And Yes I said Yes I Will Yes …
What else could you say under the circumstances?
Here is the form I gave Pam to sign when she finally consented to open heart surgery:
I hereby give my consent and authorize Doctor Yuh/Cameron of the Johns Hopkins Hospital to perform the following operation or other procedure: Mitral Valve Repair/Mitral Valve Replacement Possible Removal of Right Ventricular pacing lead
The nature and purpose of the operation or other procedure and anesthesia,the risks involved, alternatives and the possibility of complications have been explained to me by Doctor Walinsky. I am aware that the practice of medicine and surgery is not an exact science and I acknowledge that no guarantee has been made as to the results that may be obtained. (Emphasis added.) All my questions, if any, have been answered to my satisfaction.
If Pam wasn’t aware that the practice of medicine and surgery at Johns Hopkins was not an exact science when we drove up to the place that morning, she sure became aware of it over the course of the next three and a half weeks.
Here is the informed consent supplement:
1. Indications for the operation: Acutely Leaking Heart Valve
2. Risks:Bleeding, Infection, Heart Attack, Stroke, Death
3. Alternatives to the Proposed Operation:Not to Operate
Well, there you have it, sign and maybe die, or don’t sign and definitely die. It’s your choice, and either way you can’t blame Johns Hopkins. There I was holding a clipboard and a pen out to my wife while she stared at the ceiling. Her eyelashes were wet. She blinked, and a tear rolled straight down the side of her face into the pillow.
“A discussion of the risks, benefits, and alternatives should be undertaken in an unpressured environment well before the procedure… It is better to explain the potential risks, benefits, and alternative therapies to coronary intervention before administration of sedatives or other agents that may affect the patient’s judgment.”
So sayeth the American College of Cardiology about informed consent.
I’m no expert, but it seems to me that gathering a signature from someone who’s doped up and crying because she’s literally just had part of her heart ripped out and who has been told to sign or die, well it seems to me that violates the spirit of the ACC directive on informed consent. But what do I know?
I didn’t discuss the possibility of mitral valve replacement with her. When Pam took the pen from my hand to make the understandably half-hearted scrawl near the signature line before she was lifted up out of the bed and on to the gurney, I am here to tell you that she did not care much for fine print. She had not read any of it, and so would not have seen the part about mitral valve replacement instead of repair. Repairing a valve as opposed to replacing it with a prosthetic valve makes a big difference in your life and I knew it. But I didn’t say anything to her about that – nor did any of the surgeons.
Drs. Walinsky, Yuh and Cameron are all honorable men and skilled physicians as far as I knew — and as far as I still know. But under the circumstances, I couldn’t recall if any of those folks were the surgeons we’d met, and neither Pam nor I knew anything of their skills or their backgrounds and experience.
But they had a signed consent form and so off she went. I squeezed her hand and gave her a kiss as she was wheeled down the hall flat on her back and she was gone behind the double doors, away to the Operating Room — wherever that was.
∞
“The patient’s chest, abdomen and lower extremities were prepped and draped …. After a median sternotomy incision was made, the sternum was divided with a bone saw… 
Reasonable exposure of the mitral valve apparatus was noted. The valve leaflets were intact; however, the posterior leaflet was completely flail due to separation of the posteromedial papillary muscle near it’s base. Moreover, two chordae on the remnant tip of the papillary muscle were also severed. It appeared unlikely that an adequate repair could be accomplished in this setting. Therefore, the anterior leaflet was excised along its chordal attachments, and the medial scallop of the posterior leaflet was also excised…”
- Yuh, David
∞
They give you a pager these days when they’re mucking about in your loved one’s innards. I suppose it’s more ergodynamic than sitting in those orange plastic chairs that line the customer lounge at the local Midas Muffler shop.
In any event, I was going to take full advantage. I took me down to Kawasaki Sushi in Fell’s Point — a great place to eat if you find yourself outside the Green Zone in Baltimore which is the Hopkins medical complex.
Mitral valve repair shouldn’t take but a few hours, according to the Docs, and then she’d be up and around in no time.
In the meantime, I was going to get something to eat and pound down some SAKE. I wasn’t sure if the hospital pager would reach that far, but as Kurt Vonnegut said about cheese, what could happen to Pam that hadn’t happened to her already?
