It is not everyday that you look down, and your "routine" breast case has turned into a chest case. THANK goodness that it is not everyday!!
Young woman--35--diagnosed with breast cancer 3 years ago. At that time, she had her (unilateral) mastectomy and tissue expander placement. Then, skin necrosis and excision, followed by failed tissue expander--they were unable to expand...
So, she went through her chemo, never had radiation, and we come to this year and her care with me. Back in February, I exchanged her tissue expander for a new one (in fact, there was a hole identified in the old one--presumably from a needle stick). I expanded her over the next 3 months. She is finally happy with size, so we schedule an implant swap--gel (silicone) in place of saline tissue expander--and to augment the other side to match. Enter yesterday...
Cancer side: trying to release capsule, I made a plane inside the pectoralis. I caught it right away, but still... not the way things are supposed to go. "Prophylactic side:" Tooling along, releasing the pec and suddenly I am looking at lung. It was not my day.
Cancer side: oversewed muscle plane and started over again... finished capsulorrhaphy and placed implant--success.
Prophylactic side: oversewed intercostal muscles over a red rubber catheter, oversewed with pec... got a post-op chest xray: tiny apical PTX
Kept her overnight, got serial chest xrays. She is fine, felt greal this morning, pneumo is resolving, and she went home. She feels like a queen, and couldn't stop thanking me. I feel like crap. I consider myself a safe, conscientious surgeon--not a cowboy or careless. How could this happen?! I have heard from a few people that the only way to become an expert is to make and overcome the mistakes.
So, maybe I don't want to be an expert!!
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- DrB
- New York Area, New York, United States
- A surgeon in NYC trying to make her way, while staying out of trouble and keeping from being disillusioned. In addition to surgery (which she loves terribly) her passions include cooking, drawing, and keeping active. :) This should be a hell of a ride!!
5 comments:
Happy to see you writing again, sorry it had to be about such a case.
Yes, it was a hell of a day. She is doing very well, though. She went home yesterday, happy as a clam... (me, on the other hand...)
Dear Dr. B,
Thanks for the story! It sounds pretty harrowing, but I'm glad you wrote it. I always worry about becoming complacent in my tasks, but fortunately the overwhelming feeling of not being able to stay on top of things usually forces me into working harder.
On a separate note, it's always interesting (and scary) to think about how little patients don't know about the care received. Even for the little stuff, like how often an IV should be changed or how medications should be timed through the day vs actual timing. I'm not a big believer in ignorance being bliss, but it seems like maybe that's what your patient had a case of.
OK, so I just deleted my own comment... oh, well.
I saw her today for the first post-op visit. She is thrilled, "They look better than ever!" she gushed.
I again talk to her about the pleurotomy (I like informed patients.), and she looks at me as though it is the first time she has ever heard such a thing. We go through it again and again... After a while, she looks at me, and asks, "So, that little hole, why did you make it?" oh, boy...
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