Indexing Title: RSMujer’s MAR (06-03)

MAR Title: No man is an Island

Date of Medical observation: February 20, 2006

Narration:

It was the afternoon at the OPD, when I noticed an old lady, walking with obvious care towards to where I was sitting.

            The old lady tried to keep the grimace on her face from showing, but was failing miserably. Each footstep was calculated and sure. Her slow gait was being assisted by a person I knew well- a female nurse whom I’ve worked with for several years now in this hospital.

      It was then I realized that that particular nurse did talk to me a few days back. She related to me the medical history of a family friend, an old lady of 65-years who was suffering from tuberculosis, which affected her right kidney. The formation of a tuberculoma proximal to the renal pelvis caused an obstruction which then expectantly led to hydronephrosis. She’d been harboring a slow and progressive gradation of pain for 3 years now, but lately it seemed that the pain could no longer be contained- the pain was becoming worse. She’d already consulted a number of physicians in the city, and it was a concensus- a surgical intervention was required. She was prepared to have her right kidney removed, my friend said. The pain searing through her back was unbearable. But, further tests had to be done before a definite schedule of her operation can be settled.

      Despite her absolute willingness to undergo nephrectomy, her surgeons were quite hesitant to operate on her. They all gave her a hard truth- they could not and would not want to risk her life with such a difficult situation.

      She would not accept it. Living with a pain constantly lingering inside of her was simply not living at all. As a last beacon of hope for her, she contacted a family friend- a nurse to help her. That nurse then asked for my help…

      Even though I had my doubts on how the surgery would end for her, I took her as my patient. The day of her scheduled OR came, and I was ready to help her.

      But my optimism slowly evaporated as we saw the right kidney. There simply was no way I could get through this kidney! The organ was seemingly engraved over the retroperitoneum with thick adhesions. The OR suite was becoming more humid as I tried to explore any window, any space to proceed with the nephrectomy. It was proving to be a lost case…

      I felt, then I saw a tiny window of opportunity just below the medial side of the right kidney. Fortune luck was smiling upon me and I was thankful! There was a chance after all.

      But as quickly my hope was revived, it was lost again as I dissected over that small area. Massive bleeding was transpiring. I accidentally severed the  artery. I feared the worst as I tried to clamp the bleeder, but with all the adhesions and blood, I was not able to locate that injured vessel. With seconds ticking and spurting blood loss, the patient became hypotensive. I was losing her! I knew then I was not helping her, so I called for help from my consultant.

      With grace and expertise, I watched with awe and admiration as he blindly located the artery and clamped the bleeding vessel.

      After an hour, the nephrectomy was a success. And after several hours, she was wheeled in the infirmary after being stable in the post anesthesia care unit. And after several days, she went home- with not a single shred of grimace on her face.

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

      Nothing in life is certain. Just as there can never be a pure black and white scenario, there’s always a gray area of uncertainty. A guiding hand of wisdom is sometimes necessary to help us get out of that gray experience. This guiding hand may either be an abstract idea of a Higher power or a tangible individual.

      Circumstances of life make us decide to do things with an assured way of confidence. But the moment a sense of wrong is felt, we must be humble enough to realize that confidence would not salvage us from falling deep into a pit of obscurity. We must have the humility to ask for help.

      There are times that a simple prayer to Him could do wonders to one’s ability to overcome an obstacle. But then, there are also times that prayers alone is simply not just enough. 

      Nothing in life is certain. Maybe that is why we need people to be beside us. To help us. To nudge us to the right direction. To help us learn to step aside when we are lacking.

      Sometimes, in our quest to help, knowing when you need help and calling for help is certainly more heroic than being stubborn to admit your needing help.