Indexing title: MDGalvez’s Medical Anecdotal Report [05-02]

MAR title: David and Goliath

Date of medical observation: MARCH 2005

 Narration:

 My uncle, a surgeon, has a patient who had undergone multiple gynecologic operations a month ago and is now septic due to pyocolpos. Drainage and curettage was done and the procedure went without any complications.

She was doing fine till 5th post operative day when she experienced spiking fever, abdominal distention, upper GI bleeding and she really looked septic. Labs revealed a low WBC count, hypo K, +widal test, amoebiasis and normal BUN/Crea. UTZ revealed no intra-abdominal and the only abnormality is distended gallbladder with lithiasis and thickened walls.

The patient was referred to a total of  7 specialists of which 5 were surgeons. It was agreed that the patient should undergo an emergency cholecystectomy because it is the underlying cause of the sepsis.

My uncle requested his friend to allow me to asses the patient hoping that 8 would be a charm.

I was requested to visit the patient and make my recommendation.

At the nurses station, I was greeted by a large man whom I felt made his presence known wherever he goes. What made things more tense, the doctor turned out to be a relative.

“Doctor, you agree she needs an operation right?” I was so scared to disagree that I said yes. I even explained to the relative why an operation is needed. I was also afraid to say otherwise since he has already decided on operating. I was such a hypocrite to even plan the operation even if I felt it was not needed. Besides, I was buying time hoping that my uncle would arrive and help me convince him that the operation is not warranted at this time.

I kept on excusing myself to examine the patient and hopefully think of a way to relate to the doctor in such a way that I wouldn’t appear arrogant. It made me sick knowing that I will soon operate on a patient with no indication.

It was so pathetic of me. I felt worthless. I failed as a physician. Surprisingly I insulted my self so much that I got the courage to stand up to the doctor and explain the patient’s condition and that surgery is not the answer. He listened. His tone of voice turned meek and mild. I felt like a teacher lecturing about physiology, medicine and surgery to a clerk.

My uncle had been behind me all the time. He patted me on the back and they both left no longer worried and more relaxed.

I am now the new doctor of their patient

INSIGHT (physical, PSYCHOSOCIAL, ETHICAL) (discovery, stimulus, REINFORCEMENT)

Armed with the proper knowledge and confidence, I was able to avert en error in judgement. It may be the manner I spoke with the doctor, being respectful and not appearing condescending, but definitely because of the evidences I presented that made the difference. Even an ogre would listen to reason if approached properly and without losing respect.