Friday, March 11, 2011

playing God

because doctors often deal with life-and-death decisions, we have sometimes been unceremoniously accused of playing God, as if dictating who should live & who should not. i occasionally have to encounter these circumstances myself but i'd like to think that i always have the patient & the family's interest at heart, although it may not be taken in positive light.

but i leave playing God to ..... God.

last nite, we had this particular difficult case in surgery. the patient had a huge pancreatic cyst which required removal together with a portion of the pancreas. pancreatic surgery is fraught with landmines as it is, so after 4 labourious hours, it was finally excised.

& right there & then, a small vessel started bleeding profusely. this was immediately dealt with, but not after 250ml of blood had been lost within minutes. (note: the excision of the cyst had resulted in a litre blood loss earlier)

this was when one of the doctors exclaimed : thank God,  it bled now & not later!

if the bleeding had occured later when the patient was in the ward, the outcome would have been catastrophic. the rapid blood loss would have cause immediate deterioration in the patient's condition & there might not be time to re-explore the abdomen in OT. most likely, it'll be a one-way trip to the morgue.

seriously, when we doctors have our heads firmly screwed unto the shoulders, we realise we are just pawns on the medical chessboard. God alone decides which piece will be moved.

i just pray there aren't too many checkmates on my watch.

28 comments:

house-tai said...

God bless you doc!

Grandpa said...

Well-said doc!

iml said...

We do our best, the rest is up to God. He alone decides when and how we exit.

reanaclaire said...

sometimes in our prayers, we tell God to grant wisdom to the doctors, especially when our love ones are undergoing treatment ..etc etc.. now i know why doctors are so smart.. :)

Unicorn Girl said...

Doc , I'm pretty sure , before you begin on a procedure or any other procedure or surgery for that matter , will u not call on God to be your working ' mate ' or working ' partner ' ? Leave it in the hands of the good old Lord !

Mei Teng said...

Yeah sometimes people try to act like they are gods.

Medie007 said...

ooooh! God bless the patient!

doc said...

House-Tai,

GBU, too!

doc said...

Grandpa,

thanks, i just spoke my mind.

doc said...

Iml,

true, except that sometimes we don't trust God enough!

doc said...

Claire,

doctors are only humans - it's just that the public put them on the pedestal.

doc said...

UG,

oh yes, i call upon the Lord all the time for guidance & wisdom.

doc said...

Mei Teng,

only people in power or in authority do that.

doc said...

Medie,

the patient had 4 bags of packed cells & 4 units of FFP, & is recovering.

missyc said...

urgh Scary thot when I had to have blood transfusion post op, was conscious when told of blood loss hovering at danger level. Reluctantly agreed, then regret, develop rashes, itch all over, then seeing alien bumps size of baby grapes popping out on my face ! Wanted to yank out everything but was too weak while nurse ran out to page for doc. Waited 2 weeks to find out reason for reaction was torturing! Still have the urge to poke myself & drain out the damned donated blood :P

I was told some religion/sect forbids blood transfusion even if its meant to save patient's life. Their reason, leave it to God. Ever encounter this ?

doc said...

MissyC,

the doctors prescribed blood in good faith but some patients like yourself do have adverse reactions to transfusion.

Jehovah's Witnesses do not accept blood transfusion under any circumstance. in fact, when they come for surgery, they make doctors sign an agreement form prohibiting blood transfusion.

i've only encountered one such patient so far & fortunately, no transfusion was required.

Yvonne Foong said...

Doctors are also pawns on the political chessboard, used by bureaucrats!

Yvonne Foong said...

At SVMC thre is no-transfusion surgery. I wonder how they do that.

doc said...

Yvonne,

there are several precautions that can be taken to reduce blood loss.

if you look at the big picture, we are all pawns tossed about by the politicians.

Kristin and TK said...

Yvonne; some places do autotransfusion; ie retrasnfuse your own blood.
Doc: well done!

Yvonne Foong said...

Precautions like discontinue any medications or supplements that can cause blood to thin and flow faster two weeks before surgery?

Yvonne Foong said...

Oooo autotransfusion!

doc said...

TK,

thks for your comment.

doc said...

Yvonne,

the precautions you mentioned apply to most general surgeries, but in particular to reducing blood loss, the surgeon needs to be meticulous with bleeding. for limb surgery, a tourniquet is applied to the affected limb. the anaesthetist can help by providing hypotensive anaesthesia.

in some centres, autologous blood transfusion is practised. the patient's blood is collected before the op, either several weeks prior or even just before surgery. then it is transfused back to the patient when needed. the risks of transmitting infectious disease is eliminated by this & the patient is certain the correct type of blood will be available.

missyc said...

autologous blood transfusion*.. noted but I think my situation was different then as I had menorrhagia plus blood loss due to type of surgery & being anaemic (beta thalassaemia). I can't opt for this* right ?

Adino said...

Good job doc. Life is really fragile ya?

doc said...

MissyC,

no, to participate in autologous transfusion, you must have normal blood cells.

doc said...

Adino,

life literally hangs by a thread!!