Glimpse of the Future?

Received this referral personally, via phone. Haha. Joint effort πŸ™‚ #geandmaan #OOD1 #burnROD @maandecastro

A post shared by Gerald Abesamis (@geraldabesamis) on

It still amazes me how, despite the big difference between the practice of OB-GYN and Plastic Surgery, we could still end up managing the same patient. Hahaha.

We’re both on duty today. Maan’s the 1st OOD (Obstetrician on duty) admitting all charity OB-GYN patients under her care, and I’m the Burn ROD (Resident on duty) seeing all charity referrals to the burn service.

On a previous instagram post, I jokingly suggested that the only time Maan and I could treat a patient together is when she refers to me for wound closure of her CS patients. Hahaha. I never thought that managing a pregnant woman with burns is also a possibility.Β So, when Maan called me up this morning, the last thing that I thought I would hear from her was a referral.

Jackpot. Pregnant patient + Scald burns.

It’s funny how we were discussing this very same topic lengthily just last week! Because of the recent mortality in the burn unit [A 28 week pregnant woman with 30% burns from a blast injury (sumabog ang LPG, tsk tsk) who also delivered her preterm child while in the burn unit!],Β I was asked to report about the management of burns in a pregnant woman in our weekly conference.

While preparing for my report, I told Maan how little literature there was about this topic. The most recent one I found was written in 1998! Sabi ko pa noon sa kanya, maybe we could co-author a research paper about this ‘pag medyo libre na kami. Interesting kasi and at least parehong malapit sa puso naming dalawa.

Little did I know that today, there was this patient we’d see together.

A glimpse of the future perhaps? πŸ™‚

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Audit

Credit goes to the artist who did this! :-) Great artwork, di ko lang alam where I found it though in the internet...

Surgery

This morning I had my very first audit, and yes, I almost cried. Not because of the sharp, stabbing, shameful words thrown at me, nor the accusing stares, and definitely not out of panic or anxiety. I almost cried because my spirit was crushed and I knew, deep down, that they were right.

Guilty as charged.

In the medical field, an “audit” may bring all sorts of feelings — anxiety, panic, frustration, pity, defeat. For those not privy to the term, an audit is when a doctor, usually one who’s still in training (resident/fellow), presents an interesting case to consultants; and this case is, more often than not, a patient who died on his/her own care.

This has been a long standing academic exercise, more like a tradition, in the medical field, to discuss whether the patient was managed appropriately or not. Others may call it an M & M (mortality and morbidity),or a CMR (case management report), and here is where all the real-life drama of medicine actually happens and not get featured at your favorite medical TV series.

An audit is where all the steps of your management of the patient gets stripped down to all the nits and grits — every wrong detail noticed, every wrong move critiqued, nothing escpes the analytical eyes and ears of the bosses. It’s like seeing the presentor being filleted alive, and then eaten (and then be regurgitated, and again be eaten!) In our native terms, kinarne.

I guess all audits goes the same way. The main reason why you are presenting the case is because the consultant who wants the case presented finds or found something wrong in what you did and wants you to learn a valuable lesson. And well, unlucky you, you just have to learn this valuable lesson the hardest way possible: in shame.

And learn I did.

Yes, I admit that there were lapses in management for this patient, and quite unfortunately, our team don’t have anything substantial to excuse us from these lapses. Most of it comes from wrong attitudes on patient care that were passed-on from seniors to juniors. Part of it is complacency. And an even smaller part of it, dare I say it, is negligence.

This was my first time, and probably not my last. As we climb the ladder of hierarchy and become more senior residents, even more patients become our own responsibility. I know I’ve learned a lot today, and in the end, I think, the most important thing that you must learn is acceptance. Accept that you were wrong, and in all certainty, know the right thing to do when you get the chance next time around.