OB- Gyne department because of a severe abdominal pain which she had been experiencing for almost 5 days. Their impression was PU 24 weeks AOG; T/C Acute Appendicitis. On physical examination, abdomen was tender on all quadrants, there was a muscle guarding noted between RLQ and RUQ of the abdomen. There was no mass palpated except for the enlarged uterus. The OB resident told me that pelvic UTZ was done and they noted a normal Fallopian tubes, ovary and enlarged uterus. Though I was thinking of a surgical abdomen at that time I doubted it as it was acute appendicitis but a gynecologic in origin. We left no choice but to book the patient for emergency operation. We optimized patient condition, explained the condition and possible outcome, psychosocial support given and consent was secured. Upon opening up, we noted a massive hemoperitoneum came from a bleeding uterus and the appendix was normal. I referred the findings to my seniors and they immediately responded. Through enough, it was a ruptured uterus. We decided to refer back patient to OB-Gyne department and they conducted further management.

 Truly, First impression never last. Like what others say, “There is lapse of judgment”. Again, the final determination is always on the surgeon. Nevertheless, the operation was successfully done.

INSIGHTS : (physical/psychosocial/ethical/stimulus/reinforcement/discovery) 

            Although as such turned out to be a gynecology case which belongs to their expertise, we still kept it as a surgical burden. That is one of the virtues I have learned and embraced from our profession, always for the welfare of the needy patients. Like the sayings, “Better err on the side of commission than on the side of omission.” However, I still believed that there should always be a realization in every case encountered. One should have its own disposition in dealing with illnesses based on each expertise. Referral is truly recognized, but it should be observed hardly ever for a speedy but a very careful treatment. In effect, I came to realize that in circles of doctors, always the surgeon is the patient’s last hope. And we the four team mates have extremely experienced it.