HealthThe Stethoscope

My Name Is Not Jesus!

I am only human after all, don’t put the blame on me.

I like this!

My name is not Jesus’.
It is something we say to patients as part of the process of obtaining informed consent for an operation: because we cannot guarantee that nothing bad will happen. We can promise many things during obtaining consent for surgery but that no complication or problems may arise and that the outcome is guaranteed 100%, is not one of them! We often joke, seriously, that any surgeon who says he does not have any complication is either lying or has not done enough operations!

Informed Consent
Informed consent means a careful explanation of the procedure, the benefits and especially the risks involved in a procedure. An informed consent can be said to have been given based upon a clear appreciation and understanding of the facts, implications, and consequences of an action. We explain the possible risks as may be inherent in the procedure and especially the uncommon and rare risks that may come and bite the doctor in the ass.

We usually promise to do the best we can; to trouble shoot and prevent complications: within the limits of human abilities and our specialized skills in the particular area. Also, that should anything bad happen, we will do our very best to try and fix it.

So, we explain things in a way that builds confidence but not in a bombastic way. Patients need to understand as much as possible without being scared off. Especially, if there is a real need for the procedure.

Planning is key
One of the things doctors do in preparation for an operation is to review the patient, the tests and the planned operation: trouble shooting and eliminating possible problems. Hospitals have also developed protocols and systems to reduce complications such as wrong operations, wrong side or wrong site surgery, adverse reactions to blood or drugs, infections and many other risks.

Planning is critical and many surgeons in fact go through a dry run of the operation in their heads before the actual surgery. Some, of course, do operations on a simulator as well or practice on a cadaver. We put things in place to reduce errors. So, you prepare but that does not completely eliminate chance events and simple bad luck.

Medical error
A medical error is a preventable adverse effect of care, whether or not it is evident or harmful to the patient. This might include an inaccurate or incomplete diagnosis or treatment of a disease, injury, syndrome, behavior, infection, or other ailment. Yes, medical errors in hospitals are a major cause of death and disability, but sometimes it can happen with the best practice and best intentions.

Shit happens
Take the following scenarios for instance. An elderly man came into hospital for surgery on his neck. He had complained of neck pains, arm pains and difficulty with walking. His MRI scan showed pressure on the spinal cord in the neck and we consented him for surgery. The actual operation was good and he recovered pretty well. However, three days after the operation he noticed weakness of the shoulder. This was not immediately there after the operation but is nonetheless a complication: since he did not have the shoulder weakness before the operation.

In another case, an elderly woman recovering from a stroke and was being planned for discharge. On the day of discharge we thought her blood pressure was a little low so we decided to shore up the blood pressure by giving her some fluid (before going home!).

Unfortunately, she reacted to the fluid and this set off a cascade of events that progressively led to her death. So some seemingly innocuous event that ordinarily would pass off without notice led to an unforeseen, almost unpredictable fatal situation. A shock to all concerned for she had already been through a lot and seemed to have come out at the end of the tunnel.

Some patients do have them!

Patient factor
There are times (very few and far between) when a patient brings their own special baggage into the hospital. Take a patient who had been bed bound at home for a while coming into hospital for an operation. Immediately after the operation, she developed a blood clot in the lungs and very nearly died. It was obvious in hindsight that the blood clot was from her legs as a consequence of being bedridden and a long car journey to the hospital.

This condition called Deep Vein Thrombosis and Pulmonary Embolism has killed many patients and though predictable, it is sometimes largely inexorable. It is one condition we can try to prevent in hospital, but in some circumstances catches up with the patient after discharge home. There have therefore been situations where the patient dies a few days after discharge.

Just like that!

We pray
Medical staff, patients and relatives have one thing in common, we are human. Therefore, we all pray that nothing bad will happen because hospitals are truly a dangerous place. So have faith and trust, but remember; only God can do the perfect operation, every single time!

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