bowel or muscle

somehow, while on gynonc, i got suckered into seeing a patient that i never saw in the or.  in general, it’s my job to see the patients whose surgeries i went into.  well this lady is quite the case.   for her cancer, she had an ex lap (exploratory laparotomy).  nevertheless, i have sucked it up and gone and seen her every morning, checked out her wound and got the heck out of there before i messed something up.  since she had a pretty unusual case, the surgery residents were the primary docs for her, not the gynonc team. 

this morning i walk in, notice her bandages were looking a little gross, so i changed them after giving the incision a quick look.  when i looked, it looked like the days prior when i first saw her with my resident.  i didn’t give it much thought.  the surgery resident comes by, and i mention to him i have changed the dressing, but i left it on loosely for him to take a look, if he wanted.   he goes in, comes out and says…

“so did you notice the thing with her incision”

now, as any half-wit or above will figure – that means something is wrong with the wound and it is not in fact like it was before.  still, i say…

“it looked okay to me…”

“except that the wound has dehis’d and the bowel is showing.”

“oh yeah that… i didn’t exactly have the best surgery rotation.”

despite my idiocy of missing the bowel (it looked like muscle!), he still gave me credit for mentioning her bandage was loose, explaining that they were going to send her home today.  on the last day, he doesn’t check their wounds, and if i hadn’t done all that garbage above, she’d be at home.  instead, it was back to the or for her.  yikes.  could explain why she told me she was in a different city and didn’t know the month (couldn’t even guess).

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