Date of Medical Observation
February 2008

The Neurosurgery service received a referral from the department of ENT HNS a case of a 2-month-old female with a huge encephalocoele on her occipital area. The size is about three times its microcephalic head. From the look of it, the occipital mass is liken to a very big and fluctuant abscess that is about to burst one would be very wary to touch.

The patient is getting  full support and assistance from the Television network GMA channel 7 under its regular program  “Wish ko Lang” which makes this patient a very special one. A full inter disciplinary evaluation was carried out granted by the our neurosurgery consultant as well as the pediatric neurology consultant from the department of pediatrics. An MRI was requested to evaluate the extent of brain tissues that have herniated. It was noted that part of the brain stem was already incarcerated  and is believed to be non functional. Planned operation is believed to be very hazardous and prognosis is very poor.

The Department of Pediatrics wanted to forego the operation, they did not bestow a pediatric clearance.

We went down again to every details and explained to the mother the seriousness of her daughter’s condition.  Despite everything, the mother is more than willing to subject her daughter to operation even after the hesitancy of the pediatric neurologist as well as our neurosurgeon. 

Being the front liner in the management of this patient, we evaluated every scenario and weighed its predicted outcome. Sort of doing nothing and taking into consideration the mother’s wish our neurosurgeon was convince to gamble with the operation.

We prepared the patient for an emergency excision of the encephalocoele even with out the Pediatrician’s clearance.

Yet, before we were able to push thru the procedure the department of anesthesia blocked it once more. They asked for an intraoperative monitoring from the department of Pediatrics and a bed in  the Pediatric ICU for post operative management. Obviously, the pediatrician would not want to do it since they technically signed out and withdrew their involvement on the case. A conflict rose again, enough to preclude the operation.

I myself would not want to pursue with the operation for I know it is very hazardous. It was well explained to the mother that there is a possibility that the patient would die on the operating table the moment we cut her herniated brain tissues. Every specialist opinion was against the pursuance of the operation for they know it would not benefit the patient afterall.

But if we are going to take a deeper look at it. I would ask. Who is so definite? Who is so sure?

And who can not sympathize a mother whose only “wish” is just to be able to hold and hug her most loved daughter. Her determination to find miracle out of anything just to save her.  She knew her daughter would not stay long enough with her condition. But what is more unbearable to her is the torture of seeing her daughter in that most pitiful condition. She can not allow to just sit beside her daughter and watch her to die little by little with out doing anything. She would rather want to gamble