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Discussion in 'Military Medicine' started by edmadison, Feb 8, 2010.
and did we do it on purpose?
My God. Ed, what did you do?
I think you read my mind with your post. I was reading a report that said he had surgery at the National Naval Medical Center. Obviously we don't have any facts. Was wondering if there were any surgery issues that might have impacted the outcome. Have you guys seen any reports about that?
This was the quote from the article:
Mr. Murtha was first hospitalized with gallbladder problems in December. He had surgery Jan. 28 at the National Naval Hospital in Bethesda, Md. He went home, but was hospitalized two days later when complications developed. According to a source close to Mr. Murtha -- confirming a report in Politico -- doctors inadvertently cut Mr. Murtha's intestine during the laparoscopic surgery, causing an infection.
So glad I'm not at NNMC right now....can only imagine what that M&M is going to look like
No worse than the M&M of the 65 year old guy that came in for fatigue and ended up dead due to TRALI. Certainly no worse than the 24 year old soldier with a shattered but repairable leg who ended up dead of TAGVHD.
In the words of a surgery attending from medical school, "Surgeries, no matter how small, are not benign procedures. There is a reason that we put death on the consent forms."
Except that TRALI and TAGVHD are unavoidable complications (presuming satisfactory indication for transfusion). A bowel perforation, especially unrecognized, is another matter.
i'm sure it will be blamed on the medstudent holding the scope camera. it's all i remember from lap-appys-- "you're too close", "you're not close enough", "did you remember to white balance the scope?", "what the hell are you doing over there" etc etc. gallbladder ruptures, an artery bleeds-- it was always due to the view.
interesting he didn't go back to NNMC when he (i assume) became septic.
--your friendly neighborhood "steadicam" caveman
All these laps. Does anybody do conventional surgery anymore? If I'm 80 yo, do I really care about having a big scar, or that the healing time will be significantly greater? So I'll be in bed for 2 weeks. Would rather have that and get the job done safely, no?!
to be held in the ... wait for it... John P. Murtha conference room. no wait, that's at WRAMC.
It's interesting that there is radio silence about this. It seems like a lot of the time where there is an adverse event at a military hospital there is a news frenzy. My thoughts are with the surgeon, probably devastated in some ways...
Well certain biotechnology companies would assert that TRALI and TAGVHD are avoidable as long as your hospital purchases their assays that screen for anti-HLA antibodies and perform HLA genotypes.
Who knows what the story is regarding the complexity of the operation. I sure hope there are reasonable justifications for this surgical complication. If his insides were that complicated and laprascopic surgery was that difficult (assuming it was laprascopic), I wonder why they did not convert to open.
Regading why he ended up at some facility in NOVA, it probably has more to do with location. He lives in NOVA and would have been taken to the nearest ER for a post-op fever. And as we can see, it doesn't look like he was ever stable enough to transfer.
Now for the million dollar question--autopsy?
In related news, President Obama has quietly announced his next physical will be at Kaiser...
Here ya go, the drumbeat begins:
The unrecognized bowel injury during laparascopy is probably one of the most feared complications. Patients don't show signs of a rigid abdomen. It seems much more subtle. Until they have cardiopulmonary failure. Then it's not so subtle...
It's when names are named that I start to really worry.
I have rotated at NNMC as a subspecialist. I can say that I am not terribly impressed with their residents. I would often get consults for a particular concern with no work up what so ever. As a resident, if I tried a stunt like that to a consultant, I would have been blown out of the water with that person over the phone.
I don't know what the surgery department is like there but if it is anything like I've experienced, I can see how this complication occurred.
Do you actually think there were housestaff involved in this case?
This is a bad situation but it has absolutely nothing to do with your observations. In general, at military and civilian hospitals (where I moonlight), residents are less inclined to work and take less ownership than ever before. I don't think this is NNMC specific. Thank you work hours restrictions.