How do you measure success?

I had a patient last Saturday night. He was involved in a road traffic accident, didn't lose consciousness but had this massive headache, went to a clinic, and was discharged with analgesia. It wasn't until a few hours later that he lost consciousness.

Textbook description of an epidural hematoma. In layman term, he bled between his skull and the outermost covering of his brain. When he was brought to us, one of his pupils (the eye, not a student) had already dilated, his blood pressure was lowish, and he had to be intubated for artificial ventilation support. To be honest, I only received the patient at the airlock of the operating theater; another colleague had managed the primary survey and care of the patient.

And since I'm being honest, the surgery was exhilarating. It was challenging, and I always love a good challenge. I had to be extra careful not to injure a major vessel, and as the bleed was over the cerebellum (just above the back of the neck), inserting a drain wasn't an option. I had to make sure the bleeding was fully secured.

Alhamdulillah, the surgery went without complications. There was no change in the patient's condition, but he was stable. The dilated pupil had shrunk to normal. He went for a post-operative CT scan in the morning, but his condition deteriorated a few hours later. Both his pupils were dilated, and he lost his brain stem function, which is the most primitive of the brain's functions.

Groggy from lack of sleep for over 32 hours, I reviewed the patient. I was disheartened when the nurse informed me about the patient's condition. Then I reviewed the CT. The clot had been fully evacuated, and there was no residual bleed. Judging from the scan, the surgery was a success.

Was it?

The worst part was that the patient's family is in another country. I had to break the news to his friends, I had to gently inform them that there was nothing else we could do, that they had to call the patient's family to tell them that he would not make it. He was in God's hands, now.

I know that when the patient came to us, it was already too late. I know that I did my best. But I wonder. I wonder if there was something more I could have done. A more aggressive surgery. A more aggressive post-operative management. Something. Anything.

I also wonder if what I had done had amounted to anything. Not for me, but for the patient and his family members who are oceans away.

Sometimes I just want to roll the windows down, close my eyes and feel the wind whipping against my face, and let God take the wheel. Because I don't know how to measure my success; not in this field.

Comments

[Breanna Teintze]

Not a lot of profound things I can write, just wanted you to know I read it--and I get it--and it never does get easier, does it?