What is the saddest case you have had as a doctor?

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ItuGlobal
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April 12th, 2017, 12:19 am

I first saw the 16 year old girl in the ER late on a Friday night. She had been tossed from the back of a pickup as it rolled off the side of a rural road just an hour or so earlier. As she lay there on the ER gurney, she actually looked pretty good despite her somewhat low blood pressure. She was frightened. We were about to take her to the OR for emergency abdominal exploration because there was blood in her abdomen. I explained how I would be taking care of her. Making sure she was asleep and how un-scary the process was. I explained that she would almost certainly do well because she was so young and healthy. I am always careful to avoid any promises such as; “everything is going to be fine”. But I do promise that I will take excellent care of each patient.

During the surgery, two excellent surgeons were working diligently to find the source of significant bleeding. We had a “cell saver” in operation which was reprocessing the suctioned blood so that we could give it back to her. I had an anesthesia nurse in the OR with me. We both worked hard and fast to keep up with the blood loss. We kept her blood pressure just high enough to maintain good organ perfusion but low enough to minimize bleeding.

The primary surgeon looked up at me and said:

“You're going to have to stop.”

“What!?”, I said.

He explained: “Her hepatic vein is torn off of her IVC. It is not repairable.”

I drew the mental picture of the anatomy that he just described. I understood that a very short but fat vein behind the liver attached directly to the vena cava, one of largest veins in the body. It was simply not accessible behind the liver.

He continued: “You are going to have to stop transfusing her. There is nothing we can do.”

I was stunned. This would not be my first patient to die in the OR from some unmanageable condition. But this was the first (and so far only) time that I had to actively stop supporting life in a person who was very much alive. I (mentally) looked for a way out of this terrible situation. “Is there really nothing we can do?”, I asked the surgeon. The surgeon was a highly respected surgeon with much more experience than I had at that time. His was the final word.

We watched as her blood pressure dwindled and her skin turned pale. Shortly thereafter her heart slowed and stopped. A young girl whom I had been chatting with just a few hours earlier lay dead in front of me. At my hands.

Epilogue …

A decade later I told this story to a now more recently trained trauma surgeon. He explained that these days, she would likely have lived. This is a well known type of traumatic injury that can be managed differently with some success.


Source: https://www.quora.com/What-is-the-sadde ... s-a-doctor

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