By Tedler D. Depaynos, MD
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In doing surgery, safeguards in preventing the occurrence of complications are a must. Precautions are done for expected complications and elective surgery is even better postponed. Patients are referred to an Internist or to a Cardiologist and Pulmonologist for clearance to make sure that the patient could undergo the stress of surgery especially if it is a major one. They are even requested to be with the Anesthesiologist especially if the surgery is a must or emergency while the patient is undergoing the operation or even after.
Emergency surgery is usually life saving and usually done anytime. Pre-operative evaluation is likewise routinely done but in this case, time is of the essence.
Surgical complications are likewise very stressful to surgeons. The surgery may be stressful but after a successful one especially with extreme confidence that it was done properly, surgeons could smile and relax.
Despite everything, unexpected surgical complications may unfortunately sometimes occur. It would make the surgeons review extensively the case and even present it in the department or hospital conferences so that opinions from other colleagues would be heard. This is all for the good of the patient and is part of the learning process. This is the advantage of tertiary hospitals where conferences are a part of the hospital routine.
A surgeon I am familiar with was recalling his stressful experience he recently underwent. A patient whom he saw one year ago because of Acute Cholecystitis who refused surgery because the pain spontaneously disappeared returned suddenly because of recurrence. The patient was not keen of undergoing surgery but because of the severity of pain and worsening jaundice he reluctantly consented. The surgery was done on a Sunday morning and although it was termed “difficult” it was finished without any hitch. The severely distended gallbladder which was filled with stones was excised and with the help of a series of x-rays the likewise distended proximal common bile duct was explored and the obstructing stone removed. A draining T-tube was placed.
A return of the abdominal function was noted after a few days and gradual feeding was routinely started. Suddenly paralysis or ileus of the intestines was noted and the renal function tests were becoming abnormal. Urine output was getting zero so that a series of dialysis on the advice of a Nephrologist was eventually done. The Nephrologist surmised that perhaps the patient had an undiagnosed Chronic Renal Failure.
Serum electrolytes were corrected and closely monitored and slight relief of the paralysis was noted. It was one evening later when the patient was having difficulty of breathing and despite the oxygen mask the difficulty was getting worse. A Pulmonologist was called who immediately intubated the patient and ordered that he would be wheeled into the Intensive Care Unit to be connected to a breathing machine and closely monitored. The Pulmonologist initially attributed the difficulty to the distended abdomen which was compressing the basal part of the lungs. However because of the non-relief of the seriousness of the breathing difficulty he attributed it mainly to the chronic smoking habit of the patient.
When everything seems to be controlled, the patient suddenly was passing out massive blackish blood. Stressful ulcers were entertained initially but because of the non-relief of the bleeding which necessitated a series of blood transfusions to counteract the worsening anemia, a gastro-endo-colonoscopy was done by a Gastroenterologist. It turned out to be negative so that bleeding from the small intestines was entertained. Surgical remedy was brought up although severely dreaded. Luckily, the bleeding spontaneously stopped.
The patient had a fighting spirit which was buoyed up by relatives and friends who took turns massaging him and who were observed continually whispering encouraging words. His children who never left his bedside were likewise always looking on the bright side and never manifested weakness.
The patient gradually recovered and it was a month after he was operated when he was discharged in the hospital walking although with human canes. The attending surgeon recalled that together with the other specialists who were called were with all sighs of relief soundly and they emphasized once more that prayers should always accompany the cares of patient. **
