October 6, 2011

Surgery at the End of Life

I've been thinking a lot this week about how strange it is that so many people are choosing such serious interventions for medical problems that are likely to not be their cause of death.  Don't get me wrong, we can do really amazing things with surgery and interventions now that save lots of lives and maybe even more importantly, improve the quality of life for so many people.  But it still seems like mostly, surgery should be an option of last resort.  Maybe this is more striking because I'm seeing all the patients in the ICU and in the hospital after surgery and recovery can be such a brutal process that it seems like, especially at an older age, surgery would be something you would want to avoid unless it was going to really make a difference in either the quality or quantity (or both) of years in your life.
Sometimes I wonder how much of it is just us not wanting to NOT be able to do something.  Like I said at the beginning of this surgery rotation, the really good surgeons are the ones who know when NOT to operate.

Check out this interesting article in the Times about how common surgery is at the end of life.

Dr. Jha provided a recent example from his hospital. A man had metastatic pancreatic cancer and was dying. A month earlier, he had been working and looked fine. “No one had talked to him about how close he was to death,” Dr. Jha said. “It’s the worst kind of conversation to have.” Instead, doctors did an endoscopy and a colonoscopy because the man had internal bleeding. Then they did abdominal surgery. “We did all of this because we were trying desperately to find something we could fix,” Dr. Jha said.
The man died of a complication from the surgery.
“The tragedy is what we should have done for him but didn’t,” Dr. Jha said. “We should have given him time to have the conversation he wanted to have with his family. You can’t do that when you are in pain from surgery, groggy from anesthesia. We should have controlled his pain. We should have controlled his nausea." Instead, Dr. Jha said, “we sent him to the O.R.”

No comments:

Post a Comment