Dr. X paged me while I was operating so I called him back after I was done.
Dr. X: I have this patient in room 321, I did a [spinal] fusion on him the other week. He fell and now he can't move his legs. We got a CT scan and it showed a T3 fracture. So I want to extend his fusion. I need you to explain to him and his mother, who's an idiot but she's his legal guardian, that he may have a spinal cord injury and could be paraplegic and then I need you to get consent for the surgery. Oh, and make sure they hold his heparin tomorrow.
Just to recap, that means I need to go talk to some patient who I've never met and know nothing about and tell him that he may be paralyzed for life. Then I need to explain to him that he needs more surgery. I need to convince him and his mother. I've never met this guy before. I don't really understand what's going on. I have nothing to do with any of this.
Seriously people, do your own damn dirty work.
So I went to talk to the patient. He seemed a little slow in that he was having a conversation with the phone while it was ringing, but he definitely understood what I was telling him. As in, I walked in and asked him how he was, he said he was terrible because he couldn't move or feel his legs, I said we wanted to do surgery to fix the broken bone in his back and he said "Oh G-d no, not more surgery. I'll do anything but that." Then he started crying. Because I have no tact, I pushed forward and I said we wanted to also look at his spinal cord while we were operating because there was a chance that whatever it was that was causing his paraplegia could be reversed. The thing is though, that's probably not all that accurate. So I had to say that there was a good chance if he was paraplegic now, he would always be paraplegic. I think my exact words were "It's likely that you will spend the rest of your life in a wheelchair."
He understood that.
Then, because his mother was his power of attorney, I had to call her to get permission for the surgery. She understood what was going on after I told her that he might never walk again. She said 'it sounds like he might not be able to walk again even if he has the surgery." I said that was true. She said she was still OK with him having the surgery. So I got consent, called the primary team to tell them the plan, and made sure he was appropriately pre-opped. The whole thing took about an hour.
See, this really does not sit well with me and I was actually pretty pissed about the whole thing. I know I tend to be more anal than most people when getting consent because i don't want a surgeon who can't sit down with me for two minutes and explain the surgery and the risks and benefits and I get that not everyone is like that and it's fine, but I really think it's inappropriate to have someone else deliver bad news to your patient. I mean, I don't think anyone enjoys telling people that they'll never walk again (and this is my second time in a week and really, the experience has not improved with time) but I feel like if you're the one who has the relationship with the patient, you should be the one to tell him. I don't think it's fair to the patient or to me to stick me in this position. I don't know anything about the patient or his history, so I really can't answer any questions. He doesn't know anything about me, so why would he trust my opinion on anything?
The patient said "I wish I'd never had the first back surgery." It was hard to argue with that logic so I slunk out of the room while he and his mother cried together over the phone.
It's really hard being a surgeon sometimes.