Indexing%20Title:%20JGGuerra

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Indexing Title JGGuerras Medical Anecdotal
Report (06-07)

• MAR Title Trust
• Date of Medical Observation March, 2006

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Narration

• The woman was transferred from the stretcher to
  the operating table, for the third time. Her pale
  and weak features clearly suggested a chronic
  kidney disease.
• She must have been complaining of constant
  difficulty of breathing and an extreme limitation
  in performing even the basic activities of caring
  for oneself.

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• This poor quality of life may have influenced the
  womans resolve in proceeding with a procedure of
  creating an AV fistula, which was preceded by two
  failed attempts.

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• The promise of resolution of symptoms after
  undergoing dialysis did not ruin the womans
  hope. And besides, she trusted her surgeon
  explicitly.

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• I met her a couple of months ago, when a friend
  asked for a favor- make her aunt my patient.
  Acquiring a brief history, I agreed without any
  hesitation.
• I have, after all, created a number of fistulas
  in my three years in surgery. But in retrospect,
  I should have thought otherwise.

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• The first two surgeries were performed by me.
  During the first operation, I noted that the vein
  and artery were very small that chances of
  failure was high.
• Post operatively, signs of av anastomosis failure
  was evident.

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• I talked to my patient that she needs a second
  reoperation. She agreed to my plan provided I
  will be the one to do the procedure.
• Despite my hesitance, I did the second at the
  insistence of my friend that I be the primary
  surgeon. However, asking a senior to assist. But,
  he too, was unsuccessful.

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• So I climbed the hierachial ladder a step higher-
  a TCVS fellow was referred to. She was then
  scheduled for a Gortex graft AVF creation, which
  brought her to her third operation.

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Insight (Physical, Psychosocial, Ethical)
(Discovery, Stimulus, Reinforcements)

• In every physician-patent relationship, there is
  complete and sincere trust. Trust that the doctor
  has every good intention in mind for his patient.
  But we are also human, some failures must be
  expected.

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• Patients have complete trust in us doctors. But
  there are times that limitations must be placed-
  we cannot simply use the trust and proceed with
  every contemplated procedure.

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• We must look into our competencies and experience
  as a surgeon, and then decide whether the
  procedure could be done, or should help is
  required.

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• Experience is vital in surgery. Guidance from
  ones superior is needed in the earlier phases.
• But as enough experience points are accumulated,
  the guiding hand can slowly be released, and a
  new skill is acquired.

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Thank You