Indexing Title: NALUDINOs Medical Anecdotal Report [07-06]

MAR Title: When the simple becomes complicated

Date of Medical Observation: June 2007

Narration:

 When do you consider something to a simple thing? When you consider it as such, do you prepare less? What happens if the simple thing becomes complicated? A simple case becoming complicated. A physician’s nightmare. Unfortunately, this happened to me.

 A man in late 50’s was referred to our department. He was suffering from gastric outlet obstruction secondary to pyloric stenosis due to a chronic ulcer. We scheduled the patient for gastrectomy. The operation went well. It was quite uneventful, or so it seemed. During the initial days of recovery, everything was routine. We thought that the patient is on his way to a full recovery. We couldn’t have been more wrong.

 The patient soon developed postoperative complications, which we considered as indications for another operation. Eventually, we did operate on the patient and tried to correct what was wrong with him. A few more days passed by. The patient was not improving. In fact, the patient was becoming worse. One complication piled on top of the other. Soon, he was transferred to the ICU and expired after a few days.

 The simple becoming complicated, a physician’s nightmare indeed. In my case, it is a nightmare that still plays in my mind.

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

 Do we ever consider ourselves fully prepared, fully equipped to meet all challenges? Can ever say that we know enough to be answer all the questions? As physicians, can we prepared for all eventualities? Some would probably prepare to debate on that. I would say that we cannot. The spectrum of possible complications are so great that we cannot prepare for all. It is just impossible.

 However, I agree in saying that we should at least prepare for most of the known complications in managing our patients. We should do justice to the trust given to us by the patient by preparing for the different modes of treatment available and the different possible complications. If still, we are faced with a situation for which we are not prepared for, there is no harm in asking for help.

 In this case, I can say that to a point, I was not prepared to face the whole gamut of complications that were presented to me. To some degree, I was overwhelmed. I resolved that I would minimized this from occurring. I would not waste the lesson learned from this. A simple case becoming complicated.