LBBERSAMIN’S MAR [15-09]:The Operative Dialogue of a Surgeon

Medical Anecdotal Report
Indexing Title: LBBERSAMIN’S MAR [15-09]
MAR Title: The Operative Dialogue of a Surgeon
Date of Medical Observation: October 2015
Tag: Understanding the importance of the pre-operative and post-operative dialogue with the patient and relatives
Category: Professional/Ethical – Reinforcement
 
NARRATION:
We received a referral at the emergency department of an 89-year-old female with a chief complaint of right lower quadrant pain of 3 days duration. She was accompanied by two adult individuals, her son and daughter, at the time we attended to her. I found the patient to be suffering from an acute abdomen with the primary consideration of acute appendicitis against a colonic mass. I informed the relatives of my assessment and what management to be given. I deemed this patient to have a surgical abdomen. “Your mother needs surgery but at her age, the chances are against us”, I told them. To give them a clear picture, I went in to detail of the risk a woman of her age would have in going through the stress of surgery and anesthesia. With this dialogue, I asked them that despite the unfavourable effects to be expected, would they still pursue a delicate procedure on such a high risk patient. They went on to explain everything we talked about to their mother speaking in their native dialect. They gave me a half-hearted “yes” since it was required of her. I could see then the worried look on their faces. I informed them about avoiding any intake temporarily, maintaining the intravenous fluids on the patient, and starting her on intravenous antibiotics. We prepared the patient for surgery seeking the assistance of the internal medicine, and having her assessed by the anaesthesiologists. We completed the diagnostics required, and provided the adequate support to the patient. One-by-one I explained everything to them and asked them to affirm my information with their understanding. Prior to the operation, as we received the patient in the operating complex lobby, I asked the relatives to pray for their mom and to also pray for me since we will both need it. I went on to do an exploratory laparotomy, right hemicolectomy, with an ileo-colonic anastomosis on the patient. After performing the procedure, I showed the relatives the specimen. “The operation is done and it looks like she is going to survive the procedure, but we are still not out of the woods”, I told them. I was happy the patient survived the surgery. The patient had recovered from the effects of the anesthesia and was subsequently transferred back to her room. During the first few post-operative days, the patient showed promise in recovery, as I was free from any signs of peritonitis along with the other systemic signs. I was careful enough in managing this patient due to her special case. I explained to the relatives the purpose and the desired effect on the patient relevant to her current condition. They were accepting of the medical updates I was giving them. But leading to the 4th post-operative day, complications had risen. The patient seemed to be suffering from the complications of her illness, the medical factors that were on the patient, and the other known complications that may arise. Again, I explained to the relatives the current concerns I had and told them to prepare for the worst. “She can either respond to the treatment we are giving now, or not”; I said. On the fifth day, with the pre-emptive support and management we were giving, the patient succumbed to the complications of her illness. I went to the relatives to explain the demise of the patient and they said that they understood the possibility of this occurrence and that it may have been that time for her eternal rest. I asked them to forgive me if I could not save her completely but to this effect, they said they saw me give my all for their beloved mother.
INSIGHT                                                                                                                                                 
(Physical, Professional/Ethical, Psychosocial)
(Discovery, Stimulus, Reinforcement)
Back then, we use to describe our dreams of being a doctor as simple as possible; “to heal the sick”. But now that we are the reality of this glorious ambition, we see that treating a patient is not as simple. A patient dealing with a severe illness prompts the family to deal with it as well. In our country, we see the very essence of the family when faced with these problems in health and life. And so, when we deal with these patients, especially when divulging their grave illnesses, we also handle the immediate family with an equal amount of strength in explaining everything. The preoperative dialogue forms the sequence in the management of the patient in where we introduce ourselves as their doctor; inform the patient about their illness, and the management we are to give. It also gives us the opportunity to get to know the thoughts and concerns of our patient and the family. It gives us a perspective on the acceptance and understanding of our patient to the care we give, and how they would respond whether in agreement or divergence. Intra-operatively, when surgeons request it, we call on the relatives to see what we find during the operation. It gives us the chance to talk to the relatives about the any information on their patient on changes in the planned treatment. It gives us the chance to present them with the best possible treatment. During the post-operative dialogue, we get to provide care to our patients and inform them of their prognosis. We detail to them the operation we performed and the effects it will give to our patients. But in times when our patient succumbs to their fatal illnesses, it leads us to a point where we provide the most respectable care we can give to beloved patients. In general, what we give with this deepening opportunity of commitment through this dialogue is the authenticity of our care. It gives us the opportunity to show them who we are; with our strengths and limitations. With this process in our patient care, the dialogue gives us the opportunity to be more accepting of our patient’s capabilities in understanding and decision in what management they would conform to. It gives us a side of our humility as a doctor and the limitation in what we can give with regards to their health altitude. Through my training here, I have learned about this approach with the different types of patients. We see the relevance in creating our own dialogue and the variations we can give in response to the needs of our patients. We should always be mindful of the individuality of our patients and that their person is different from our last patient. This is what helps us in treating our patients, not only physically, but through the different dimensions of their suffering. This is what helps us heal a family in suffering when we heal or support a member in their family. This is one of the ways we become holistic. How we become doctors.
ROJoson’s Notes (15nov22):
A vivid illustration of informed consent and continuous communication in patient care in establishing rapport, in being a holistic, professional, and compassionate physician-surgeon. Congratulations to Dr. Lucas Bersamin.
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