INDEXING TITLE: JPINGUL’S Medical Anecdotal Report [5-02]

 TITLE: Knowing is Loving

 PERIOD OF MEDICAL OBSERVATION: February 26, 2005

 NARRATION:

 All of us make important decisions at least once in our life.  As a resident surgeon, we make decisions between life and death, almost everyday.

I was on duty, when a 34-year-old man was brought into the emergency room because of a stab wound on the 4^th intercostal space on the right para-sternal area.  He was gasping for air and in cardio-respiratory distress.

The team on duty initiated ABC’s of trauma, one member inserted a chest tube, which initially yielded 700 ml of blood.  We inserted 2 large bore intra-venous lines, but the patient’s blood pressure remained hypotensive.  At this moment, I was thinking of a cardiac injury, aside from the chest or pulmonary injury.  So I directed the patient to the operating room (OR).

When the patient was placed on the operating table, the patient was unexpectedly calm, his blood pressure was normal, his cardiac rate was normal.  I checked the chest tube, there was no more additional output. He was breathing easily.  I needed to decide, do I proceed with opening up his chest, or was the chest tube enough to save this patient?

I relayed my findings to my senior, who advised me to do a sub-xiphoid window to check for a cardiac injury, while observing the patient in the OR.  I saw the beating of the ventricles, without any trace of blood in the pericardium.  After the procedure, I noted that the chest tube output was profuse.  Having ruled out a cardiac injury, I was thinking of a vascular injury on the right side of the chest. I relayed my findings again, and was advised to do a thoracotomy.  So I proceeded with opening up the chest, repaired the bleeding vessels, repaired the heart (since there was injury after all), checked for other injuries, revised the chest tube, and closed the chest.

The patient was transferred back to the ward, thankful, and with a statement to reform his life.  A few days after that, I removed the chest tube and sent him home.

 INSIGHTS: (discovery, stimulus, REINFORCEMENT), (physical, PSYCHOSOCIAL, ETHICAL)

 When making important surgical decisions:

1. Read on information – we read books on Principles of Surgery, Mastery of Surgery, Trauma, and other books for us to understand the basic concepts in the management of surgical patients.  To keep us updated, we read on journals through the internet and try to solve problems encountered in everyday clinical practice.  We constantly learn and re-learn, continuously looking for ways to make things better.
2. Consult a more experienced person – a few words from the experience of our consultants or senior residents, is worth a month of reading books. And when we refer, the person we referred to will be accountable to us, and in turn, we are accountable to them with the follow-up of the patient.
3. Prayer – never take this for granted. First, because it clears up the mind of the unnecessary thoughts.  It removes the panic.  The train of thought becomes clear and simple.  Second, prayer brings confidence that the person is in the palm of an Absolute being, God.  What can go wrong, if God is in control.  The patient may die, for reasons beyond our capacity, but the giver of life is God, and may take it in His perfect time.
4. Vision – we have a goal.  We want a live patient, with no complications, with no medico-legal suits.  We are doing the procedure because we want to save the life of the person, not because we have to fulfill a requirement for our log books.  Each option is compared to others in terms of benefits, risks, cost, and availability. If the procedure is simple, but it will save the person’s life, then that is option for the patient.  Rather than a complex, time consuming operation with a lot of morbidity and a high risk of mortality.

 And this pattern of decision making is the same, when deciding on matters concerning our lives.  What residency to take? Which hospital to apply for? Whom will I marry? Where will I live?

 For us to make the right decisions for these life changing choices, we must take into account to get information on our options, consult a person with experience and knowledgeable in the field, pray, and always remember the life goal you have set for yourself.