[ There is always a reason...]
對一個新進主治醫師來說
最煩惱的事是怎麼有機會施展一身功夫
大概兩年前
她是一位七十幾歲的婆婆
因為下背痛加上雙腳酸麻 來就診
檢查起來是蠻嚴重的腰椎退化合併壓迫到神經
所以我照著常規的做法 先保守治療
再來申請要用的脊椎耗材(cage & screws)
就安排了開刀
我還記得開完刀的隔天
阿嬤稱讚我說 醫生怎麼這麼厲害
她的背都不痛了 腳也比較不麻了
阿嬤很順利的出院了
我也叮囑她背架要好好穿著 記得要按時回診
但奇怪的是 我下次看到她 是三個月後的事了
她坐著輪椅進來診間 看起來一副虛弱的樣子
詳細詢問之下 才知道
她出院大概兩個禮拜之後
因為穿尿布的關係 無法解尿解得很乾淨
就因為泌尿道感染引發敗血性休克 進了加護病房
差點連命都沒了！
雖然我知道不是因為我開刀直接造成感染
但是的確是因為開刀造成的破壞 讓她臥床
我不禁開始懷疑 我到底是幫了她還是害了她 ？？
傳統開放式的手術 帶來太大的破壞
而忽略了每個人與生俱來的自癒能力
上個月在德國🇩🇪的會議上
許多專家都提到自己開始做內視鏡手術的原因
對於我來說
是這麼一位婆婆讓我決定開始做對的事！
First, do no HARM.
[ There is always a reason...]
For a young Orthopedics surgeon, how to get a patient and convince him/her to take operation is always hard.
About two years ago, I got a 70 years old grandma to visit me in my clinic due to low back back and bilateral legs numbness
It turned out to be the degenerative spine and the spur caused her discomfort.
I followed what I was taught and prescribed some conservative treatment as standard way. Due to poor response to conservative treatment, I convinced this grandma to have operation, a transitional lumbar decompression and fusion surgery.
I still remember what this old lady told me at the second day after the operation. She said to me: “ You are good. My back does not hurt anymore and I feel less numb over my legs”
She was discharged one weeks later. I told her do not forget wearing the brace and do not forget coming back my clinic. I thought I did great job.
Oddly enough, she missed next clinic and did not come back until three month. She was on wheelchair and was quite weak. I asked her what happened and I was absolutely freaked after hearing what she said. After she went home from hospital, she stayed at bed most of time. After two weeks lying on bed, she had urinary tract infection. The infection was so severe and it almost killed her. She stayed in intensive care unit for weeks due to septic shock.
I knew the operation was successful and had nothing to do with the infection. However, It was the collateral damage of the traditional open operation that put her on bed for weeks!
She did not blame me for this. But deep down in my heart, I started to blame and question myself, I was helping her or I was hurting her??
Last month, I went to an expert meeting held in Germany. Many experts mentioned the reason why they gave up open surgery and started to do spine endoscopic surgery. For me, it was this lady woke me up and let me decide to do the right thing.
After all, we all know: “First, do no harm”.
