Thursday, December 9, 2010

Brain Dead Interventions

The conversations in the operating rooms are not always that interesting or informative. But sometimes it is amusing to hear the surgeons complain about their work. The other day, they were whining about the inane consultations they sometimes receive from internists. They seemed to be trying to top each other with clueless internist referrals.

The first surgeon said she received a call about a patient who had a hematoma under the arm where the blood pressure cuff was wrapped. She goes to see the patient and evaluate the arm. The patient turns out to be ventilator dependent, brain dead, and was about to be terminally extubated per family request. Needless to say she did not drain the arm hematoma.

The next surgeon said he could top that. He got a referral from an internist for a patient with dry gangrene of a leg. The leg was literally black and mummified. The doc wanted to know if the surgeon can do something about that hideous leg. The kicker was that the patient has anoxic brain injury, is ventilator dependent, and is fed through a gastrostomy tube with no hope of being ambulatory ever again. The patient's family was pressuring the internist to do something, anything, for the leg. The surgeon rightly told the internist that since the leg has dry gangrene, nothing needs to be done. If it gets infected and turns wet then an amputation will be necessary. The internist couldn't go back to the family with that answer. Therefore the surgeon acquiesced and ordered a vascular study of this vegetative, bed-ridden patient to appease the primary doc and the family with no intention of ever following up.

Besides what these stories say about the economics of health care in this country, I'm just so glad I decided to become an anesthesiologist.

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