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DRAMA INSIDE OPERATION THEATRE (April, 2004)

Drama inside Operation Theatre !
Every surgical operation has the potential to surprise the doctor by sudden occurrence of a most unexpected and sometimes; life threatening complication. This may occur in spite of taking all proactive precautionary measures. Although awareness and readiness to face and tackle possible mishaps would minimize complications, it cannot be always be eliminated. Complications strike literally like a bolt from the blue in the most unexpected direction and situation.

Operation successful, but patient …..!!
The most serious of these complications is “death on table”, which means that the patient dies before the attempted corrective surgery could be completed or at the end of an otherwise technically perfect and “successful” operation!

Once this happened to a surgeon friend of mine. He was operating on his own wife, doing a “minor” operation under local anaesthesia. His dear wife was fully awake and alert at the start of a surgery expected to last 20 to 30 minutes. The surgeon was an experienced doctor with thousands of surgeries over a period of 20 years under his belt. His wife was healthy and did not have heart problem, high BP or diabetes. Hence she was considered as having “standard risk” in undergoing this relatively small surgical procedure under any kind of anaesthesia, including general anaesthesia. And this “minor” operation was done under simple local anaesthesia, injecting some Xylocaine solution around the lump in the breast to be biopsied. Hypersensitivity to Xylocaine was tested before the start of surgery. Surgery was performed easily without any hitch and at the completion of surgery, the surgeon called the patient by name and asked her how she was. There was no response! Then it was found that she is not responding to any stimulus! There was no pulse palpable at the wrist; no breathing; no heart beat! She was dead! All attempts to revive her by immediate cardiorespiratory resuscitation measures were of no avail!

Standard risk & high risk in surgery:
During every action and situation in life, some unexpected problem or accident may arise; sometimes it may end in fatality. This is normal risk and we take it everyday in our day to day activities. Similarly in every surgery in an otherwise healthy individual there is an element of risk considered “standard risk”. But if the patient has any complicating disease like high BP, heart disease, diabetes, asthma or respiratory disease, anaemia and many others, surgery in such patients carries more risk. The severity of the risk of developing complications and even fatality depends on the pre existing diseases, the nature and severity of the surgery, age of the patient, type of anaesthesia administered, facilities available to tackle any expected complications and finally the skills of the surgical team including the anaesthesiologist. The doctor/ surgeon has to assess the risk benefit ratio in all patients, discuss with the patient and/or the relatives and take a decision which is likely to be beneficial to the patient.

Life saving operations in patients having life threatening medical diseases are some of the most difficult decisions in a doctor’s career. If surgery is not performed, patient may not survive; and if surgery is performed to save his life, there is considerable risk to his life! There are also emergency surgery to be performed on a high risk unconscious patient, say following a major road traffic accident, when even the patient’s relatives are not available. Then the doctor’s conscience is the only guide in deciding on life saving , but potentially life threatening surgery. If the operation is successful and patient survives, the doctor’s timely action may be appreciated or he may even become a “hero”! But if the accident victim does not make it through, the doctor has to face the music!

Every doctor, particularly a surgeon is called upon to make difficult decisions; sometimes quickly, but often after careful deliberations. He is expected to always come up with the right decision! Knowledge of medicine, experience and skills in diagnosis and decision making, wisdom acquired over a period of time, a humane approach to every patient and boldness and courage of conviction to execute and complete the plan of treatment or surgery are some of the attributes of a good surgeon or doctor.

Such difficult real life situations faced by doctors and how they were handled will be explained in some of our forthcoming newsletters.

 

Dr. M.Mohan Rao, MBBS,MS,FICS,MCH,

M.D. & Chief Surgeon, Dr. U Mohan Rau Memorial Hospital.
E-mail: mmr@mohanraohospital.com




 

Updated on 01.04.2004.
 

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