Registered: Feb 2004
Location:
Posts: 41

On May 7, 2001, my mother, Eileen Bialek {age 72} underwent elective surgery for correction of a prolapsed uterus and cystocle. The surgeon in the department of Urology at a major medical facility in Cleveland agreed to perform an open laparotomy with a uterine suspension. Eileen’s past medical history included colon resection for bowel cancer 18 years prior. The surgeon was aware that she had previous abdominal surgery but decided that open laparotomy was the procedure of choice and did not discourage Eileen from this type of surgery despite the risk of complications. He did not offer her a second opinion. No prior medical conditions pertinent to this surgery were present. With the exception of symptoms of urgency and a visually prolapsed uterus, Eileen had no other medical problems. She was active in her church and community as well as taking care of her spouse.
Postoperative course initially was normal until discharge when she started to vomit bile and was readmitted 18 hours post discharge. The surgeon evaluated Eileen and suspected she developed a postoperative ileus. His initial treatment consisted of telling her daughter to " give her a milkshake" to encourage her bowel to move. She did indeed follow the surgeon's advice; however, Eileen’s condition continued to deteriorate. Conservative treatment over the following two weeks consisted of clear liquids and nothing by mouth. Total parenteral nutrition {TPN} was then initiated and finally bowel decompression via nasogastric tube. Preliminary x-rays were done but results were not followed up on.

At two weeks postop a computed tomography {CT} scan was done which revealed a blockage in the small bowel. The surgeon advised Eileen of the need to return to surgery because he suspected that an adhesion was causing the blockage and it needed to be released. Eileen consented to the surgery and requested that her previous surgeon {bowel cancer} be in attendance. The current surgeon said he was out of town and he was asking another colorectal surgeon to be on hand.

Eileen was taken to surgery May 17, 2001. After 5.5 hrs of surgery the surgeon informed her daughter that he found a portion of the small bowel had twisted and he had to resect a portion of it. Because there were enterotomies, a jejunostomy was placed along with two mucous fistuals. Blood loss required transfusion of six units of blood during surgery. Eileen was transferred to the surgical intensive care where she required full fluid resuscitation and mechanical ventilation for two weeks. She sustained atrial fibrillation, required seventeen units of blood and clotting factors secondary to developing large retroperitonal hematoma. She remained in the ICU for 4 weeks and transferred to the floor for two more weeks at which time she was admitted to a long term acute care hospital. Before discharge the resident informed her that she had a rectal laceration and would need to have that repaired when her jejunostomy would be reversed in one year. She remained at the acute care hospital for 4 weeks then transferred to a nursing home to continue her recovery. Eileen was so debilitated from the surgery she required daily physical and occupational therapy.

During this entire time she experienced daily nausea and vomiting. Physicians at two different hospitals were consulted and determined that gallstones in the common bile duct were causing her symptoms along with elevated liver function. Eileen underwent repeated endoscopic retrograde cholangio pancreatopography {ERCP} over the next several months as no surgeon would remove her gallbladder for risk of causing more bleeding and complications.

Eileen had two episodes of sepsis treated by antibiotics during several readmits to the original surgical facility.

Finally in December of 2002, she became acutely septic and unresponsive and was transferred to the emergency room of a nearby hospital. The hospital surgeon determined that removing her gallbladder was probably her only chance to survive. She was placed on full life support, aggressive antibiotic management, vasopressor agents and taken to surgery. The surgeon successfully removed the gallbladder and informed the family that her organs were stuck together like cement. He gave no guarantees but stated that with antibiotics and life support she may be able to survive but with an arduous recovery. The bilirubin continued to rise; she was severely jaundiced and no longer responded to increase vasopressors or dialysis. Eileen Bialek expired on January 8, 2002. The postmortem documents indicated that she died of organ failure secondary to sepsis. The origin of the infection was vancomycin resistant enterococci {VRE} in the common bile duct probably secondary to the ERCP or the residual retroperitoneal hematoma.

I believe she was deceived by her surgeon in terms of the full disclosure of the risks involved in this kind of surgery. Anyone who knew her would testify that she was not one to take un-necessary risks. Accordingly, I am asking Congress to pass "Do No Harm" legislation requiring a neutral third party to be present during all pre-surgical consultations.

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Registered: Jan 2001
Location: Zion
Posts: 4444

First off, I'm sorry for the loss of your mother. I can't imagine, nor do I pretend to, what that must be like.

I didn't understand everything in your statement and a Doctor I will never be but there are a few opinions I have that are based on my understanding of what you wrote.

Elective surgery means she had a choice to not have the procedure performed, correct? If this is true then she is responsible for making the decision to have the procedure done. I am also sure that at the age of 72 the risk of complications has got to be drastically increased. Sometimes complications lead to death.

My biggest hang-up in this is that you want congress to mandate a third party be present during consultations. This, in my opinion, is bullshit. Why do we have to pass a law to enforce something a loving family should be responsible to do? Why would her children let her go in there alone? I know that the patient can have anybody they choose present during a doctor's visit.

Again, I'm sorry for your loss but it seems a bit "big-brotherish" to mandate that somebody be responsible for a person's decision making when they should have a friend / family support system that should feel the obligation to do it.

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Registered: Nov 2003
Location: North Myrtle Beach SC
Posts: 3351

I am sorry for your loss, my parents are still alive but I went through a nightmare with my grandmother who had pancreatic cancer.They told her for months it was just a backache and gave her muscle relaxers.It is a nasty cancer , little could have been done even if they would have caught it early.

The numbers of people in America killed every year by Medical Malpractice and mistakes are mind numbing , most recently it was reported that it claims more people than car accidents.

As Cruise Director said surgery has risk , even the so called minor ones , when they open you up there is always a risk of infection or bad reactions to the drugs , people need to be told about all their risk and options.

Last edited by lucidnightmare on 02-13-2005 at 08:47 PM

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Registered: Sep 2000
Location: Kansas City
Posts: 7504

Condolences on your loss.

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Registered: Aug 2001
Location: Hilbert Space
Posts: 35561

quote:

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Originally posted by Cruise Director
*snip*.

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Registered: Feb 2004
Location:
Posts: 41

Thank you for your kind words. A medical ombudsman would serve well as a checks and balance for both doctor and patient. Today most companies record conversations between company and customer. Had the surgeon explained to my mother that one of the possible complications could be a jejunostomy she would not have had it done.

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Registered: Jul 2000
Location: Beatrice, Nebraska
Posts: 18490

I'm nonplussed with his suggestion of "give her a milkshake" as a treatment for an ileus. I watched a man die because his ileus resulted in bowel perferoration over time.

What I'm not clear on is why she would have not gone along with a surgery simply because they would have to put in a J-tube.

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Registered: Apr 2002
Location: At Home
Posts: 4056

I send you my deepest regrets for the loss of your mother.

Maybe the introduction of a Surgical Councillor would be better, aperson who requires surgery is informed of all the associated risk by a person with better communication skills who has recieved notes from the surgeon who performed the assessment. This person could retrieve information pertaining to the surgery, risks and such, and convey them to the patient so that an informed choice could be made. This would allow a surgeon to "go technical" with an intermediary, who in turn could explain it in lay-terms to the patient.

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