Monday, July 18, 2011

Complications

I was reminded of a very important fact this week: No medical therapy is without risk.

I did a paracentesis a few days ago, a procedure I have done numerous times with no problems. This is something that is done when a patient has excess fluid floating around in their belly, a problem that most commonly arises when someone has a diseased liver. It is not a complicated procedure. I even had one of our ultrasound technicians come up to the patient's bedside and mark a spot where there seemed to be the most fluid.

When I did the procedure, I put the needle in, and normally, the fluid is a nice, clear yellow. Saturday, though, what I got out looked like, well, let's just say it looked like the kind of fluid you would find inside someone's bowels. Just to recap: putting a needle into someone's belly and getting out nice, clear fluid = good. Getting out something that looks like it came out of their bowels = you probably stuck the needle into their bowel = you perforated the patient's bowel = very bad. Because it wasn't clear to me yet what had happened, I got an xray and ct scan and watched the patient overnight. Then she had a fever. Then she had more pain.

The next morning, I just realized that I had to call a surgeon to tell him what had happened. I was so nervous that he was going to yell at me. But he didn't. He was exceedingly nice and gracious and didn't make me feel bad at all. He could tell I already felt bad, and like many people with whom I've discussed this issue, understands that sometimes these things happen. He took my patient to the OR, and didn't find any evidence of bowel damage (whew.).

Sometimes, it is easy to forget that the things we do can cause problems. Big problems. Even though I don't think I necessarily did anything wrong, there were several things I could have done better. I was in a rush that day, trying to get it done, and then having to rush down before the cafeteria closed to get lunch. Even something as routine as a paracentesis should not be rushed. I ended up leaving the patient in between doing the ultrasound and the paracentesis, so something probably moved into that nice pocket of fluid I had seen earlier. I will never do that again. In fact, I learned that our radiology department actually has a special ultrasound probe specially designed to do procedures, and so I can actually do the whole thing watching with ultrasound guidance. That will be my plan from now on.

I hate that bad outcomes have to happen for me to learn, but hopefully I will remember with everything I do that no treatment is totally benign.

1 comment:

RT said...

(Hi! I've had problems commenting here. Hope this works.)

Things happen, things go wrong. I totally understand that and appreciate your gentle humility! I'll never forget coming out of a D&C when I miscarried and Jeremy told me my uterus got perforated. It was such a non-issue to me---just a potential side effect of having a procedure done. My mom was fighting mad, but that's 'cuz I'm her kid. :) God bless you, Aubrey. You are a great doctor.