Tuesday, January 19, 2010
"Thou shall not operate on the day of the patient's death."
In other words, avoid an operation that will kill the patient. I don't always know about this advice as certain surgeries require some risk to result in saving a patient's life, but today Sharon and I found ourselves very near exsanguinating a patient. The surgery was to remove a pelvis abscess (or so we thought) that had occurred 4 weeks after the patient had a D&C at another hospital. What had really happened was the the entire uterus had become a necrotic, actively bleeding, purulent mess. This patient initially presented with septic shock and after 48 hours seemed stable enough for surgery to drain/remove this mass that was about 20 centimeters. A visiting family practice doctor happened to walk into our room during the surgery and Sharon asked, "What's your name and can you scrub?" Thankfully he answered yes and was told to hold pressure on the aorta while we began to try to control the hemorrhaging. In the end, the patient lost 2.5 liters of blood, got 4 liters of fluid and 4 units of blood (plus some more units were being freshly donated from visiting staff) and she did leave the OR alive, but intubated and transferred to the ICU. This is particularly remarkable when you know her starting Hg was 6.5 and after 2 units pre-op only 8.2, Reflecting on her surgery, I am amazed her life was spared. Yet, I'm seeing over and over God does amazing things sometimes in a very simple way. We had the right people in the room: 2 skilled OB/GYNs, 2 anesthetists, 3 nurses, an intern to get more blood, a visiting pathology resident willing to donate with the right blood group, an FP who just happened to come in when we needed pressure, and a general surgeon (who was thankfully in between cases) to review the necrosis on the rectum. We work in a hospital that has visitors coming and going all the time, is short on nursing staff and sometimes the theater staff disappear from the room, but for this case ALL the personnel we needed was graciously provided. God is always faithful.