Indexing Title:

DCHUA’s Medical Anecdotal Report [05-5]

MAR Title:

Dead Man’s Hand

Date of Medical Observation: May 18, 2005

 Narration:

             An 18-year-old male was referred to Surgery from the Internal Medicine Emergency Section for ruptured viscus.  The internist smugly showed us the x-ray plate with air under the patient’s diaphragm, but was reprimanded for not starting antibiotics, monitoring or correcting the hydration, or eliciting the prior hospitalization of the patient.

            The parents reasoned out that financial constraints led them to transfer their son to our institution from a provincial hospital where no medications were being given during the previous four days.  The patient claimed to have voided that lunchtime, but after a quick four liters of intravenous fluids, he still produced no urine.

We explained the direness of the situation and directed the patient to the operating room where he convulsed and was intubated.  On induction of anesthesia, his blood pressure dropped.  Should I save myself the trouble and just let the septic shock take its course?  We would be spared from the effort and the stress.  I would be spared the questions, the audit, and the blame.  Both the hospital and relatives would be spared the resources.

The patient faced certain death with his failing organ systems.  Controlling the spill from his necrotic intestine might give him a lottery of a chance.  This was the first time I’ve had an anesthesiologist-consultant cross-examine me prior to an operation, and the first time I would be seeing, let alone doing a procedure one only reads about in history books, simple as it may be.

A few minutes later, I had the gangrenous segment of the ileum laid out, did a quick toilet of the soled peritoneal cavity, and closed up the patient.  He eventually recovered his blood pressure and even some renal function before succumbing the next day.

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

            When dealt a loosing hand of cards, do we go down fighting or do we realistically just fold?  Is life but a game?  Are patients but numbers?

            Volumes have been written on Ordinary versus Extraordinary means to save and maintain lives as well as to assist death.

            Would I do it again?  We were not overwhelmed with patients at the time and my hands were not tied down by so limited resources.

            If I saved but one in ten or one in a hundred, yes- it would all have been worth it.