"Primum Non Nocere"---"First, Do No Harm"

"First, Do No Harm" These words are not actually in the Hippocratic Oath, but that is a discussion for another time. I want to tell you about their application in my life.

EDIT: in the first edition of this post, I had a long story about a pt and surgery. Here's the 2 sentence version.

Chance finding on CT, pt to surgery, pt experienced a complication, different surgery. Now with colostomy (he had a bowel resection after a perforation) intubated and in serious condition with a good chance for a MAJOR infeciton that could lead to septic shock and his death.

I tell you this story because it reminded me that nothing we (I) do in the practice of medicine is without consequence. Pt. X's AAA was an INCIDENTAL finding. If we hadn't done a CT Abdomen, he might have lived the rest of his life (?30-40 years?) and never known he had this. And now, he's fighting for his life in th ICU because we "helped" him. I belive we did the right things for Pt. X and no malpractice has occured. But life is fragile and sometimes even feeding a patient after surgery can be dangerous and not without risks.

The morning of this second surgery, there was ALOT of confusion when he came back from surgery. He was dehydrated and evetually required 17 liters of fluid. His family was there asking questions that didn't have an answer. I had come to know X's wife, because he's been in the hosptial for several weeks. I noticed that no one had gone out to talk with her.

So I went.

I couldn't give her a prognosis, I could merely explain what had happened, what the surgeons had done, and that all we could do at this point was wait. We had hit a bump in the road and things were going to be rocky for several...?days? I felt completely inadequate, like ANYONE other than me should be the one talking to this family. But I was the one who had rapport with them and felt I should go.

So I went.

His wife started crying, which meant that I started crying. She hugged me and we cried a little more. It was good. I don't mind admitting to you that I cried. I was scared, she was scared, neither one of us knew what was going to happen in the coming days. I'm glad that I went. I believe that I made a small difference in this family coping with bad news. The day I can't cry at something tragic and sad, is the day I need to find a new line of work.