Your Medical Mind_ How to Decide What Is Right for You - Jerome Groopman [70]
“I think it’s worth her undergoing the procedure, so that we can find out where we stand,” the oncologist said. “If there is extensive regrowth of cancer, this will help tell us whether we should push on or not. I’ll come back tomorrow and we’ll all talk again.”
Not long after the oncologist left, the gastroenterology fellow came to obtain an informed consent for the procedure. He paused, looking at Mary’s wasted form, dwarfed by the hospital bed. Deidre said, “You know, she was a librarian for forty years. Just an amazing woman.” The doctor nodded. “She raised four children, three daughters and a son,” Deidre continued, “and now she has seven grandchildren. One of them has a birthday next week.”
Deidre told us, “I always wanted to bring a human face to people about who she was. This is my mother, a person and not just a patient. Because it can get just to be that way, patients all hooked up to machines, nurses and doctors doing a job.”
Not long after the young doctor left with the form signed by Mary, a case manager entered the room. Mary was sleeping, so the case manager and Deidre moved into the hall. “I’m arranging the transfer for Mrs. Quinn to a rehabilitation facility,” the woman said.
Deidre was shocked. No one had ever mentioned discharging Mary from the hospital and transferring her to another facility. “My mother doesn’t want to go to rehab,” Deidre told her. “We want to bring Mom home.” Deidre told us that the manager said flatly, “‘Well, you’ll never be able to care for her at home.’ And I said, ‘Well, we’re going to figure something out.’
“Mom had told my father that she wanted to die at home,” Deidre recalled. “This news would have made my mother even more upset than she already was. We decided we didn’t have to talk about it right then.”
A half hour after the news about transferring Mary to a rehabilitation facility, a transport person arrived, saying, “Hi, Mrs. Quinn, I’m here to take you downstairs for your procedure.”
“That day, I felt everything slipping away from any sort of rational progression,” Deidre said. “All sorts of things were happening that we weren’t aware of. And it felt like we couldn’t get a handle on who was in charge or what was going on. It seemed like decisions were being made automatically.”
Deidre had another observation to share with us: “There just is this massive bureaucracy that hospitals have become. It seems so crazy, you are sort of caught in a whirlwind. And sometimes it’s like, ‘What’s going on here?’ And there were times when there was just no clear communication, when everything felt so out of control.”
Mary was taken to the procedure suite. She’d been given a mild sedative, and she soon fell asleep. The liver specialist cleaned her skin and then, under ultrasound guidance, he inserted a needle into one of the large cavities. Almost immediately, Mary began to gasp for air. The doctor put an oxygen mask on her face, then listened to her heart and lungs. Within short order, the reason for her respiratory distress became clear: He had punctured her right lung when he inserted the needle into her liver. Although uncommon, this is a known risk of this procedure.
The liver specialist checked her orders; there was no “Do Not Intubate” directive. The code team was paged—residents came rushing in. A breathing tube was placed into Mary’s trachea. A surgical resident sliced between her ribs and inserted a chest tube to reexpand her lungs. Mary was rushed to the intensive care unit.
Deidre, her father, and siblings were awake all night in the family room next to the ICU. The nurses told them that Mary had not woken up since the lung collapse. It was still unclear why she hadn’t regained consciousness. Shortly after noon, the oncologist visited and told the Quinn family that the liver biopsy showed “extensive cancer.”
“I’m so sorry this complication happened,” the oncologist said. “But I think the procedure