Index Title: HCRUZ’s MAR [06-04]

MAR Title:  Ode to the Great Surgeons

Date of Medical Observation: May, 2006

 NARRATION                                                 

            With time comes great wisdom. I say this with enormous respect and admiration to the remarkable surgeons we residents call OUR CONSULTANTS. Let me give you an example why I’m such a big fan of theirs. We had a 45-year-old male patient who came in due to persistent right lower quadrant abdominal pain, anorexia and the works that shouts out “Hey, I have appendicitis!” The patient was operated on approximately 8 hours after being diagnosed with the condition.

            After the operation, the patient was recuperating well. Bowel movement was in order. On the 2^nd post-operative day though, he had abdominal distention with colicky pain. We put him under support for ileus, smug that the incident will come to an end after a day or two. But this was not to be, things only got worst. Although adequately hydrated, the patient had anasarca and was not producing urine – clearly in acute renal failure.

            Personally, I was in a state of panic – if you haven’t guessed it yet, obviously I was the surgeon of the appendectomy.

 Then his complete blood count came that showed a drastic drop of hemoglobin from a 12.0 to a 5.3, at that point I think I looked extra paper-white than the patient. I was numb, Hiroshima might have taken place then and I would not have mind. Although we could not elicit any signs and symptoms that indicated acute abdomen that may be due to intra-abdominal bleed or an evolving infectious process, we see no choice but to reopen the patient. My seniors were as cool as ice; nothing seemed to fluff their feathers, while I felt like a plucked duck.  Our consultant was not convinced either that the case was surgical. He explained calmly why it wasn’t so; he advised us that the best management would be medical. The amazing thing was, he never even saw the patient, yet he had already built up his initial deduction based on our assessment and bits and pieces of information.

In the end, we performed an exploratory laparotomy and saw….nothing. Our consultant was right! I was so relieved; it felt like receiving the gospel from Christ Himself.

INSIGHT (Physical, Psychosocial, Ethical) (Discovery, Stimulus, Reinforcement ) 

I have always held those who have great intelligence and wisdom in awe. Since I could remember, I‘d listen open-mouthed to conversations and arguments being hurled around the table among the discussants. I told myself I’ll never be that good. Some younger doctors may exude intelligence, but the consultants have a way of channeling their thinking to a common goal and a common good that can only be acquired through the passing of time.

After I had given a report once, I was asked if I can see in my mind where all the questioning is going. That was after 20 minutes of rigorous query and subject matter discussion by the consultants. I knew they were trying very hard to guide me, for me to contemplate in a proper and orderly approach in order to reach an apposite answer. To leave no stone unturned. But sad to say my brain potential was never at par with theirs – I was left behind by a continent! Frustration kept creeping in and I said to myself “I can’t wait to start being like them and stop being like me.” Someday I hope to be better, maybe not as good, just enough to feel that I’ve finally reached the golden gates of being a great surgeon.