Davao Blogspace

a href=”http://www.ciccparenting.org/newsimages/istock_000000357240small_child_crying_1.jpg” onblur=”try {parent.deselectBloggerImageGracefully();} catch(e) {}” style=”clear: left; float: left; margin-bottom: 1em; margin-right: 1em;”img alt=”" border=”0″ height=”200″ src=”http://www.ciccparenting.org/newsimages/istock_000000357240small_child_crying_1.jpg” style=”float: right; margin: 0pt 0pt 10px 10px;” width=”181″ //ab(Disclaimer: All names and characters in this story were deliberately changed to protect the privacy of the patient concerned. If you felt the story was referring to you or someone you know, you are wrong.)/bbr /
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“Hepe, you might want to go the ward now.” The nurse on duty ’s voice on the phone, sound a little bit gloomy. I just came down from assisting a junior for an OR that extended to almost 12 midnight and I barely touched “the bean bag” to rest. My team wasn’t on duty that night.br /
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“Bakit hepe?” (Hepe, is our pet calls for male residents and male nurses in the wards, sort of brotherly respect). “Nag icode/i si bNanay Delia/b..iIkaw yung hinanap nya/i…” For a moment, I don’t know what to think of or how to react to this news. I immediately ran to the wards and joined the code team doing bACLS/b on Nanay Delia.br /
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Just 5 hours ago bNanay Delia/b and I are happily exchanging goodbyes and hugs in what supposedly a very heartwarming patient-doctor relationship punctuated by a successful OR procedure. To thank me, she insisted I’ll take a gift wrapped iPierri Cardin/i hankies and neckties fresh from underneath her pillows. To bNanay Delia/b, I was her savior-son. To me, she was a motherly patient I can never forget. iI am her surgeon/i.br /
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“She what???!!!”br /
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I first met bNanay Delia/b in the outpatient clinic two weeks before this incident. She was this jolly faced 56 years old ilola/i with a very happy disposition and a charming talker. Without make up but only the ever infectious smiles you see in your grandma’s face, her wrinkles in the forehead looked like lines of happiness. Needles to say, resisting her motherly charms is totally futile. Unable to walk because of nagging pain in her right hip, she was totally unfazed by her predicament and was in fact very much hopeful she can walk again.br /
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“Sa tulong at galing nyo doctor!” Nanay Delia was proudly chatting with some patients at the end of the clinic room. She was already infecting the whole OPD team with her crazy punchlines and contagious laughter. We can’t help but be swooned by her charm.br /
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After examining Nanay Delia and her xrays, a decision was made to have her right hip replaced (a procedure known as bTotal Hip Arthroplasty/b) to ease out pain and make her ambulate again. I asked her and her son who was assisting her to come back next week for admission and OR.”Tialaga duktor? Makaka pamalengke pa ulit ako??!/i” Everyone in the clinic saw the face of bNanay Delia/b lit up. She is over flowing with joy giving hugs to all the members of my service. A gesture that touched everyone in my service. Nothing extra ordinary, but a gesture in the right timing and execution, will melt the hearts of stone cold surgeons that we are. “iNany Delia just smooched us all!/i” Said one of my juniors.br /
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Our arthroplasty service see quite a number of outpatients everyday . Believe me, bNanay Delia/b seem to be an epitome of hope among these poverty stricken and ill patients. In this institution, residents spend hours and days haggling for funds and implants among sponsors, philanthropist and politicians(with their CDF),so that these patients can have their OR, free.We were able to get funds for her implants, and since the surgeon, anesthesiologist and procedure itself is free,b Nanay Delia/b will be operated with minimum of expenses.”Hay, salamat talaga duktor!”br /
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bNanay Delia/b passed the cardio-pulmunary clearance and labs easily. The internist classified her “low risk” for this surgery. So the next week, I saw bNanay Delia/b happily sitting in one of our ward beds. A number of bantays and ambulatory patients were already crowding near her bed. I can even here the laughter and giggles these people made because of bNanay Delia/bs funny stories and punchlines. She was the center of attention in our wards because of her friendliness, jolly type personality and talkativeness. She even talk loudly with patients on the other end of the ward, at least 10 meters far from her bed! i”Kung tayo nga na infect ni nanay, mas maganda tong mga patient natin masaya din!/i” I jokingly told my service.br /
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When bNanay Delia /bsaw me and my team coming for the ward rounds, she shouted: “iShhhhhhh! Tahimik na tayo, nandyan na ang mga gwapong doctor natin/i!” She was gesturing her companions to keep quite but I still could here giggles from the other beds. “iNanay, napasaya mo ata ang buong ward ah!!!/i”br /
