MESANICO’S MAR [15-04]:Knowing and Accepting Your Limitations

Indexing Title: MESANICO’S MAR [15-04]
MAR Title: Knowing and Accepting Your Limitations
Date of Medical Observation: May 2015
Tag: Learning to accept your own limitations
Category: Professional / Ethical – Reinforcement
A 47-year-old male with a hacking wound injury had been called in from a sister hospital from a different part of Manila. The patient was attacked almost 4 hours prior to him being transferred to our institution. Upon arrival at our emergency room, we noted the affected limb had already a dark discoloration to it. Pulses were not appreciated with a significant amount of bleeding from the cut area. We decided to immediately take the patient to the operating room (O.R.) for emergency wound exploration. As we were making our way to the O.R., we were quickly gathering all the necessary materials which may be needed for the surgical procedure. We prepared Prolene sutures, an embolectomy catheter, heparin vials, vascular clamps, and more. We began the operation, slowly exploring the wound and identifying the source of bleeding. We noted that the significant amount of blood came from a transected brachial artery. Methodically, we went about to suture and anastomose it, preparing the blood vessel properly. Three hours in and our anastomosis kept failing. Although we were able to attach the distal and proximal part of the artery, a pulse was still not palpable on the distal, cold, dark part of the limb. Fatigue and frustration had set in, and despite constant communication with our consultants, we knew in the back of our minds that we would not be able to save this man’s limb if we continued on. With almost every resource and technique exhausted, our consultant informed us that it would be in the best interest of the patient if we have him coordinated for transfer to a different institution. Knowing of our limitations skill-wise, we agreed and transferred the patient. The patient was said to have undergone the same operation, however, we still have to get an update on the outcome.
 (Physical, Psychosocial, Professional / Ethical)
 (Discovery, Stimulus, Reinforcement)
 Training in a government or public hospital gives us the opportunity to diagnose and treat all sorts of cases, especially those involving trauma patients. We are believed to have more than an adequate amount of training, sufficient number of materials and equipment, and resources enough to operate on these types of patients, as compared to our sister hospitals spread all over the Manila area. However, despite having a sheer number of hours devoted on operating on trauma victims, there will certainly be some which we may not successful treat. Such as the case in my narration, even with enough preparation and previously had been able to perform the same procedure on a different patient, the outcome truly had us frustrated. Even with repeated attempts, we were met with failure of our anastomosis. Knowing that time was of the essence and that any more delay could lead to an amputated limb, we accepted the fact that transferring the patient was the best way to address his condition. After what had transpired that night, I realized that the only way we can at least decrease the probability that this may happen again is through thorough preparation. Studying well on all matters concerning the case, learning from our seniors and consultants on how they do the said procedures, procuring all the necessary materials or equipment, and most importantly, if all these fail, have a back-up plan. With our consultants always within a phone call away, it’s very comforting to know that they will always be there to support us.
ROJoson’s Notes (17feb2):
There is always a limit to what physicians can do.  In such instances, call for help and have a back-up plan.
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