Husband is angry....

Read this letter in the Straits Times forum :

Op scare but patient discharged 2 days later

ON AUG 21, my wife had keyhole surgery at Tan Tock Seng Hospital (TTSH) to have her gall bladder removed. Shortly after the operation, she developed complications, with her blood pressure dropping to 50/30.

The doctors (excluding the main surgeon) that operated on my wife were alerted. They immediately ordered intravenous drips, a blood test and an X-ray machine, apparently to arrest the problem and also to check for the cause. When I enquired, I was told that it was due to the after-effects of surgery.

Two days later, we were astonished to hear the surgeon tell my wife that she could go home. This was because she was still in pain and her stomach felt bloated.

On Aug 31, my fears came true when my wife complained of extreme pain in the abdomen. I immediately drove her to TTSH's A&E.

A CT scan confirmed internal bleeding, which the doctors suspected could involve the womb and they might need to have it removed. However, after the operation, the surgeon - a different one from the first - told me that the actual site was the fats area around the abdomen and not the womb.

I have several questions:

1)During my wife's follow-up appointment on Sept 11, the first surgeon said that the keyhole surgery was the likely cause of the internal bleeding. I was rather unhappy when he told us that this was the first time he had encountered such a case and they were still investigating the cause.

What upset me further was that upon hearing that my wife had undergone ligation, he said that as both types - ligation and gall-bladder removal - of keyhole surgery used the navel as the entry point, the possibility of internal bleeding was increased.

Should not the medical staff to be extra careful in treating such patients as my wife did tell them about her ligation before the surgery?

2) Was the surgeon aware of my wife's complications after surgery and did he study her blood-test and X-ray results before certifying her fit to go home?

3) Last but not least, was it not the duty of the doctors to be more precise in their diagnosis, rather than to speculate on the site of the internal bleeding, resulting in such a long laceration?

Allenn Tay Boon Leng

You can read TTSH's reply to Mr Tay here.

Dr Chia's approach to replying to the letter is to give the facts of Mrs Tay's medical history ( I am not sure if that is really a nice thing to do, but I guess if you write to the open press then it sort of means you waive the right to privacy), but he does not really answer Mr Tay's questions.

He may have sort of answered his 2nd question but he certainly does not answer questions 1 and 3.

Question 1 is really Mr Tay suggesting that the surgeon might have been negligient because he was not more careful when operating having "failed to remember" that she had previous key hole surgery for ligation. Well here's the thing. The umbilical route is still the safest port of entry for the key hole surgery. However having had surgery before makes the risk of bleeding higher. But is it higher than going by another route? I am not certain. Well Dr Chia certainly chose not to answer this question. I wonder why?

As for question 3. Perhaps Dr Chia doesn't realise it. But Mr Tay is very upset that his wife now has a huge operation scar (most likely midline from pubis to rib cage). It is well known that such scars do affect sexual and marital relationships. However in emergency setting, scar conditions and not the priority. Save the patient first. An operation to remove the scar can always be performed later. Mr Tay's wife's life is obviously more important than her appearance during those few hours when she was bleeding internally.

Finally, all surgery carries a risk. What happened to Mrs Tay was unfortunate. But she is NOT the first and last person who will have such similar complications.

Which is why we get patients to sign a consent form. However, the consent forms in Singapore are pretty pathetic. They are no where like the contracts that lawyers draw up for people when they sign to buy a house or a car or get a loan. As a matter of fact I think as doctors we should have 16 page consent contracts for patients to sign before they go for the operation. You might say "But how will I read 16 pages and will I understand it?" Well then ask yourself when was the last time you understood all that stuff written in the contracts you sign to buy that HDB flat? It's the same. It's all there to cover your ass. Except as doctors we don't cover our asses very well.