Friday, December 30, 2005

Sometimes in medicine, we have this bad habit of blaming ourselves. Or maybe it's just me, I don't know.
I saw this patient last month for osteoporosis. Probable parathyroid adenoma. But being the wiseass endocrinologist that I am, I noted too he had a goiter (actually it was quite large, funny how no one noticed earlier). And he had a couple of dominant nodules.
So I sent him for an ultrasound guided biopsy. He was supposed to see me late afternoon for follow-up. But came early because he was in pain.
Neck was swollen to twice its size. Did a quick bedside ultrasound. Hematoma. I had him sent to the ER for impending airway obstruction.
The next thing I know, he's in the OR, and for a time, they were considering a tracheostomy.
The stupid thing is, in all probability, those thyroid nodules will be benign. But in the meantime, he was placed in a potentially life-threatening situation.
I was pretty disturbed by this most of the night, and angry at myself.
We did things by the book. And, when one finds a nodule in the thyroid, a biopsy usually IS indicated. And bleeding and hematomas do happen, no fault of the interventional radiologists. But, sometimes that adage is true; if it ain't broke, don't fix it.
We did nothing wrong; conversely, we probably did the right thing but things just didn't fall into place. So why do I still feel like it was my fault?
I wish I never found that lump in the first place. If only I just rushed a bit and thought to myself, no, he's here for osteoporosis, I don't care about the rest.
Thankfully, when I visited him late at night he was doing alright. A trach wasn't necessary.