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I talked with the cardio fellow and seek out another CP clearance, this time asking for repeat ECG and echo cardiogram. This premonition somewhat baffled me also. She was already cleared for OR twice and I was still asking another one. Obviously the fellow hated me for that, but I got what I wanted. bNanay Delia/b was cleared for OR. Nothing in the repeat labs picked up anything suspicious. Getting the final pointers and go signal from my consultants, I scheduled the OR in two days.br /
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Talking to bNanay Delia/b about the procedure, the risks, the benefits and preparations, we were all set for the OR. If there was one happiest person involve in this procedure, she wasb Nanay Delia/b herself. She was so happy and proud that at some point, we heared her overtly exaggerating our scalpel wielding prowess that I can only sigh in disbelief and smile.br /
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It was not my first bTHA/b as a resident and I have planned for this procedure several times In all of my previous surgeries, I have been chided for being too detailed on preparation and precautions to the point of obsession. bNanay Delia/b’s case was no special procedure and she too did not escape my obsession to preparation. Ironically she was a symbol of hope for most of our patients admitted to the wards. Her happy disposition is so infectious that my service actually felt the outcome of her surgery will be the barometer of how good our delivery of service was. “If this procedure will have a glitch, we will be devastated. So lets make this again, our best!” I pleaded my team.br /
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It was an uneventful OR indeed and the most satisfying one, finishing faster than we expected. bNanay Delia /btolerated the OR well and we were so admiring of the outcome of the procedure. The planning paid off and more. Everyone in the OR team had a pat on the back and even bNanay Delia,/b who was mumbling my name under anesthesia.br /
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The next day when I made my rounds, bNanay Delia/b was already sitting at her bed, her eyes glowing in joy. “iDok!, salamat po sa inyo. Maraming salamat talaga!”/i Coupled with a hundred more praises and exaggerations, I can’t help but gave her our “iakbay barkada/i”, a gesture we made to our nicest friends. She was already inviting me to her upcoming birthday and the christening of her grand son, to which I would be a godfather. i /ibr /
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i”Nanay, you still have to start your hip range of motion exercise so that by tom, I can teach you how to walk with quad crutches./i”I deliberately changed our topic of conversation.”iYes doc/i” was her smiling reply. I just shrugged my head. But deep inside, I was extremely please at the sight of one very happy and satisfied patient.br /
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The next rounds she was motioning my team again to her bed. “iKain tau dok!/i” “iMamaya na po Nanay after ma dress natin yang sugat nyo and maturuan namin kayo ng quad crutch ambulation/i.” Teaching bNanay Delia/b ROM exercise was no sweat at all. She was even proudly showing off to us that her hip pain is gone. I was just smiling at her antics. “iHinay-hinay lang nanay!/i” I told her, she will be discharged tomorrow, once I inspected her wound and assessed her fit for home ambulatory rehab program.br /
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bThat discharged never happened./bbr /
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“iAnother epi please!”/i I was shouting while doing chest compression(CC). I am perspiring heavily since nearly doing CC for almost 10 minutes already. I’m still dazed as to what has happened but I’m racking my brains at reviving bNanay Delia/b. “iWhy was I not informed immediately about this?!/i” I was shouting already. “iHepe, ginigising lang si nanay nung bantay nya for meds nung napansin di na pala humihinga. Before natulog yan nakipag kwentuhan pa sa mga katabi at tawa ng tawa/i. She was asking for you and looking for you at may sasabihin daw.”br /
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It was a massive MI according to the IM in the code team. “iHow can that be?”/i I said, bNanay Delia/b was cleared two times before this OR! Even the 2D echo did not pick up anything! It is frustrating to look for impossible answers. The obvious reason was, I, my service became attached so much to bNanay Delia/b. Nobody was expecting this event to happen because everything went well and she was one hundred percent happy just before sleeping. She never woke up to walk again.br /
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When the IM declared bNanay Delia/b dead, I was still shocked and dazed. I was literally angry and frustrated at the same time. “Why did this happen? Was there anything we could have done that might have save her life???” I can see bNanay Delia/b’s smiling face in my mind.br /
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I mustered enough courage to talk to the family gathered around her bed. I offered my best consoling words. I almost cried when each of the family member hugged me. “iShe was asking to see you before she slept, doc. She was very fond of you/i.” I was in the ORbr /
