Disappointing outcome

It was an exciting Monday morning. Unfortunately, the final outcome was very disappointed. I was called by Emergency Room doctor at 10:45pm last night. There was a man admitted with a stab wound at left front chest wall with active bleeding and patient was in shock. We immediately returned to hospital. I put in a chest drain but drained no blood. I alerted that there might be something more serious in the central part of chest with either major vessels or heart injury. I performed a thoracotomy and found a one cm tear in the superior vena cava (SVC, major vein in body draining the blood from upper part of body to the heart), and torn left internal mammary artery. Once I opened the pleura covering the torn SVC, there was pool of blood leaking out. I struggled a lot but finally controlled the bleeding and sewing the tears. I packed the bleeding site and waited nearly for an hour to get the patient blood volume replaced and pressure returned to normal. When the time we left the hospital, the patient blood pressure and oxygen saturation were all normal. We went home at 5:15 am in morning. When I was celebrating my success in a re-freshening shower, I received call from the ER doctor. The patient wake up and was very irritated. He wanted to calm him down with sedation and got my opinion. The patient suddenly bursted into sudden bleeding with blood pouring out of the drain and wounds. I finally lost my patient. I guess that the repair or the fragile vein was torn apart because of sudden rising of the venous pressure due to his irritation. If it happened in Hong Kong, we certainly would sedate and ventilate the patient in intensive care unit in this very critical post-operative period. It could not happen in Teme Hospital or in my other missions. We even could not afford to look after our own patients well in this critical time. It was very sad. In the morning, I discussed the case with our colleagues and OT staff. Hopefully, we could learn some lessons and gained some experiences from this tragic event. I showed the OT staffs the use of different instruments in the thoracotomy set. It seems that they are not very familiar with them. They all said it was useful. It’s my last week in Teme. The OT staffs start feeling miss me. Yes, I did give them quite a lot of challenges. I’ll miss the work in Teme too, although it was tough but challenging. Hope to give you some other cheerful story next time.