Indexing Title    BCDEVEZA's Medical Anecdotal Report

MAR Title  "Playstation"

Date of Medical Observation   May 2005

Narration

      It was another day in the hospital. I was on duty and as usual, we received the endorsements from the other teams. The from duty group endorsed 3 patients which they assessed to have Acute Appendicitis. Somehow I felt excited because most probably, I will be the one to handle these patients. I know that my seniors will give me the chance to do the operation, But little did I know that something will happen which will leave an imprint in my life.

     It was on my third and last appendectomy on D.T., a 21 year old male. He was quite big for his age. Pre-operatively, I re-assessed him and there was direct tenderness in the right lower quadrant. I, together with senior, proceeded to do the operation. Everything went smoothly not until we reached the peritoneum. Upon opening, we noted purulent peritoneal fluid. Thoughts were running through our minds that this might be a perforative appendicitis.There was generalized peritonitis  which was not evident on physical examination. True enough, the appendix was perforated proximal to its tip. We removed it and washed the abdomen thoroughly. Layer by layer closure was done, leaving the subcutaneous layer open. He was then transferred to the recovery room. Post-operatively, he was stable. I was able to talk to him and he said, "Kuya, pag labas ko dito, itutuloy ko yung paglalaro ng playstation ko." After that, I went to his room and talked to his parents. I explained our intraoperative findings and the dangers it can bring to their son. It was difficult for them to accept it, but I had to do it.During our conversation, I told them that their son mentioned something about the playstation and they said, "Doctor, naglalaro kasi siya ng playstation bago namin siya dalhin dito.

     Later that day, he was transferred to the ward. I made my rounds and he was doing fine during that time. When I went home. I never thought that something bad will happen to him. Around midnight, I received a message that he was not doing well. He had minimal urine output, had bibasal crackles and hypertensive. When I came to the hospital the following day, I noticed that he had changes in sensorium, was febrile and had episodes of hypotension. We did the necessary measures and somehow we were able to maintain him. I was in shock and was thinking what could possibly happen to him. I talked to the parents, family members and relatives. I told them about the pressent condition and reassured them that we will do everything to save him. But it seems fate has to take its course. At around 9 p.m., the inevitable came. Tears flowed in the room. His mother approached and hugged me, while whispering to my ears, "Maraming salamat doctor, maski paano, ginawa niyo po ang lahat para sa anak pero hanggang dun na lang talaga siya. Hindi ko kayo makakalimutan."

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

     This incident reminds me of a great lesson taught to me during medicine school. It is something I always keep in mind whenever I am confronted with a situation like this. It goes :

HONORA MEDICUM, OPERA EIUS SUNT NECESSARIA.DUES AUTEM EST QUI VITAE ET MORTIS.HABET POTESTATEM ( HONOR THE DOCTOR, HIS WORKS ARE NECESSARY.

HOWEVER GOD STILL HAS THE POWER OVER LIFE AND DEATH. ) 

     More often than not, as doctors, we find ourselves dealing with dying patients. Patients whom we never know. But it is our duty and responsibility to do all that is necessary in order to extend their life. If we fail, we just have to accept that its something that we cannot decide.We must realize that there is a higher power that has control over us. Acceptance is always difficult but it can be done.

     The life of my patient has to end there, for reasons I do not know. Perhaps he has already accomplished what he has to do or God does not want him to continue playing with his playstation anymore. Perhaps He wants it to be played SOMEWHERE else.