The elephant in the room

By Karen Sibert 26th February, 2012

One of my partners recently sent out a call for an extra pair of hands to help out in the operating room—and with good cause. The patient on the OR table was a woman in her 60’s whose massive stroke had left her hemiplegic, aphasic, and unable to swallow. She weighed well over 400 pounds. Attempts to place a percutaneous endoscopic feeding tube had failed due to her size, and she was now scheduled for open gastrostomy tube placement under general anesthesia.

Even with two experienced anesthesiologists working on the patient, getting vascular access and an endotracheal tube in place wasn’t easy. She was anemic for reasons that weren’t fully worked up, and her blood pressure was alarmingly labile. At the end of the procedure, the patient couldn’t be safely extubated so she went to the ICU. As it turned out, she never left. The family couldn’t agree on any reduction in the level of life support, and after a stormy five-week stay, she finally expired. The cost must have reached hundreds of thousands of dollars, and all was spent on sustaining a patient who had no hope whatsoever of meaningful recovery.

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