Delay would be Dangerous, Potentially Catastrophic

AS FOR PAM’S CHANCES of surviving her early contribution to the learning curve as she lay unconscious that day in the CCU, it may have been his instinct to soften the blow, or it may be he didn’t know any better, but Calkins said that the mitral valve repair could wait until morning.  He and Richard Wu, still a-tremble, then slipped away. If it could wait until morning, I thought, maybe things weren’t all that bad.

Surgeons, however, were not so sanguine. I could hear the hushed and urgent voices in the hall. A chart note tells it:

CCU Attending… Plan: Urgent MV repair/replacement… I believe delay would be dangerous, potentially catastrophic…

I was being told with increasing frequency that while this surgery was not an emergency as such—and Pam was at liberty to refuse—she would die if she elected to forgo the pleasure.

So now the plan was this: as soon as Pam came around, expecting me to hand her some street clothes so she could come home, I  was to instead hand her a clipboard with a consent form to sign, authorizing surgeons to crack open her chest so they could repair her freshly eviscerated heart.

“And we can’t wait too long,” advised a fatherly surgeon, “If we don’t do this right away, she will not make it.” “OK,” says I, a bit stunned, wondering why, if it’s a life and death situation, they don’t just go ahead and fix it. Like right now.

But they needed her signature. They couldn’t act to save her life until she signed a copy of the very same form which had, hours earlier, given them license to endanger her life.

How did we get here?

As I was pondering this, Calkins slid the curtain back and stood at the end of Pam’s bed, Richard Wu behind him like a shadow.  Calkins had a question for me. Did I know of any reason why Pam shouldn’t take blood thinners on a daily basis? Did she have bleeding stomach ulcers or anything like that? Was it OK for her to be on blood thinners permanently?

Because there was a chance maybe that they couldn’t fix the valve, they might have to replace it and, ah… you wouldn’t want a mechanical heart valve in you without taking blood thinners, you know, because of clotting and all…  Of course, there are pig valves, porcine valves…

I chose my words carefully because, after all, I hadn’t been to medical school. “She doesn’t have bleeding stomach ulcers as far as I know… So, I guess I wouldn’t let that stop me…” Then I remembered a visit to the ER some months back when she’d been sick and had thrown up some blood, but they scoped her and found nothing and the situation seemed to resolve itself. But Professor Calkins and his mysterious minion had disappeared, leaving the curtain wide open.

He’s asking me. I suppose that was the first time I started looking around and wondering if this was really the famous Johns Hopkins Hospital – America’s Best Hospital. And as it turns out, if Calkins had bothered to read Pam’s chart, he’d have seen a note in his own handwriting that “she has a history of GI bleeding.”

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