Date of Medical Observation:
JUNE 2006
Narration:
“Single,
live intrauterine pregnancy in cephalic presentation with equivalent sonographic age of 15 weeks
and 6 days”. This was the ultrasound result of my wife taken last June 1 2006. How would it be like when
we have our first baby? I am so excited! I’ve always wanted my first born to be a boy. I keep on day-dreaming..
My son and I were together, playing, laughing. I even had a dream once where I was able to see his face so much like mine.
Im going to be a father soon, very soon. I want to make sure that my firstborn is healthy. Free
from any ailment, from any danger as he come out.
It was my from-duty
status, my post was at the ward, care for ward needs and to attend to ward referrals from other department. Then there was
this medical clerk who referred to me a newborn male patient confined at the NICU due to clavicular
fracture. I’ve just answered 2 referrals of a clavicular fracture from the same medical clerk
during my tour of duty the night before.The Patient was born to a 25-yo G1P1 (1001) mother via spontaneous
vaginal delivery with APGAR score of 8/9, birth weight was appropriate for gestational age. His x-ray plates
showed a complete, transverse displaced fracture , middle-3rd of Right clavicle. I went to the NICU
and found the patient on the crib with his father staring at him. He is Ronnie 27-yo, a neophyte to fatherhood. He was so
delighted. An overflowing joy escapes on his very eyes as he watched his firstborn play, kicking the air.
But the gladness on his face was painted with sorrow when he realized that his son had a fractured bone. He can
not help but to get worried. As I started to do the figure of 8 I asked him to help
me hold his son’s back as I placed the elastic bandage. I noticed his hesitation. He was afraid to hold his son. He
was worried that if he do so he might hurt his child. I taught him how to place
back the elastic bandage around his son’s shoulder and told him to get used to it for he will going to do it everyday
for a couple of months.
“Fathers just love their sons. Just like Ronnie to his, just like me
to mine. I would not let anyone or anything cause harm to my child.” I told to myself. After the procedure I talked
to the pedia resident. I told her that it is becoming too frequent to receive referrals from them
regarding clavicular fracture. She confirmed, their census of clavicular
fractures among newborn is rising.
Insights: ( Discovery, Stimulus, Reinforcements / (Physical,
Psychosocial, Ethical)
Census showed 500 deliveries
all in all per month, about 350 of it were from NSD. Seven cases of clavicular
fracture were reported for the month of May only and 10 cases this month.That is 1 case for every
35 normal spontaneous deliveries, almost 1 patient every 3 days.
Alarming right? A clavicular fracture in a newborn with birth weight appropriate for gestational age is something worth
an investigation. And a rising census is another thing. I did this MAR not to accuse anybody of anything. I just wanted to
bring it in the open hoping to find answer.I just happen
to be a doctor who see different cases everyday. No big deal.. But I’m also a
man who will become a father a little sooner. I can symphatize
with Ronnie. I just hope that this MAR would be of help to let us figure out what really has gone wrong. Then we shall be
able to correct it.
THANK YOU!
