Indexing Title: DCHUA’s Medical Anecdotal Report [06-2] 

MAR Title: Concrete Thinking 

Date of Medical Observation: January 2006 

Narration: 

A thirty-one-year-old sought consult with a 10 cm breast cancer with overlying orange-peel-like skin.  She had the tumor for half a year now, had underwent incision biopsy at another institution, but had financial constraints to further workups prescribed.  Measuring the maximal allowable superior and inferior displacement of the mass within the breast, I thought the operative wound couldn’t be closed if she underwent the operation then.  She procured the chemotherapeutics to shrink the tumor thru the help of a sponsor. 

When the time came, my consultant saw her, decided otherwise that the resulting wound could be closed, pointed out that I had overlooked ongoing medications that might make the chemotherapy less effective, and decided to get estrogen tumor markers for possible simultaneous removal of the ovaries.  Estrogen markers turned out weak but reactive, and it was decided to forego the oophorectomy. 

Later, she instructed me when to admit the patient, and a couple of days later, the weekend before the operation, the patient came as planned.  On the morning of the operative day, I received a text message from my chief, informing me that a different case could not push thru as planned.  I was to inform my consultant that her operation would suddenly be moved up by half a day with just thirty minute’s notice. 

My failure to inform my consultant of the patient’s admission, and my informing her of the sudden change in plans led to unbridled anger and my loosing the case.  The patient underwent an uneventful operation after my borrowing various medications from other people.  I then saw her thru an equally uneventful recovery.  As it turned out, problems with her government insurance benefits left me holding the ball long after the game had ended.

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

Medicine is constantly evolving and one has to keep up with currency of recommendations. 

One has then to keep in mind interactions and variations of different treatments.  It is better to confer, thereby keeping better tract of the picture. 

Transmission of information should then follow, in good time, and thru clear media, to all concerned, as everyone have tendencies to see just single sides of any coin. 

Still, there are many things beyond our control.  When dealt with a loosing hand, make the best of it, accept the loss, and keep on going.  Things will even out eventually.