回到辦公室我們繼續討論病情，主治醫生和住院醫生若無其事地把話題轉移到下一個病人身上，而我的眼眶卻慢慢潮濕起來，不知道為什麽，隻是覺得心裏非常難受，一個健康快樂的老太太，兩個星期，就這樣被徹底改變了生命曆程，她看我的眼神，帶著微笑，每天早上還總是先問我：how are you today, doc? 我怎能當作什麽事情都沒發生過。
主治醫生發現我神態異樣，說are you OK? 我搖搖頭，說no, I feel bad about Mrs K, this case broke my heart. 主治醫生說，我們都盡力了，我知道你每天接觸她時間最多，建立了感情，感覺很難過，但是作為醫生，要明白自己的職業局限，不能太attach。
落花醫生：
I am so sorry to hear that. Hug...
Please try to have a relaxing weekend :)
落花飄零 發表評論於
today i signed Mrs K's death certification.
綠豆紅茶，HIT is certainly a concern, we did follow her plt count everyday, no obvious dropping, I don't know what's the exact reason of her LE arterial occlusion, my guess is from massive compression during sugery.
落花醫生：
I have been reading your blog for a long time and I really admire your hard work :)
I don't know if you watch the TV show "Grey's Anatomy". One of the interns, Dr. Izzie Stevens has told the chief that she is both a compassionate person and a surgen, and that both are essential in defining who she is as a human being. She and other real surgens I know, including my mom, have taught me that it is the compassion you feel for your patients that makes you a better doctor.
I know too little about Ms K's condition to make a guess here, but may I ask two questions:
Did doctors administer unfractionated heparin, or low molecular weight heparin for her surgery? What happens to her platelet count? I just thought her symptom looks similar to one of the thrombotic disorder--heparin induced thrombocytopenia (HIT). HIT typically develops 4-14 days after the administration of heparin, and with the auto-immune type (type II), clot formation is mainly arterial and rich in platelets, while thrombotic events are mostly in the lower limbs, skin lesions and necrosis may also occur at the site of the heparin infusion.
Again, I do not know the genetic background and family history of that lady. If this sounds irrelavant, or the information comes too late, then forget about it :)
Have a good night.
小馬999 發表評論於
獅王說的好像很對，專業水平高！另外，是不是有些凝血因子突變的病人 under stress 時，就特容易出現血栓，高凝血狀態。落花妹妹能不能給我們從專業方麵分析一下？端個板凳我先在前排占個座。
A recent study researched the overall quality in almost 5,000 non-federal U.S.hospitals. Interesting findings showed that on average, 28% overall lower inhospital risk-adjusted mortality associated with the 16 procedures and diagnoses, and 5% overall lower complications associated with the 10 procedures experienced by Medicare patients at Distinguished Hospitals for Clinical Excellence compared to all other hospitals.
Do the search and see where your hospital stand, our one is not within the top 5% although it was listed on the top 10 ranked by another annual publication.
I was in your shoes once. I would loss sleep and my appetite over every little disappointment. I was barely survive in my intern year. I had learned to lower my expectations, which was " do no harm to patients, get by and pass each rotation so no need to repeat again, try not to be the weakest intern in my class". I was so busy that I didn't even notice how the other interns were doing. In the end, there were two interns did not get 2nd year contracts renewed and another one had to let go in his 6th months. All three were American graduates. I ranked 2nd at annual in-service exam. Most likely, you are not as weak as you think. What will be worse: kill yourself by pushing self too hard vs repeat intern year? Yesterday, on Pri-med CME conference, I met the guy fired from our program, he is all happy and is currently practicing in Louisiana, I can't trace any past trauma on him at all. Life goes on.
It is OK for a intern to say "I don't know or I am not sure". As a attending myself, I always like those interns who are sincere and trying hard though may have a difficult start and I never fail them. I worried the most are those who know a little and pretend to know it all, make mistakes and always blame on others. You are definitely not one of them, you are fine intern and good physician. Have faith in you. Another point is: medicine is what we do but not who we are. Trying to have fun with other interesting things.
落花飄零 發表評論於
thank you guys for the support, i think i am over reacting for this case, every team did their job, just happened to have a very unfortunate outcome.
6hr, i think i need to defense myself and my colleagues a little bit here. there is no malpractice in this case, everything was well done and followed with guideline, if we could do this again, we would still do the same thing. As a matter of fact, the family was giving up, but we are still doing everything we can to see if there is any chance. I don't know how far we will go, maybe tomorrow my attending will give the call.
WUXIMM, thank you for the advice, i think i am exactly this kind of personality you described, and i think most of my colleagues are like me. I care about every feedback from other people, how can I not? my attending has talk with me every two weeks about every improvement after i recieve the feedback. i am struggling with my self esteem everyday, a word can make my day, and a word can ruin my day. this is driving me crazy.
6hr 發表評論於
有一種可能性：他們知道有，但是沒有告訴你。怕你更傷心。Do you have Mortality & Morbidity Conference month/weekly? When I was in Sir Run Run Shaw Hospital in Hangzhou, we did that, for better doing next time. Learned a lot from that.
We had more terrible experience, In 1994, the 1st year of the hospital, we, a group of not well trained young doctors just like murders in the Hospital. one of my head trauma patient loss life because of GI bleeding, the blood arrived a few minutes after he died. Only if I know more about Cardial Pulmonary Ressusitation. He may well alive now. Another case is a 17 year young girl, trauma, died of spleen(may be more organs) rapture. If the 1st line doctor had more experience. The girl will have a happy life. Fortunately, things changed after Dr. Bryner from California trained us Advanced Trauma Life Support and lots of other things. He has all the characteristics of American surgeons, and furthermore some religious devotion spirit. When he set a goal he never give up.
He trained many good doctors in Sir Run;;and the Hosptal is a good Hospital, famous in Laparoscopy now.
Yes I cried for my head trauma patient. I have more to blame than you.
Observing a lovely lady withering away, you felt the sense of failure and naturely broke down. You only can save those who can be saved. Practicing medicine is indeed very stressful. To heal a person, one must first be a person. There is a limit how much a person can achieve. Most physicians fit the descrpition of obsessive-compulsive personality-want everything to be perfect, set a unrealistic goal and put on lots of stress on themself. During this busy season, I hope you take good care of yourself. "Taking care of yourself is not selfish, but rather it is self-preservation". I hope you set a realistic goal and reduce the need of external validation. It will help you cope with the stress.
回到辦公室我們繼續討論病情，主治醫生和住院醫生若無其事地把話題轉移到下一個病人身上，而我的眼眶卻慢慢潮濕起來，不知道為什麽，隻是覺得心裏非常難受，一個健康快樂的老太太，兩個星期，就這樣被徹底改變了生命曆程，她看我的眼神，帶著微笑，每天早上還總是先問我：how are you today, doc? 我怎能當作什麽事情都沒發生過。
主治醫生發現我神態異樣，說are you OK? 我搖搖頭，說no, I feel bad about Mrs K, this case broke my heart. 主治醫生說，我們都盡力了，我知道你每天接觸她時間最多，建立了感情，感覺很難過，但是作為醫生，要明白自己的職業局限，不能太attach。
