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.


Anonymous coolcat said...

Wow, that's quite a drama there. Glad yr patient is ok now. Don't be too hard on yourself, 'kay?

Oh and Happy New Year to you and yours!

9:13 PM  
Blogger Gina said...

Don't blame your efficiency as a burden. You are a good doctor, and ought to be proud that you found the lump. What if it is the minority case? Turned out to be maglinant? There is no room for what-ifs or should haves later. It is all conscience, dahling. You did good.

4:05 AM  
Anonymous masdie said...

Wow....a real life scenario from the House of God? Fat man is right after all huh.

9:29 AM  
Anonymous Anonymous said...

What has happened to primum non nocere?

8:12 AM  
Anonymous Anonymous said...

What ever happened to primum non nocere?

12:07 PM  
Blogger vagus said...

yea, first do no harm is ideal.
but this world ain't ideal; everything you do, irght down to a simple antibiotic injection, has potential complications.

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