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I excused myself and hurriedly left for the call room. I sat in one corner staring at the blank wall. I am looking at nothing. I still couldn’t believe what has happened. bNanay Delia/b and that this whole procedure meant nothing. I wanted to cry, but I couldn’t. I don’t know where to get my tears..I just sat there and wanted to cry but couldn’t…I was crying dry…br /
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In my most isolated and stoned cold medical life, . I am hardened by pain and several deaths to our patients. I have trained myself to get detached and not be affected by emotions. I was trained to empathize, not sympathize.Yet, every time something like this happened, I felt it is easier to just cry and make ease the burden of guilt. It feels lot lighter and starting again, becomes easier.br /
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bBut tears never came./bbr /
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Perhaps, it was because bNanay Delia/b’s jovial face smiled on us every time. That for a short time, we were able to make another patient happy and satisfied with what we can do with our god given knowledge. That we learned from this mistake and that she gave hope for our other patients. More importantly, Nanay Delia taught us all that happiness is a constant state of mind. And you need no superfluous things or event to enjoy it. No excuse.br /
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I cried dry…/span/spandiv class=”blogger-post-footer”Bone MD is a board certified orthopedic surgeon and a Fellow of Philippine Orthopedic Association practicing in the hinterlands of Southern Mindanao, Philippines. He took up medicine at the UP College of Medicine and finish his Orthopedic Training at UP-PGH Department of Orthopedics. He is a visiting consultant in the Department of Orthopedics, Davao Medical Center and several other hospitals in South Mindanao area./div
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a href=”http://www.bryanchristiedesign.com/uploadfiles/279pill_man_lores.jpg” onblur=”try {parent.deselectBloggerImageGracefully();} catch(e) {}” style=”clear: left; float: left; margin-bottom: 1em; margin-right: 1em;”img alt=”" border=”0″ height=”200″ src=”http://www.bryanchristiedesign.com/uploadfiles/279pill_man_lores.jpg” width=”200″ //aIt’s not only irritating to hear horrendous “cure all” claims of some food supplements manufacturers and advertisers about their “drug” but the lack of advertisement control also nauseates me to no end. The sickening charade of food supplements jumping out of nowhere and claiming to heal all kinds of human afflictions thinkable (just so they can corner the poor man’s pocket) is staggering to say at least. Taking these supplements at advertisement value is already one big step to your sick bed. Deceiving someone with false hopes and killing the patient in the process is another “crime” worthy of span style=”font-style: italic;” harakiri/span.br /
span style=”font-size: 85%;”(Photo taken from Science Blogs.)/spanbr /
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In almost everyday that I listen to the radio, some airtime (at times lasting a full 15 minute!) is spent on miracle cure throttled by exaggerated personal testaments of complete strangers.br /
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What happened to “span style=”font-weight: bold;”PANA/span: Truth in advertising?” or the KBP’s commitment to “Nothing but the truth, so help us GOD?”br /
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Here’s a href=”http://www.bfad.gov.ph/faq.htm”span style=”font-weight: bold;”BFAD guides on how to spot false claims/span/a by these unscrupulous supplement manufacturers.br /
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olliThe product is advertised as a quick and effective cure-all for a wide range of illness./li
liCertain key words like “scientific breakthrough, miracle cure, all natural without side-effects or ancient remedy” are used./li
li The promote claims that medical professionals and scientists have conspired to suppress the product./li
li Adverts contain undocumented, anecdotal cases, but with amazing results. No science involved./li
li These products sell falls hope for extreme physical attractiveness and shortcuts to weight loss. They will never emphasize the value of healthy lifestyles, like avoiding smoking, excess drinking of alcohol, eating appropriately, adequate rest and sleep, and regular exercise./li
li Remember that legitimate health supplement products will never carry claims for quick cures; claims such as cancer prevention, good for arthritis, good for diabetes or good for hypertension, should be high suspect./li
li The product is advertised as available from only one source./li
li There is a money-back guarantee promise./li
/olThe usual excuse laid for such drug supplements goes along the lines of herbal medicine being natural and hence, is the best form treatment. Another sad excuse propagated by these unscrupulous manufacturers and advertisers is the soaring prices of span style=”font-weight: bold;”BFAD/span certified drugs. Both of these excuse “prompts” the ignorant listener to buy the cheaper, food supplements that claims healing every imaginable human disease yet lacking in rigorous scientific testing! It’s like jumping on a plane hoping your jacket will save you (it may even get tangled in the plane’s props) instead of your chutes. Stupidity does have its additive effect remember. It might not only rob you of your hard earned money but it may sometimes kill you or your patient!br /
