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most surgeons i’ve met refer to themselves as the fixer. they fix things. that’s what they do. for example, if flow is blocked- by anything imaginable; blood, urine, faeces, bile, etc, remove the clog. if the clog is too extensive, create a route to bypass the blockade. and i can sense their greatest satisfaction when discharging the patient home after surgery, saying proudly, ’see, i told u i’ll fix it’.

but like all things in life, some things can never be fixed. in those cases, the patients never get to see a surgeon. or they do get the opportunity only to be turned down later on - go back to your medications and pray for the best and don’t bother to see me anymore, they are told.

but in rare cases, the surgeons thought they could fix the problem, but end up causing more problems. that is when complications happen. sometimes mistakes are made. sometimes things just get out of hand. sometimes problems present instantaneously. sometimes much later.

it is true that surgical-related mortality and morbidity rate are kept to minimum with better techniques, concurrent medical therapy, closer patient monitoring and such. for example even a complicated procedure like open abdominal aneurysm repair has only 5% mortality rate. (amongst other complications like wound infection, dehiscence, bowel paresis, etc). it is quite a wonder considering the extend of the cut, the fact that the bowel and everything else are manhandled and shoved aside, and the blood flow to both legs is halted for the whole 3-4 hours whilst the operation is underway.

so yeah, for 95% of the patients, their bulging aorta got fixed and the imminent threat that it will rupture and leak precious blood is no longer there. to them their surgeons become their saviour. but for the 5% of patients got more than what they bargain for; earlier death.
it is all as well churning these statistics on complications when luring the patient to consent to surgery. 5% is such a small percentage and the patient could be easily coached into thinking along the line of; what are the odds it will happen to me? no way.

but explaining what went wrong to the relatives and loved-ones of the 5% of patients would be a much trickier business. like in mr. w case (whose fault is it anyway?), what went wrong is already known; a tear from the puncture site in the right femoral artery causing retroperitoneal haemorrhage, he then went into shock after losing so much blood. considering his recent MI, his weak heart just couldn’t cope and stop beating. but i wouldn’t want to be in the surgeon’s/radiologist’s shoes when they are explaining all this to his wife and daughters.

it’s a risky business. complications still and will continue to happen, no matter how good the surgeon is because one simply can’t be good enough. after all, surgery and medicine is nothing more than what it exactly is; an imperfect science.

i even question the whole thing; why bother? why not just let nature takes its course? why this need to intervene? recently i have heard of a new surgical procedure to repair extensive abdominal aortic aneurysm involving open surgery as well as endovascular intervention. what happen is all the arterial branches coming out of abdo aorta are re-routed before the anurysm itself is being repaired. it takes 7 hours and involves 2 surgeons, with mortality rate  reaching 30%. but when i look from the patient’s perspective i consider this; if i am doomed to die and there’s even a slight chance for anyone to fix me up so that i can live i’ll take it, no matter what.

p/s ; for better insight into the whole subject try and get hold of "complications; a surgeon’s note to an imperfect science" by atul gwande. it really is an interesting book.

i stumbled upon the book a long time ago. but the tittle put me off. i mean, yeah of course u’ll meet people in heaven..and it does not necessarily be five. and does it matter anyway? as long as i get to go to heaven i’m happy

then ida brought he book home. she said it is brilliant. ning read it too..then they launched into endless philosophical conversations that involves love, death, sacrifice..yeah heavy things like that. i felt stupid for not being able to keep up. out of a sudden my friends are having a seemingly interesting meaningful conversation instead of our usual stupid banter..all because of one book.

so i read it. i discovered eddie. but before i could get to know him, he died. and it was through his death that i learned about his life.

these were what the five people he met thought him, and quite coincidentally, me.

strangers are just family you have yet to come to know. two strangers meet and a year later their bond becomes closer than blood. eventhough most people remain strangers, human spirits know that, deep down, all lives intersect. take death for instance. It doesnt just take someone, it misses someone else, and in the small distance between being taken and being missed, lives are forever changed.

sacrifice is part of life. sometimes when you sacrifice something precious , you are not really losing it. you are just passing it on to someone else. so it needs not be something to regret. it is something to aspire to.

all parents damage their children. some parents smudge, others crack, a few shatter childhoods completely into jagged pieces, beyond repair. and youth, like pristine glass, absorbs the prints of its handlers. but one thing parents rarely do is, letting go. so children let go of them. they move on. they move away.but it is not until much later that children understand; their stories and all their accomplishments, no matter how far they moved away, sit atop the stories and accomplishments of their mothers and fathers.

holding anger is poison. we think that hating is weapon that attacks the person who hurt us. but hatred is a curved blade. and the harm we do, we do to ourselves.forgive. let it go. when the soul is freed from it, the soul feels lighter.

life has to end. but love doesnt. lost love is still love. it takes a different form; memory. first you cling to it out of need. then you nurture it. you hold it. you dance with it. and your love is as strong as ever. and in the end you realize you dont really lose anything at all.

no life is lost. no one goes through life without accomplishing anything. the only time we lost is the time we spend regretting the past, thinking of all the what ifs in our life.

so there, that’s eddie’s life in a nutshell.

remember the feeling you get when you finally found a good book after so many others that just gave you something to do instead of doing anything to you. and you still think about the story long and hard days after you put it down. well this is one of them books.

i was a bit shaken on friday, to find out first thing in the morning that mr. w is dead. rewind to thursday morning; i said hello and shaked his hand, started a small talk before dr seriki launched a series of mini-tutorial on his carotid duplex scan’s findings. later on during angiplasty procedure, we chatted some more and i even got to scrub up and helped with the angioplasty procedure. he had 2 stenosis in left common illiac and left superficial femoral artery that needed correcting. so i happily but shakily helped passed and hold down the guidewire, the catheter, the ballon, etc etc. after all was done, he was as good as new, and ready to go back to the ward. i said goodbye and wished him all the best.

from what i heard, later the night his bp drop and his abdo became progressively swollen. then he died. but how come the falling bp didnt raise enough alarm for anyone to do anything to him sooner? and has it got anything to do with the angioplasty earlier? (fact; mortality rate from angiplasty is about 1 in 10 thousand). but he must be bleeding from somewhere wouldnt he or what will otherwise explain the drop in bp and the swollen tummy?

so yeah, untill the autopsy report is made available, everyone is playing a guessing game; what actually happened? why was it allowed to happen? whose fault is it?

what had happened got me into thinking; if at anytime in my career later (finger crossed i get to become a doctor), how would i feel if something like this happens and autopsy report confirm that the death of my patient is my doing. sure i will feel like shit, but what will happen after that?
but as dr seriki put it; sure we take risk all the time, most of the time we dont do the patients any harm but sometimes we do and that’s that.

i cant help bit wonder that this is the attitude that made these surgeons and interventional radiographers so good at what they do; taking risks and never flinch to cut and ever so ready for all consequences.

it was such a sad thing that has happened. but yesterday i was called to work and sit in with this MS lady for 8 long hours. that was the easiest money i have made because she cant speak so she couldnt ask me for anything, she cant swallow so she has peg tube in situ, she has no bowel and bladder control so she has catheter and nappies, and she cant walk or even sit up so she’s bed-bound. basicall i’m just there to make sure she continues to breath. that is an even sadder thing, to have her life and everything in it taken away from her slowly and surely until what is left is just the small space of her room and the comfort of her bed that she could never get out of. so when i think about it, mr. w got the better end of the deal, really. dont u think so?