Indexing Title: DCHUA’s Medical Anecdotal Report [06-5] 

MAR Title:  New Things Learned, Old Instincts Abandoned 

Date of Medical Observation:  May 30, 2006 

Narration: 

            A week ago, I received a referral from the Pediatrics Department for a newborn male with apparent evisceration.  The baby had an omphalocoele, which on inspection was a wide-based transparent peritoneal sac containing most of the intestines, the liver, and the stomach.  I referred the case to my consultant, who agreed that the operation faced was wrought with difficulties.  In trying to close the abdomen, we would take up part of the space of his lungs.  Prolonged intravenous nutrition and breathing support with machines would be out of reach financially, as confirmed by the baby’s parents.

            My consultant also told me to inform the regular specialist who was allegedly still on leave.  I quickly brushed up on a new Pediatric Surgery reference textbook and was surprised to find non-operative treatment options.  I was even more surprised when the regular consultant instructed me on such a definite plan of conservative measures to let the sac firm up until skin grew over the defect.  Leaks from the sac would be sutured and only frank rupture would entail operations that I knew for the past 5 years to be the standard of care.  This picked the interest of the first consultant, a fact that surprised me the third time over.  The wound would allegedly contract smaller during healing, and the repair of the fascial defect under the skin would be done a year later.

            Today I heard that the parents slipped away from the hospital, abandoning their child behind.  With the ongoing infection, without financial support, and without unconditional love from his parents, this child will not make it through.

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

        Medicine is an ever-changing science.  As new research and clinical experience broaden our knowledge, changes in treatment are required.  We should make every effort to ensure that the treatments are in accord with the standards accepted at the present time.  This is of particular importance in regard to new or infrequently done procedures.  This common medical precept does not exempt even those with vast experience or knowledge. 

        Love is an ever-changing emotion.  As new hardships constrict our hearts, changes in relationships occur.  We should make every effort to ensure that our reactions are in accord with the underlying basis of such love.  This is of particular importance to a mother’s love for her defenseless child.  The common notion that it is inviolable is sadly untrue for those who have seen enough.