Debakey Asc aortic dissection

[deleted87051]

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What would you guys have done?

He is 97 years old and apparently had a DNR and a note in the chart stating he did not want surgical intervention for aortic dissection or rupture. Anesthesiologists at his hospital refused to do the case. He could easily have died intraop and more likely days or weeks after. But now he is greatful that he received the full-court press.

Clearly not your average patient. Not your average decision making process on the part of his surgeons. I would venture to guess that no other 97 year old would have received the same treatment.

http://www.nytimes.com/2006/12/25/health/25surgeon.html?th&emc=th

 

[NYC Wolverine]

I had to shake my head when I read that article yesterday. The author basically villifies the hospital's anesthesiologists for respecting the patients written and signed DNR / do not operate orders in the chart and refusing to administer anesthesia.

"Dr. Noon said none of the anesthesiologists had been involved in Dr. DeBakey’s care, yet they made a decision based on grapevine information without reading his medical records"

What?? It's not grapevine information when there's a signed DNR AND a note in the chart saying the patient does not want the surgery. Then the patient becomes unresponsive and all of a sudden, it's okay to operate on him? Where's the gray area here? Am I missing something?

Regardless of whether or not this pioneer in the field (which he is) received extraordinary care (which he did) and whether he's happy that they ultimately operated (which he is), is this not setting a very dangerous precedent in terms of respecting a patient's decision-making autonomy?

Curious as to what others out there thought of this.

 

[canavarim]

I dont know the details of do not operate .. but if it is clear in the chart .. then ..
what do you think could have happened if he died intra or postop ???

 

[Gern Blansten]

I believe assault is the formal charge for what was done.

 

[powermd]

I wrote to the author about his portrayal of Debakey's anesthesiologists as being selfish and obstructionist. Ridiculous. I'll post his reply if he writes back.

 

[VolatileAgent]

maybe debakey needs to come to this anesthesiologists defense and make a statement that he'd done the right thing... if it was clear that the dnr/dni was intact, that is.

 

[Qtip96]

I wrote to the author about his portrayal of Debakey's anesthesiologists as being selfish and obstructionist. Ridiculous. I'll post his reply if he writes back.

i read a similar thread in "general residency issues", so i thought i'd bounce this off here. i'm not an anesthesiologist but a cardiologist, but reading the NYTimes article made me mad as hell. i'd also be interested in hearing what feedback you got.

from what i gathered from the article, and the data seems clear. DeBakey had a seld-diagnosed type II aortic dissection beginning on Dec. 31. He did not agree to a CT scan until Jan. 3, but refused surgery with full knowledge of the natural history of the disease. On Jan. 28th, repeat CT scan demonstrated his aorta increased in size from 5.2 to 6.6 cm, an interim increase in 1.4 cm and a forboding sign. He STILL refused surgery and at some point in his hospitalization he signed a DNR order. By Feb. 9, DeBakey was unresponsive, hypotensive, and in renal failure.

the SURGEONS had 5 WEEKS to convince Dr. DeBakey to undergo surgery. it had been his EXPLICIT WISH that surgery NOT be performed. these "heroic" surgeons waited until their iconic mentor became unconscious before attempting to do what they knew he forbade, by which point the surgery was performed in the setting of advanced complications, extending his post-operative recovery.

did i miss something? WHY are the anesthesiologists being portrayed disparagingly here? it seems they were the only ones obeying the law, and the surgical team's delaying surgery sounds like cowardice. if they truly thought the patient, DeBakey, exhibited life-threatening clinical denial, why didn't they have the balls to bring in psychiatric consultations and assess for incapacity to make decisions? clearly, 5 weeks was not enough time to do the right thing, eh?

 

[bigdan]

How does this go on without consequence at the hospital, and then have the story re-told in (arguably) the most popular paper in the US, and have it persist without action against the medical team?

dc

 

[VolatileAgent]

just need debakey to say, "i was wrong."