More amazing than the fact that Dr. DeBakey invented the surgery that saved his life, is the fact that he was almost denied the operation . . .
But beyond the medical advances, Dr. DeBakey’s story is emblematic of the difficulties that often accompany care at the end of life. It is a story of debates over how far to go in treating someone so old, late-night disputes among specialists about what the patient would want, and risky decisions that, while still being argued over, clearly saved Dr. DeBakey’s life.But Dr. DeBakey’s rescue almost never happened.
He refused to be admitted to a hospital until late January. As his health deteriorated and he became unresponsive in the hospital in early February, his surgical partner of 40 years, Dr. George P. Noon, decided an operation was the only way to save his life. But the hospital’s anesthesiologists refused to put Dr. DeBakey to sleep because such an operation had never been performed on someone his age and in his condition. Also, they said Dr. DeBakey had signed a directive that forbade surgery.
As the hospital’s ethics committee debated in a late-night emergency meeting on the 12th floor of Methodist Hospital, Dr. DeBakey’s wife, Katrin, barged in to demand that the operation begin immediately.
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{ 3 comments }
The idiotic part of the whole process was the idiots in the ethics committee arguing about whether or not a DNR meant that the surgery should not take place. The last time I checked, type 2 dissecting aortic aneurysm repair was not resuscitation. The patient advocate at my hospital has gotten so incensed about DNRs being read like this that the advocates office sends someone down to look in on each ICU admit and each request for a DNR in order to explicitly document what non-resuscitative care is desired (generally our pts want everything short of the crash cart, contrary to what many house staff seem to think the DNR means)
Understanding the patient’s intent is the purpose of the ethics committee meeting here. There were some statements early in the NYT article about how the patient was extremely hesitant to proceed with surgery because he knew (perhaps the best informed patient as ever could be) that the probabilities of languishing in an undesired state were quite substantial. Further, his very actions of delaying the surgery and attempting medical management for months further solidified understanding such a ‘do not operate’ wish of the patient; that is he would not wait and see if his aorta would blow up if he intended the surgical option.
The final line in the article tells exactly why an ethics committee meeting was required. The patient’s surgeons felt that the purpose of such a group, to reach consensus of the medical team, was superfluous and that the surgeons alone could and should make such decisions. But surgeons have long ago ceased to be the only physician on the team. Those most immediately involved would be the intensivist (never mentioned in the article), cardiologist, and anesthesiologist as those who would be responsible for the patient’s care. It is precisely because so many are responsible for managing the patient that it is no longer appropriate for a surgeon alone to divine the patient’s desires and dictate all treatment goals.
Nothing like an insistent wife to get decision-making off dead center!
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