Saturday, 2 February 2008

My 19 hours operation

I was on call last month and I had to take over an elective case which was running late. The operation started at about 9 am. I took over the the case at about 11 pm and the operation finished at 4 am the next day. It was a case of Malignant Teratoma in the abdomen. The sad part was that the arm of the surgeon was "twisted" to perform the surgery. The patient was told that it was inoperable as the tumour had grown so much that it had involved the major vessels such as the abdomen aorta and inferior vena cava. Refusing the accept the surgeon's advice .... this patient pulled some "major cable" and managed to get a prominent person in the health ministry to call this surgeon and demanded that the surgeon perform the operation stating that the surgeon is not being compassionate, etc.

So here we are doing this operation on this patient .... and the surgeon was telling me how he was forced to do the surgery.... but he was not bitter...he just felt sad that his professional opinion was not take . He did the best he could. The tumour was dissected out ... released from the adhesions to the other structures in the abdomen.... he reached the base and he could not operate further as he was not able to differentiate the tumour from the major abdominal blood vessels. So at 11 pm the discussion to abandon the surgery was decided. The only problem now is that when the tumour was released from all the adhesions .... he was not able to close back the abdomen. Therefore now he had to do a "debulking" of the tumour in order to close back the abdomen. At about 1 am, we decided to order some McDonald's to quench the thirst and the hunger pangs.

So the debulking took another 5 hours. The patient had lost a total of 17 liters of blood. Massive blood transfusion given. 2 cycles of DIVC regime given. A lot of crystalloids and colloids given. The patient was kept warm with the warming mattress and the hotline. Serial ABGs and dextrostix and haemacue was taken to monitor the patient. The patient was transferred to PACU post op for monitoring and ventilation. At 8 am the patient was fully conscious and alert and he was extubated. At 6 pm he was transferred back to ward as all the parameters were normal. All his blood investigations came back as normal.


Night shift staff nurses

Tools of the trade
Keeping count of the blood loss
The CT Abdomen showing the extend of the tumour
The surgeons and nurse hard a work.
And me .... watching over the patient.

But my mind was thinking about what the surgeon had to go through.... and that nowadays I have seen people questioning doctors and forcing them to do things against their own better judgement because the patient or the family member know some VVIP. I have heard many times .. that this is a VVIP so therefore it is ok to do the operation even though fasting period is not enough ..... this patient is this someone and that someone's relative blah blah..... oh this patient is Pengarah's relative lah ... etc etc .... for me I believe that all patient deserve the best care be it the Prime Minister or a beggar. These are the times I feel helpless and discouraged working as a doctor. People have lost the respect for doctors ... yes no doubt there are some doctors out there who are abusing their position but most of the ones I had spoken to ... have a genuine concern and selfless sacrifice for the patients under their care. I wonder how long I will continue in this profession.

7 comments:

Anonymous said...

Hi

Please stay. Malaysians need you.

My mom have brain tumour & she told me there's only 1 neurosurgeon left in the gov hospital. So she need to wait long for the appointment.

Life for us. :)

But God Most Wise is with the patient. I mean Iraqi doctors have it tough, but if they migrate to a safe country for their own safety - who will help Iraq? People need doctors. I myself think highly of selfless, caring doctors.

I guess, what will we get doing the hard jobs. I myself wish I can sing & get RM30,000 an hour. Maybe a prince will give me a diamonds, million fans, the media telling me beautiful nice everything. Spend time at spas, marry with wedding of the year, deemed as the ultimate role model, a national treasure. Yeah why do these hard, pressuring jobs. But yeah. Iraqi doctors. Somebody gotta do it. Conscience.

I believe in God Most Great. So it's easy. Faith & good deeds will earn the best reward - heaven. Bersakit-sakit dahulu, bersenang-senang kemudian. The best forever. :)

Hope you're happy & prosperous always. God Bless.

Cytusm said...

The patient has cancer, without the surgery, he will definitely die. But the surgery is a gamble between life and death. I think the patient deserved the right to choose to have the operation done. It may not be necessary for the surgeon to decide on the patient's fate, who knows miracle may be on the patient's side. It may worth the risk.

winter said...

Although every patient had their right to choose for their prefered treatment despite being advised, medico-legal wise it's still up to the surgeon decision whether he would proceed with the procedure. The question is if things do NOT turn out well, and if there is a complaint. I just wonder what is the role and responsibility of the VIP in "lobbying" for this procedure?
Usually they don't bear the legal responsibility. Surgeon as a profesional is to bear the sole legal responsibilities.

narrowband said...

Thanks for sharing. I am not subscribed to many medical blogs and although yours isn't exactly one, details and experiences like this are enlightening.

[danial][ma] said...

hej! whoah! what a marathon! i believe that in whatever we do, we have to be compassionate and patience...Gong Xi Fa Cai to my Bro. You are great man!

doc said...

hmm...who is watching over the patient when you're taking the photos?

;P

Kiwi-Bird said...

Doc! I bet you have done ur best in Medical field, no? Every field has its dark side, and we will be dragged to the black hole. Nonetheless, you will get out soon =) Stay on!!