Indexing Title: DCHUA’s Medical Anecdotal Report [06-4] 

MAR Title: Look Before Leaping With Faith 

Date of Medical Observation:2005 

Narration: 

            Another hectic day had just started when I was called in as substitute-surgeon for an old lady with hemorrhoids.  I rushed to the operating room and skimmed the chart while the patient was being anesthetized.  I mentally rehearsed the procedure, it having been a long time since I’d done such a case.  Hemorrhoidectomies were usually assigned to second year residents after all, and here was a nice little sketch (by someone who had done quite a few himself) of the cauliflower-like anal mass that was causing the grandmother all the trouble.

            I decided to leave the octogenarian flat on her back instead of on her tummy, as was the usual practice in this particular hospital.  Spreading her legs onto the lithotomy stirrups, I was surprised that the anus looked quite normal.  It would have been difficult for a huge hemorrhoid to have resolved in less than two weeks.  The hemorrhoidal piles could still not be appreciated on retracting open her anus.  I just stuck in a cord of gauze, pulled it out stimulating defacation, and proceeded with excising what I presumed to be the dilated vessel cushions.  All the while, a little voice kept telling me that such small hemorrhoids could easily be treated medically.  I was caught in the stampede of events and could only follow-through.

            When I saw the admitting resident sometime later, I chided him on his findings, which he did not recant.  When I saw the patient sometime later still, his husband told me that her hemorrhoids had returned less than a day since the operation!  I took a peak and saw a large prolapsing soft fleshy polyp, which I tied and cut-off at bedside without further ado.  I sent the patient home the next day, all smiles and thankful for what I had done for her.  Weeks later, the pathology report revealed a benign polyp and I advised the patient to undergo colonoscopy to screen for other problems.

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

            There can be no substitute for assessing one’s patients even before admitting them to the hospital.  In the ever-growing world and hospital however, it is sometimes necessary to delegate.  One should learn how to assess the validity of second-hand information, by personally learning the capabilities of the delegate and matching it with the situation at hand.  One should not go too far off the other end though.  Balancing a healthy amount of caution with that of controlling paranoia is similar to balancing critical appraisal against abject disbelief of third-hand information while reading the news or technical journals.  These are skills learned through mistakes.  Fortunately for me and my patient, nothing bad happened…this time around.