Surgical Reflection

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Approximately three weeks ago, I encountered a patient in her late 70s who had an oophorectomy, months prior to her presentation in the ER, due to a previous cystic ovarian cancer. After all the lab tests and the CT of her abdomen and pelvis, it was evident that she was having septic shock secondary to a perforated bowel and new metastasis from her previous cancer. Based on her clinical presentation, the patient did not have a good prognosis. The ER physician explained to the patient and her family that the surgery was more of a palliative method to prolong her life from the ongoing sepsis, and not a cure to her current diagnoses. Based on her H/H levels, the patient was a few points from receiving a packed RBC transfusion, so I requested an order from the …show more content…

Upon hearing this, the patient’s daughter and her grand daughter did not agree to her parents’ decisions. She was so upset that she and the rest of the family members caused a commotion, which prompted me to request for the ER physician to explain the risks and reexplain the prognosis of the patient. The ER physician, as well as the colorectal surgeon, explained the risks of hemorrhage and death during the procedure as well as the advanced stage of her cancer and its poor prognosis with the septic shock. I truly understand both sides, and I know that this is a sad situation, but for the patient’s sake we always follow their decision no matter how difficult it can be for the whole family. It took a while for the family to fully understand the situation, again I think they are in a very tough position to respect their mom’s wishes and at the same time spend their last few days with her in an unexpected manner. To make matter’s worse, the patient was unaware that there was new metastasis from her cancer because the last time she was seen by her oncologist, she was informed that she was cancer-free, and the family celebrated the good news

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