Date of Medical Observation
January 2007

Narration

The famous Dr. House once said..  “ Everybody lies.”    Even your patient is a liar.                           

  Hear this one story of mine….

A 48-yo-male was transferred to ER from OPD due to abdominal pain.  He allegedly sustained blunt abdominal trauma secondary to vehicular accident 2 weeks ago. He  underwent exploratory laparotomy in a hospital in Marikina city.

He claimed that his companion left him at the hospital and nobody fetched him when he was discharged 10 days ago. The patient lives in Nueva Ecija. He presented with 6 days history of abdominal pain, no fever and no vomiting. There were no symptoms pointing to intestinal obstruction.

He sought consult at Surgery OPD complaining of abdominal pain. Initial consideration was an acute abdomen hence subsequently transferred to ER for further evaluation. Physical examination revealed a flat abdomen, with a healed midline surgical incision scar, soft but tender on all quadrant. There was no muscle guarding. Digital rectal examination revealed no rectal mass and non-collapsed rectal vault with stool on tactating finger.

I referred him to my senior co-resident. His assessment was that of acute surgical abdomen. He then ordered to book the patient for exploratory laparotomy. I explained to the patient the nature of his illness and immediate surgical intervention is necessary requiring his consent.  

This was the time I asked on the whereabouts of his relatives.  “Kaya ko naman, ayoko magpaopera, gusto ko na umuwi” then he went on outburst, he pulled out his IV line and walked outside “ Walang kwenta ang ospital na ito.” He said. I reported the situation to the social service. I told them that the patient is agitated and wants to go home but he has an acute abdomen.

Honesty, I had a little remorse towards this patient. I didn't care if he walk away and go home. I have a handful of patients to care and worry about. It’s not that I doubted the diagnosis of my colleague but I smelled something fishy toward this patient. I felt that something don’t just fit in.

 Is this patient psychotic? Are we going to operate on him?  Who would consent? I have all these in mind. Until I came to ask again. Is this patient really in pain?

As I reviewed his chart, the history didn’t look right. I noticed lots of loop holes.His whole abdomen was soft and the scar do not look a couple of week old. Moreover, I don’t think somebody with an acute abdomen could move and walk the way he did.

This was the time I confronted him.  I asked again frankly, is he really in pain or just faking it?  If he say so, he will be brought to the operating room right away. If not, maybe I could help send him back home.

Then he replied. “ Hindi po talaga masakit tiyan ko.. Gusto ko lang po umuwi sa amin.”

Whew!!

Insight, Discovery, Stimulus

Physical, Emotional, Psycho-social

Maybe Dr. House was right.

Everybody indeed is a liar.

There are a lot of issues brought out by this story.

A reflection of our society concerning again those less fortunate individual.

This is the psychosocial aspect.

Yet, I chose the physical aspect to begin my personal insight about this MAR.

We really are as busy as bees.

ER-trauma complex is our beehive.

More often than not, we are pre-occupied with everything concerning each and every patient of ours. Not to mention our homeworks.

When I was still a student, my mentors taught me how to do a complete examination of the abdomen.

Inspect, auscultate, percuss then palpate.

Unfortunately, Dr. Bee in the beehive sometimes failed to do a thorough examination because of his overwhelming tasks.

Moreover, Patient’s illness doesn’t seem to just pop in at once.

Disease process is somewhat an entangled grid presenting with constellations of symptoms and signs.

That’s the reason why our diagnostic formulare must not be limited and fixed in a box.

I don’t claim to be the best or rather good enough.

I just want to share this story because it stimulated me.

END