Post-operative complications

Since I came on the medicine service, my team has been taking care of a man who because of one of his unfortunate afflictions I will call Mr. Scrotum. Mr. Scrotum is a 70-something man who came to the hospital with an infected prosthetic knee joint. He had surgery to clean it out, then came to our service to get medically stabilized prior to beginning physical rehabilitation. Unfortunately, Mr. Scrotum had some post-operative complications, including some wacky mental status changes and a fairly reversible kind of kidney failure.

Mr. Scrotum’s medical course, while not ideal, is a fairly common one. His family, however, is exceptional. Although Mr. Scrotum has full mental capacity, he defers to Mrs. and Daughter Scrotum for all of his medical decisions, and I imagine it has quite a lot to do with how unbelievably exceptional they are.

Mrs. Scrotum is the kind of person who, after she is served lemon butter instead of parsley butter with her lobster at the club, asks to speak with the manager; has the waiter fired; writes a series of angry letters; forms a community coalition; hires a lawyer; and still isn’t satisfied after she wins, because it’s the principle of the thing. Her daughter is the same way, only with younger, sharper teeth. It is really very unpleasant to be regarded daily by these people with such spectacular anger, distrust, and paranoia.

Understand, now, that I do not take the Scrotum family personally. To me, their collective affects speak of nothing so much as abject terror: They are so, so afraid of losing their beloved Mr. Scrotum. In a flailing attempt to gain control over something that threatens to take him from them, they scrutinize and question what they do not understand. Any barrier to their scrutiny is seen as an intentional, adversarial move–after all, it’s far more satisfying to have someone to blame when bad things happen than to just chalk it up to bad luck.

If we don’t take the time to help the Scrotums identify what they are feeling–fear and frustration–and to explain to them why we are doing everything we do, we run a great risk of making them feel that we are not on the same team as they are. It’s that dynamic that results in lawsuits.

Ironically, the time that we could spend talking with the family once a day–which indeed is a pretty big demand on any doctor’s schedule–we spend trying to cover our asses in case this situation does end in a lawsuit. We call consults, we call attendings, we have bitch sessions. If we could swallow our pride, answer questions for 15 minutes a day, and remember how little control this family feels they have, I think we could avoid a bad outcome, psychosociolegally speaking.

At least, until he dies. At that point, no explanation will alleviate their grief, and anyone who can possibly be blamed will be. I just pray it doesn’t happen in our hospital. 

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2 Comments on “Post-operative complications”

  1. Garth Says:

    Oh, the lemon butter analogy is all too apt. Welcome to Chez Med:

    Customer: “I hate to trouble you, but I specifically asked for parsley butter. This is lemon butter.”

    Waiter: “Uh huh. You can ask the busboy about that. What’s important is that you’re getting lobster. Why do you mention it? Do you have a lemon allergy? Any difficulty breathing? After you tasted the lemon butter, did you notice any occasions when your heart stopped beating?”

    Customer: “No, but…”

    Waiter: “Excellent. Well I wouldn’t worry about it. Your meal really looks like it’s coming along. We’ll just have to wait for the entree to be served.”

    Customer: “But I didn’t order lobster!”

    Waiter: “You sound upset.”

    Customer: “I’m not upset, it’s just that I ordered a steak with a baked potato and some parsley butter and at least two thirds of the order seems to have been botched already.”

    Waiter: “It must be awful. You must be feeling really out of control.”

    Customer: “Is that all you have to say? How about getting me a steak and some parsley butter?”

    Waiter: “Well… It’s very important to me that you receive food you feel is appropriate. The choice is completely yours. All the same, as your waiter, I have to tell you that I think the steak would be a serious mistake. Lobster is what most people come here for. It’s all that the kitchen makes, and it’s my personal recommendation.”

    Customer: ” Fine. I will have the lobster. With parsley butter, please.”

    Waiter: “I know this is hard. But your idea to order the lobster is really very fresh and very smart. I’ll have to suggest that to some of my other tables. In the meantime, I’ll be right back with your lemon butter.”

  2. signout Says:

    G–
    Although this is hilarious, it demonstrates that you have absolutely no idea what you are talking about.
    Big love,
    Dr. Signout


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