Index Title: OLEYSON’s Medical Anecdotal Report [05-10] 

MAR Title: Perforated life 

Date of Observation:  December 4, 2005

 Narration 

            78-year-old male who underwent Explor laparotomy for suspected perforated gastric ulcer. One week prior to admission patient experienced generalized abdominal pain. He was on medications of non-steroidal anti-inflammatory drug because of his arthritis of the knees. Intra-operative finding were perforated prepyloric ulcer. I did a biopsy first and primary repair by suturing with silk 0 and an omental overlay to protect the wound. Patient recovery was unremarkable was discharged and surprisingly on the 5^th hospital day. 

He followed-up at the surgery out-patient-department and when I saw him there was radiance in his smile and handed over his histopathological report. It revealed a Gastric Malignancy highly considered, I smiled back at him with his wife and told them about the devastating news. I explained the case to him and surprisingly no amount of problem could ever take away his smile at me. He uttered to me “ Doctor alam ko na po  un sinasabi nyo, naiintindihan ko nap o. Maraming Salamat pa rin po. Hindi na po ako magpapaopera. Tama nap o iyon dinagdag nyo pong buhay sa akin. Tanggap ko na po”. I paused for a while and agreed to his decision and let them sign our agreement.

Insights (physical, PSYCHOSOCIAL, ethical) / (Discovery, stimulus, REINFORCEMENT):

         My patient helped me realize my own humility. Though I was in no doubt of my diagnosis, my plan of operation still the consent lies on the part of the patient who will trust you with his life. In this case under such circumstance patient received the enough through his life and was contented after the first surgery. Maybe he know he might not make it the second time around because of the risk involved albeit the gravidity of the second diagnosis at hand.  Nevertheless, he chose the path that would make his life more contented.

The best evaluator of my maturity in decision making was neither the length of years I spent learning, nor the number of operations I had; but the experience and wisdom my mentor partake and the patients who entrust us with their life.