Previous Challenge Entry (Level 3 - Advanced)
Topic: ADEPT (10/19/23)
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TITLE: The Patient I Nearly Killed | Previous Challenge Entry
By Nnenna Moneme
10/25/23 -
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After completing my Breast Interventional training, I was prepared to start performing wire-guided localisations for breast cancer patients. This procedure assists the surgeon in precisely locating the cancer within the breast for removal. After an initial one month of mentor's support, I was informed that I would begin performing this procedure independently from the following Monday. While reminding me the importance of visualising the tip of the wire under ultrasound guidance, my mentor narrated what happened during his training. He shared how he underestimated the wire's length during insertion and ended up perforating the patient's lungs, resulting in a pneumothorax and the need for emergency care. Fortunately, the patient made a full recovery. Hearing this story made me realise just how risky the procedure could be. It was eye-opening to learn that my supervisor, who seemed so adept in clinics, had also made mistakes post-training.
The following Monday, I arrived at the clinic and began reviewing the x-ray images. I quickly identified the location of the lesion, noting its close proximity to the chest wall which required an angled approach. I then called in the patient, explained the procedure to her, and proceeded to perform it. With ultrasound guidance, I could see the wire crossing the lesion, giving me confidence to complete the procedure. As per protocol, I requested a check radiographs after its insertion and called my mentor to review the post-procedure images.
As soon as we saw the images, it became apparent that the wire's tip was not visible. This was concerning because it meant that I had advanced the needle beyond the breast into the chest wall, potentially risking puncturing the lungs.
"Ask the patient if she is experiencing any breathlessness," my mentor instructed.
My heart pounding against the ribcage, stomach churning and hands trembling, I hurriedly flung the door open and rushed into the sub-waiting area to check on the patient.
"Are you okay?" I asked, my tone filled with concern.
"Yes, I am fine," she grinned.
"Are you sure? Do you feel any chest pain or shortness of breath?" I inquired, trying to evaluate her condition.
"No," she replied, her eyes widening as she stared at me.
Observing her probing eyes, I knew I had to be honest about the incident. I quickly explained the situation in minimal detail; outlining the next line of action.
I gave feedback to my mentor, who promptly informed the surgeons about the incident. We collectively agreed that proceeding with surgery would be unsafe until we locate the wire tip. The patient was swiftly sent for an emergency CT scan of her chest.
After reviewing the CT images, we discovered that the wire had indeed penetrated the chest wall but was halted by the sternal bone, preventing it from perforating the lungs.
"This is nothing short of a miracle. Your God is truly watching over you," my mentor confessed, aware of my Christian faith.
"Thank you, Jesus!" I exclaimed with relief.
This outcome alleviated my turmoil and the patient had a successful surgical removal of both the wire and cancer.
Fast forward one year, and I have performed over a hundred similar procedures without encountering any near-miss scenario again. Interestingly, numerous patients, surgeons, and colleagues have commended my skill in inserting these localisation wires. Much like my mentor, I made a mistake soon after completing my training, but I have since become proficient in this clinical skill that was once daunting.
This entire clinical journey parallels my personal Christian journey. As a new believer, understanding the Bible was a challenge. However, after two decades of studying and walking with the Lord, I find myself effortlessly teaching God's word, like one who has mastered the art. God's word in Philippians 4:13 - "For I can do everything with the help of Christ who gives me the strength I need" remains a dependable truth. Surely, with dedication, effort, and a willingness to learn, one can become adept in anything.
True story
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