MBVELEZ’S MAR [15-02]: A Hunger to Learn

Medical Anecdotal Report
Indexing Title: MBVELEZ’S MAR [15-02]
MAR Title: A Hunger to Learn
Date of Medical Observation: February 2015
Tag: Treasuring the importance of learning from patients’ cases
Category: Professional/Ethical – Reinforcement
It was a fruitful Tuesday morning when an anxious-looking lady approached me after our weekly conference. I immediately saw a device on the right side of her neck covered with gauze and confirmed that it was an Internal Jugular (IJ) Catheter. She was diagnosed with Chronic Kidney Disease (CKD) Stage V and underwent a few sessions of hemodialysis. She consulted in this institution for Arterio-Venous Fistula (AVF) Creation, as she was handing me a copy of the result of her Vein Mapping. I immediately referred her to our Thoracic and Cardiovascular Surgeon (TCVS) and agreed for the planned surgery for her. I immediately scheduled her case to one of our elective operation days. During the day of her surgery, I was really excited of being the one to actually do the operation to her, with hands-on supervision from our TCVS Consultant. I prepared everything properly to facilitate a smooth-sailing surgery. Before doing my incision on the skin, we noted that the radial pulse, which was supposed to be used for the fistula, was barely palpable. We still continued with the surgery, hoping to be able to palpate a viable radial artery, but unfortunately, upon seeing and palpating directly the artery, we noted that it was calcified, with poor pulsation. We then tried to palpate the more proximal brachial artery, but noted similar findings. We then decided to defer the surgery for her, and advised her for further work-up. That time, I got so depressed that the patient would not be able to undergo the surgery that she needed, and at the same time, of the chance that was lost that would have made me learn so much. The patient was then explained of the possible alternative surgeries and agreed as planned.

(Physical, Professional/Ethical, Psychosocial)
(Discovery, Stimulus, Reinforcement)
As surgeons, we are often faced with problems that are beneath the surface. This is often comparable to a tip of the iceberg that seems small but underneath has massive ice formation.  Just like what happened in Titanic, they thought it was just a small iceberg that they hit but it wasn’t. In relation to my patient, she was at first a good candidate for surgery but then once we get to the procedure itself, to my dismay, wasn’t a good candidate after all.  I am so eager for this case because as a surgeon this would be a great learning process for me. Rubbing more salt into the wound, this procedure is to be supervised by our TCVS consultant. I can only imagine the knowledge and technique that I would be getting if the procedure was pursued. I can walk along the hallway knowing that I’ve performed a procedure under the latter. However, as they say, we don’t always get what we want. I was really disheartened with what happened. I planned everything to make this procedure a smooth sailing one. However, as doctors, even though we are hungry for learning different procedures, patient’s safety always comes first. Two of the qualities of a five-star doctor are that we are our patient’s health care provider and also their manager. We act on their behalf thus we must give to them what we think is best for them. Having that in mind, we’ve decided that we cannot continue with the procedure. I just explained to the patient possible alternative surgeries thereafter. At the end of the day, when things have calmed down and I am no longer that depressed, I’ve decided to put myself unto my patient’s shoes. I was just saddened for the learning I didn’t get but what she wasn’t able to get was a procedure that could make her quality of life better. With that in mind, I’ve changed my outlook on what happened. Instead of just complaining of things that didn’t happen, I’d rather just be thankful for the things that come by, moment by moment. 
ROJoson’s Notes (16dec30):
There will be occasions in the life of a surgeon that “even though we are hungry for learning different procedures, patient’s safety always comes first.”   That’s the mark of a professional and compassionate surgeon.  There may be frustration of a personal want but there will be satisfaction in giving in to what is best for the patient.
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