As much as I write about the foibles, pseudoscience, and misadventures of cranks and quacks that endanger patients. However, never let it be said that I don’t also pay attention to the foibles and misadventures of real doctors that endanger patients. Sometimes that occurs due toincompetence. Sometimes it’s due to the persistent use of invasive modalities that have been shown not to work far longer than they should have been abandoned (e.g., vertebroplasty) . Sometimes it’s poor judgment. Of course, because I’m a surgeon, I tend to gravitate towards discussions of surgery when I leave my usual bailiwick of discussing alternative medicine, antivaccinationism, and various other skeptical topics.

So it was when yesterday I saw discussion of a post over at KevinMD by a surgeon who blogs under the pseudonym Hope Amantine (or apparently used to blog) over at Simple Country Surgeon entitled A lesson in the OR that prepared this doctor to be a surgeon. It is a story of training, a story that was clearly intended by its author to be a “real life” story of how a senior surgeon taught Dr. Amantine as a resident to handle a dangerous situation. The problem is that it was appalling on so many levels. You’ll see why as soon as you see the story. As a surgeon, albeit one who doesn’t do such large, risky cases anymore, I sort of understand what Dr. Amantine was trying to get at, while at the same time the story disturbed me greatly.

Dr. Amantine’s article tells the tale of a case she did during her training. It was an elective repair of an aortic aneurysm. The reason surgeons repair aortic aneurysms when they grow to a certain diameter is because, beyond a certain diameter, the risk of rupture becomes unacceptable, and the larger such aneurysms grow the greater the risk of rupture. As you might imagine, a rupture of the largest blood vessel in the body is an immediately life-threatening occurrence. At first, the blood is contained in what we call the retroperitoneal space by membrane that lines the surface of the abdominal organs, the peritoneum. That can last mere moments after the rupture to even a few hours, but sooner or later the pressure will break through the peritoneum, allowing the blood to flow freely into the peritoneal cavity, basically into the abdomen. When that happens, the game is up. Exsanguination is rapid. Indeed, the vast majority of ruptured abdominal aortic aneurysms (AAAs) are rapidly fatal before the patient even has a chance of being brought to the operating room. A few, however, remain contained, and there is a chance to save them.

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