Anxious mother

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ANXIOUS MOTHER (PERFORATED APPENDIX)

STEM - You are a surgical SHO on call for emergency general surgical admissions. A 10-year-old girl Sarah was brought by her neighbour as an emergency with peritonitis, Her mother was at work when she was told that her daughter is in hospital.

The child Sarah, is febrile and extremely ill, A perforated appendix is suspected and she is being resuscitated by your registrar before being taken to the operating theatre. You've just arrived in the hospital for your shift and haven't seen the patient. Your consultant, Mr, Mann is on his way from home, and will perform the operation, She became anxious when she realize that Mr. Mann is the same surgeon who operated upon her husband and couldn't save his life.

Considering this communication skills station, you are asked to talk to this anxious mother and answer her queries.

Doctor: Hello, good evening, I'm Dr. Z, one of the surgical doctors. Am I talking to Sarah's mother?

*Patient: It's not a good evening for me, doctor, at all. What's going on here? All of you have taken my child for an operation even without letting me know. How is this even possible?*

Doctor: I was told to speak with you about your child condition. Can we please have a seat so that we can discuss about everything a bit more detailed? Could you first tell me what do you know so far?

*Patient: My child had fever from yesterday; but still I went to my work. I have no clue, doctor. It's all happened because of not being in home.*

Doctor: First, you don't have to feel guilty because this could happen anyway. Your daughter was brought by your neighbour complaining of tummy pain. Our initial investigation revealed the suspicion of acute appendicitis.
She was managed by our registrar and received some TV fluids and antibiotics. We are now waiting for theconsultant who will operate upon her.

*Patient Are you sure that my daughter has acute appendicitis?*

Doctor: We are suspecting acute appendicitis as this is common condition and also her signs and symptoms denotes
this. But we cannot be certain 100% until we open and see. Usually we do a keyhole first, then look for it.
Then after observation we complete the procedure. if it ruptures and case general infection of your tummy, or
if this failed, we need to convert it to open appendectomy by giving a small incision over right lower tummy.

*Patient: Is it dangerous, doctor?*

Doctor: In children specifically, there is less fat inside the abdomen, so perforation can be particularly dangerous. In such case your child may go to a higher care area called HDU. But Mr. Mann is a very good surgeon, I can assure you that your childis in very good hands. We will be looking after her but there are still some concerns.

*Patient: Will the wound be disfiguring?*

Doctor: A small horizontal wound will leave a little scar, but we may need to expand the wound and this may leave a bigger scar.
We will try to make as little scar as possible. / As she is a girl, it's conecrning, but still we will try to make it as short as possible.

*Patient: Is there any other problem that could occur?*

Doctor: Yes, probably severe infection can block the reproductive tubes in young girls, so future sub fertility may
happen.

*Patient: Do you mean that she can’t get pregnant in the future?*

Doctor: I understand your apprehension, no need to worry because she has another fine working tube on the other side.

*Patient But Mr, Mann did operation for my husband, and he died,*

Doctor: I am so sorry to hear that. Please accept my sincere condolences. May I ask when and how he died?

*Patient: Mr. Mann did operation for him because he had colon cancer and he died few weeks after the operation at home.*

Doctor I am so sorry to hear that again. I think those are two different situations. I think your husband died from the cancer not the surgery and Mr. Mann one of best surgeon we have in the hospital who has a vast experience on this, we will take good care of your daughter.

*Patient: Can I change the consultant?*

Doctor: Of course, you can because it's within your rights. But it’s time consuming as the new consultant will study the case from the beginning. As i's a suirgical emergency it will have a deleterious impact on your child health.
So, I will not recommend you do that.

*Patient: Can I see her?*

Doctor: Obviously, you can see her. But she will be kept in observational room just after the operation. Once she regains her consciousness, you can definitely see her. Do you have any other concerns?

*Patient: I just need to be everything ok for my child.*

Doctor: Of course, my team is trying our best.
Lets summarize what we have been through here. Your child has been brought here by your neighbour complaining of tummy pain. Our initial investigation revealed acute appendicitis and we are now waiting for the consultant to operate upon her, and I’ve explained the risks and benefits of this operation.

We all are here to help and support you and to dive you a hand at any time. Should there be any concerns, please don’t hesitate to contact me at any moment. I will leave my bleep number at the nurse station.
Thank you so much for your co-operation.