Doctors make life-and -death decisions every day. Was today's the right one?

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The medical chart’s esoteric inclusions confirmed Dr. Fulbright’s concerns regarding his patient’s condition. He was dying.

A reminder left by the ring of keys removed from his abdominal cavity during surgery threatened Jeremiah Rustin’s life. He entered the hospital two day ago following a fork lift accident. As a forklift driver tried to pass him in a narrow aisle Jeremiah was forced against a wall. The keys hanging from his belt were pushed into his abdominal cavity. Either the damaged intestines or the unsanitary keys initiated an infection.

The laboratory report informed the physician that cultured blood, collected from three separate locations of Jeremiah’s body, contained an anaerobic, gas-producing, spore forming, Gram-positive bacillus...

Dr. Fulbright recalled the Microbiologist saying, “Based on morphology, I would tentatively identify the bacterium as a Clostridium species.”..”More specifically, I would say it is Clostridium perfringens,” he added during the telephoned preliminary report.

He knew from experience antibiotic-susceptibility studies would not be forthcoming. There were no protocols for susceptibility studies with anaerobic organisms, and if there were no standard protocols and if there were they would require at least 48 hours. He didn’t have 48 hours.

There were multiple therapy choices; none of them eased the anxiety he was experiencing. He could treat empirically with an antibiotic; if that failed there was no turning around. He could follow the suggestion made be the Microbiologist; however that suggestion included the caveat, “I am a Ph.D. not an MD.” Liability for the extreme measure would lay directly on his shoulders. He had to make a choice, quickly, or Jeremiah Rustin would become a statistic in the Centers for Disease Control’s “Weekly Report.”

I can’t worry about my liabilities, Dr Fulbright reasoned. I am going to charter the flight. The Microbiologist had suggested a procedure whereby a surgeon would “unzip” the patient from below the diaphragm to the pubic region. The cavity would then be flushed with a hydrogen peroxide rinse and the patient placed in an oxygen-charged hyperbaric chamber. The procedure, though extreme was logical, however it was exclusively available at a University Hospital in another State. He ordered the flight, and the transfer.

Two weeks after making his decision Dr. Fulbright was summoned to the Hospital Administrator’s Office. He was informed the family of Jeremiah Rustin had assembled there and requested his attendance. Malpractice, he assumed. Two weeks ago he made a radical decision, now he would learn his fate. He had not followed his patient’s case since the transfer. Did I cause this man’s death? he asked himself as his anxiety destroyed his steadiness, and composure.

There were more people than he anticipated. No one breathed as he walked into the room. Were they expecting horns and a forked tail, he wondered. Then the clapping began. Each family member embraced him. “Thank you,.. you saved my husband, thank you ...you saved my son, thank you ...you saved my daddy,” each member had a personal message for the relieved physician.

Having recovered his composure, Dr. Fulbright asked the Hospital Administrator if he could lead the family to the laboratory.”There is someone I would like you to meet,” he informed them.

By Robert L. Scarry

From: United States

Twitter: usnavy1990

Facebook URL: facebook.com/robert.scarry.3