Index Title: RDELEON’s Medical Anecdotal Report [05-06] 

MAR Title:    Duty Calls 

Date of Observation:  July 2005 

Narration 

It was a relatively easy Friday morning duty and I was manning the Emergency Room (ER). Since our team had no elective operation, I was thinking that the morning will come as a breeze.  

At around 10 a.m., a man approached me and handed me a letter from the Director’s Office. The letter was addressed to Surgery Resident on Duty, asking us to assist the bearer in evaluating and managing his epigastric pain. 

The man introduced himself as the Station Commander of Precinct 9. I asked him of his present condition. I took the history and did the physical examination and from the data that I gathered it looks like the patient was having acute appendicitis.

Since my degree of certainty of the diagnosis was around 70 %, I opted to observe and monitor the abdominal pain of the patient. I referred the patient to my senior resident and he agreed with my present management. After serial abdominal examination, the degree of certainty was still low and we asked for urinalysis.  

As we were waiting the result of the requested examination, serial abdominal examination was still being done. Every now and then I talked to the patient and explained his present condition. 

Since he was a policeman and has a major position in the rank of police, his two-way radio was on. From this, his kept himself updated to the present situations and kept in touch with his colleagues. 

When the results came in, I went to the patient with the intention of doing another physical evaluation and explain the results to him. As I approached him, I overheard him talking over his cellphone. So I let him finished his call. 

His companion told me that the patient was finished with his call. The patient immediately told me that the call came from a general and asking him to attend to a present situation somewhere in Manila. He begged me to be released from the hospital and told me that he was alright.

I did my re-evaluation and from my assessment, Acute Appendicitis can not be totally ruled out. Still their was direct tenderness on the RLQ but no guarding and rigidity. Again, I referred the patient to my senior. As my senior resident evaluate the patient, he to agree to my assessment.  

The patient once again begged to be discharged so he can fulfill his job. Seeing that the policeman was determined to be discharged, my senior resident and I agreed to discharge the patient with proper advice. 

So I explained to the patient his present condition. He attentively listened to my advice and possible outcome of his decision. As I was discharging the patient, he told “Kung di lang sa aking trabaho, eh magpapaadmit po ako. Kaso tawag po ng trabaho at sadyang kelangan na kelangan ako!” 

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

I have to say that I salute this policeman. Even though he was ill and he knows he needs medical attention, he set aside his personal needs just to accomplish his job, his pledge of loyalty and service to his countrymen.  

As for all of us, we should fulfill our oath of duty to the best of our ability. We should give more of ourselves to accomplish our work. 

We should explain thoroughly to our patients their conditions and its possible complications and outcomes. Though the patient is at liberty to decide for himself, we should make sure that they fully understand of their decision.