I was sleeping soundly at home while on call when my pager went off a 1:30 AM. The hospital said I needed to come in for an emergency surgery for an ischemic limb. Grumbling, I quickly dressed into my scrubs and hightailed it into the hospital, knowing that there is a limited amount of time to save a limb from dying due to a lack of blood circulation.
I quickly set up my room then went to preop to talk to my patient. There, I saw on the gurney an anxious looking elderly woman holding her leg while her husband stood faithfully by her side. Trying to sound cheerful and optimistic despite having just been awoken twenty minutes ago, I introduced myself, "Good morning! I'm Dr. Z. I'm here to help save your leg!" Probably not the smoothest introduction I could have made, but at 2:00 in the morning that was the best I could muster.
However that lack of subtlety was not well received. The patient stared back at me in shock and retorted, "What do you mean 'save my leg?'" The husband looked at me disapprovingly. Uh oh. This was not going well. I tried to clarify myself, "Well, the surgeon says there is not enough blood flowing down to your leg so we need to fix that to keep it viable." That explanation also was not to her liking. "So you're saying I could lose my leg?" she cried through her sobs. "The surgeon never said I could lose my leg!" I was starting to wonder how the surgeon was able to get a consent for this operation if he didn't explain all the risks and benefits of this emergency surgery that was keeping all of us up at 2:00 AM.
Finally the surgeon, who I have worked with for many years and greatly admired his skills, walked in. Gruffly, he asked if we were ready to get started. The patient verbally lunged at him and asked why did I say she might lose her leg. That was never explained to her. The surgeon quickly plunged a knife in my back and said, "I never said you would lose your leg. I explained to you that we needed to restore blood flow to your leg to make it better." I can see I was getting thrown under the bus tonight.
Not wanting to escalate the tension, I backed out of the room while they hashed out the consent. From my side of the doorway, I could hear the patient ask the surgeon, "Is that anesthesiologist any good?" So now my professional integrity was in question for daring to give the patient a complete picture of her medical emergency. At least the surgeon had some esprit de corps left in him and answered in the affirmative, that we had been working together for many years and that I was an excellent anesthesiologist.
As the circulating nurse wheeled the patient to the operating room. the husband started to dress me down. "You didn't have to tell her she could lose her leg." By then I was in no mood to make nice talk to anybody anymore. I quickly shot back, "Well sometimes the truth can hurt," and walked away.
When I look back on the events of that night, I have to admit it was not my finest moment. In fact it was one of the worst. Well, that's what happens when doctors are not truthful to their patients in a misguided attempt to sooth their fears. If the surgeon had given a truly complete informed consent, the patient and her family would have understood the gravity of the situation and why we were all gathered there in the wee hours of the morning. It wouldn't have been sprung upon them by a straight talking sleep deprived anesthesiologist.
You don't need this pep talk from me, for crying out loud. But don't you dare beat yourself up. The moment of glory and integrity was the surgeon's to bask in, and he muffed it. "Your anesthesiologist is right, and I will do everything in my power to save the leg, and you." See how easy? If 20 years of surgical experience has taught me anything, it's that.ReplyDelete