There are times in my career that I hesitated in the operating room; whether to do further surgery or be conservative. And this is one of them.
A patient who drifted in the high seas for 3 days after their boat capsized during the HURRICANE PABLO which devastated Mindanao sustained contusion of his left hand. This became swollen and the fingertips darkened. He was in pain while drifting holding on to a small wooden flank. He was picked up by another boat barely surviving with other multiple body injuries. When he was brought to the shores of General Santos, attention of the doctors were focused in reviving him by placing him in the ICU. His hand was misdiagnosed as an ordinary swelling. He was always severely in pain and complained about his hand. Nothing was done to it. The family decided to transfer him to Davao for further treatment.
When I received him, his index-middle-ring and small digits were black on the tips with severely swollen phalanges. The swelling also involved the palm and the dorsum of the hand.
He was in a late stage of CARPAL TUNNEL SYNDROME; severe constriction of the middle nerve and venous system of the hand.
The patient wanted me to cut the tips of the fingers. I explained to him that that is not the main problem right now. He was losing the whole hand. I wanted to do FASCIOTOMY; cutting the fascia of the hand to relieve the compartmentalization. But in the back of my mind, I wanted to do what the patient wanted me to do.
After doing FASCIOTOMY, I argued with myself whether to proceed with the finger amputations or not. But I was sure, the amputation stumps will not heal because the phalanges were so swollen. Despite the wish of the patient, I did not amputate. I went out of the operating room and came back several times not knowing whether my decision was right or not.
The next day was a cliff hanger for me. I made my rounds and the first thing that I asked the patient was: is it still painful. The patient was smiling and told me he had a good night sleep the only one since the HURRICANE.
A patient who drifted in the high seas for 3 days after their boat capsized during the HURRICANE PABLO which devastated Mindanao sustained contusion of his left hand. This became swollen and the fingertips darkened. He was in pain while drifting holding on to a small wooden flank. He was picked up by another boat barely surviving with other multiple body injuries. When he was brought to the shores of General Santos, attention of the doctors were focused in reviving him by placing him in the ICU. His hand was misdiagnosed as an ordinary swelling. He was always severely in pain and complained about his hand. Nothing was done to it. The family decided to transfer him to Davao for further treatment.
When I received him, his index-middle-ring and small digits were black on the tips with severely swollen phalanges. The swelling also involved the palm and the dorsum of the hand.
He was in a late stage of CARPAL TUNNEL SYNDROME; severe constriction of the middle nerve and venous system of the hand.
The patient wanted me to cut the tips of the fingers. I explained to him that that is not the main problem right now. He was losing the whole hand. I wanted to do FASCIOTOMY; cutting the fascia of the hand to relieve the compartmentalization. But in the back of my mind, I wanted to do what the patient wanted me to do.
After doing FASCIOTOMY, I argued with myself whether to proceed with the finger amputations or not. But I was sure, the amputation stumps will not heal because the phalanges were so swollen. Despite the wish of the patient, I did not amputate. I went out of the operating room and came back several times not knowing whether my decision was right or not.
The next day was a cliff hanger for me. I made my rounds and the first thing that I asked the patient was: is it still painful. The patient was smiling and told me he had a good night sleep the only one since the HURRICANE.
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