Medical Anecdotal Report
Indexing Title: OPLIZASO’S MAR [15-7]
MAR Title: Even a hero could not save the day
Date of Medical Observation: August 2015
Tag: Knowing our limits as doctors
Merely a week ago, I assisted a Craniotomy (surgical operation in which a bone flap is temporarily removed from the skull to access the brain). We operated on a 47-year-old female patient who had a large mass located on her left part of the brain. Prior to the operation,I was the one making daily rounds, doing updates, preparing the patient for surgery. For about 5 days, I relayed our plan for operation, explained to her the procedure and possible complications. With all of that, I thought I was able to built a good patient-doctor relationship with her and her relatives.There was one time when I made my rounds,the relatives jokingly told me that I looked like an action star, a hero (Rambo). That, together with our Neurosurgeon, we can defeat our enemy (the patient’s illness) and save the world (solving the patient’s dilemma). Five days later,we did Craniotomy. It lasted for about 3 hours, intraoperatively we had about 1 liter of blood loss and the patient was transferred to the recovery room. After about 6 hours inside the recovery room, then came bleeding of about 200cc of blood per surgery site accompanied by expanding hematoma near the operative site. I immediately called my Neurosurgery consultant and he told me to apply pressure dressing and give tranexamic acid. The bleeding stops temporarily but the hematoma progresses. A plain cranial ct scan was done revealing diffuse cerebral edema. After about 72 hours of monitoring, an early morning shocked me telling that our dear patient lost her life.
(Physical, Professional/Ethical, Psychosocial)
(Discovery, Stimulus, Reinforcement)
There was one saying that came from a Neurosurgeon that we only accomplished half of the battle when we finished an operation, the other half should come from managing our patients post-operatively.
ROJoson’s Notes (17jan2):
It is true that a successful operation consists of successful operation proper and a successful postoperative management. Preoperative management is also important in influencing a successful operation.