She was previously well until few months ago.
At that point, instant relief with Ranitidine made gastritis the most probable answer to her condition.
Yet, retrospectively, I wished I had referred her early to the Surgical Team in JB for an upper scope and Clo-tested her. Probably I should also screened her through a simple erect abdominal X-ray or referred for hepatobiliary scan to rule out cholelithiasis, although she wasn’t exactly the fat, fair, fertile female of forty (the risk factors for that disease as I remembered it from my medical school days)
The pain over the epigastric recurred but now referred to right hypochondrium and she had mild jaundice. She was admitted after a scan from the district hospital showed a probable stone with a possibility of external compression. The line of thoughts towards malignancy probably pushed them for a quick decision for a CT scan, which at my centre may take longer period of interval to materialize.
She was stable, afebrile and do not have raised total whites, although initial house officer’s information to me was inaccurate (inaccurately shocking) and did caused a bit of turbulence in my troubled minds over the withheld decision of commencing antibiotics.
The CT’s result was a consolation as from the board of blacks and whites, possibility of carcinoma could probably be thrown out of the window. She told me about her CT scan findings and going for op tomorrow, but unsure about the approach, but she had already signed the consent. Yep, typical Malaysian patients. But I wished to confirm for her.
I called several times to the hospy, only managed to speak to the junior doctors (HOs), and I really did not want to bother the Medical Officer until tonight because the junior doctors were surprisingly incompetent in conveying basic information about my mother-in-law even with the patient’s record in front of them. Sad, really.
Me: Hi, I’m Dr L, son-in-law of patient Madam T, may I know what is her current condition?
HO A: OK. Wait
(Went for the records)
HO A: Hi, I’m Dr. A. Your mother-in-law is well, tolerating orally, afebrile, haemodynamically stable.
Me: May I know the plan for her?
HO A: continue observation. Keep nil by mouth 12 midnight. That’s all.
Me: Any reason to keep her nil by mouth?
HO A: Wait ha.
(Turned and softly can be heard HO A consulting some people, presumedly more senior HO or Nurses)
HO A: Oh, she is for open cholecystectomy tomorrow.
Me: What is her CT scan findings?
HO A: Wait ha.
(Turned and softly can be heard HO A consulting some people, presumedly more senior HO or Nurses)
HO A: Err.. Cholelithiasis and left ovarian cyst.
Me: Is there a reason why she planned for open instead of lap chole?
HO A: (silent)
Me: (thinking. okay, my fault. This should be asked to someone with more experience) Never mind, may I know who is the MO on call?
HO A: Yes, he is Dr. X. You can speeddialled him at 6xxx.
Before I called up Dr. X, I googled up Open vs Lap Chole and landed in the Cochrane Review with the conclusion of superiority of Lap Chole against Open approach. To double confirm, I consulted my colleague from Surgery, Dr N. He told me even with difficulties, even with chronic cholecystitis is resectable laparoscopically, and possible indication is gallbladder empyema and probably suspected stones in the common bile duct (choledocolithiasis).
I called up Dr. H through their hospy’s operator.
Dr. H: Hi, Ya!
Me: Hi, I’m Dr L, son-in-law of patient Madam T, a patient in Ward E2
Dr. H: I’m not in-charge of that ward. I don’t know about her.
Me: Actually, she was planned for open cholecystectomy tomorrow. I would like to enquire why the more common laparoscopic approach was being differed.
Dr. H: That is my surgeon’s decision. I don’t know anything about it, and I can’t decide for her.
Dr. H: Why you insist on laparoscopic? You from where?
Me: I’m from Hosp xx.
Dr. H: I mean you’re from WHAT specialty?
Me: I’m from O&G.
Dr. H: Let me tell you OPEN CHOLECYSTECTOMY is very common. Even if we do Lap Chole, we can always convert to OPEN, you know. Why do you insist of wanting it?
Me: Err… Less hospital stay. Better recovery post op. I checked the Cochrane Review.
Dr. H: Err… What’s your mother-in-law’s name?
Me: Mdm Txx.
Dr. H: Wait. I go take her records.
Me: OK.
(flip flip flip)
Dr. H: She actually have Choledocolithiasis. We plan to do cholangiogram for possible stone in the bile duct stones.
Me: Thank you, just to clarify, I’m not insisting on laparoscopic approach, I just wish to know the indication for open.
Dr. H: OK (Shut off the phone).
This is the most patronizing conversation ever with a colleague in medical field. I was thinking that probably I should just tell Dr. H, I am just a first posting house officer and hear how much more demeaning can he be.
Probably the junior doctor should be given some brownie points for being polite enough to introduce before the conversation.
I hope my mother-in-law will have a smooth uncomplicated uneventful operation tomorrow and a speedy recovery from then onwards.
2 comments:
Prayerfully your MIL will be in good health with the best surgeon's hands doing the surgery.
God bless~!
:)
Very different medical culture. Did the Surgical team even get a informed consent for the procedure from your MIL? These would be very valid questions from pt about surgery on their body.
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