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To argue that some drugs or supplements need not pass rigid testing to be effective is an outright lie. Often, these arespan style=”font-weight: bold;” Russian Rolette/span type solution to a worsening health economics. Licensing and BFAD approval of any drug aims at at least two basic goals. Rigid and scientific testing makes sure the quality and quantity of any drug is not only safe for human consumption but should also be effective against the illness(es) it claims to combat.br /
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At the very least, any drug must be tested for its safety profile and efficacy. Remove the first and your taking in a poison. Any dubious drug efficacy even in rigorous scientifically studied drugs, is nothing but pure waste of money. Take out both, and you make yourself poor on your way to your deathbed.br /
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One (or two) person’s testimony, no matter how famous that person, is not tantamount to a safe and effective medicine.Some physicians or physician’s name is even attached to these claims. In the current recommended evidence based approach to treatment and procedures, anecdotal testimonies ranks the lowest in the strength of evidence.br /
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Now would you want any food supplement giving you all these complications? Would you even dare to give food supplement to someone you love and risk losing his life base on false claims?br /
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Think again…/spandiv class=”blogger-post-footer”Bone MD is a board certified orthopedic surgeon and a Fellow of Philippine Orthopedic Association practicing in the hinterlands of Southern Mindanao, Philippines. He took up medicine at the UP College of Medicine and finish his Orthopedic Training at UP-PGH Department of Orthopedics. He is a visiting consultant in the Department of Orthopedics, Davao Medical Center and several other hospitals in South Mindanao area./div
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a onblur=”try {parent.deselectBloggerImageGracefully();} catch(e) {}” href=”http://bp0.blogger.com/_3J-pISBmOI8/SHLnmBCUp1I/AAAAAAAABHc/y1M_V6cJYr0/s1600-h/wrong+site.jpg”img style=”margin: 0pt 10px 10px 0pt; float: left; cursor: pointer; width: 151px; height: 127px;” src=”http://bp0.blogger.com/_3J-pISBmOI8/SHLnmBCUp1I/AAAAAAAABHc/y1M_V6cJYr0/s200/wrong+site.jpg” alt=”" id=”BLOGGER_PHOTO_ID_5220489558375049042″ border=”0″ //aAlthough rare, a href=”http://runningahospital.blogspot.com/2008/07/message-you-hope-never-to-send.html”wrong site surgery /ahappens even to the most able and busy OR team such asa href=”http://runningahospital.blogspot.com/2008/07/message-you-hope-never-to-send.html” in this hospital/a. Imagine the horror of both the OR team and the patient discovering the closure stitches in the normal side after the procedure. But thats another story.br /br /What I’m a bit surprised is how the hospital administration managed to “rectify” the error and came out with better policies to prevent future incidents like this to happen. Their CEO even a href=”http://runningahospital.blogspot.com/2008/07/message-you-hope-never-to-send.html”blogged about it/a, so the whole community would know about the lapses, the steps taken to correct it, and prevent further “errors” to happen in the same way.br /br /I can help but wonder if most of our health institutions here in our country have the same attitude towards wrong site surgery and medical errors. A a href=”http://www.jointcommission.org/PatientSafety/UniversalProtocol/”universal protocol for wrong site surgery/a has been existing and updated regularly for quite sometime already. The span style=”font-weight: bold;”American Academy of Orthopedic Surgeons (AAOS)/span also had a href=”http://www.aaos.org/about/papers/advistmt/1015.asp”span style=”font-weight: bold;”its recommendations/span/a to reduce surgical sites error in orthopedics. Most of the stories I hear in our country from the gossip tree end up in long, expensive court duels. And even with the pay off, none of the parties learned anything (but money and pride) from the mistakes which should have been preventable in the first place!br /br /Not to be over simplistic about this but parallelisms can be drawn between mistakes like this one and that of mistakes done on people you care of. Admission is a braved act. Facing the consequences is an even braver act. But taking actions to prevent such errors from happening is a mark of a true caring physician. That is how we deal with people we care. To us physicians, that would be our patients.div class=”blogger-post-footer”Bone MD is a board certified orthopedic surgeon and a Fellow of Philippine Orthopedic Association practicing in the hinterlands of Southern Mindanao, Philippines. He took up medicine at the UP College of Medicine and finish his Orthopedic Training at UP-PGH Department of Orthopedics. He is a visiting consultant in the Department of Orthopedics, Davao Medical Center and several other hospitals in South Mindanao area./div
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