"Why is my surgery over so fast?"

[IDGARA]

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How do you handle questions from patients when they realize that somethin aint right, and their diagnosis is much worse than they thought?

Case in point: patient comes in for a robotic lobectomy for suspected cancer. As soon as the camera goes in, we see that the mass is adherent to the pleura. Surgeon says, "Stage 4, we're done here," and we drop the patient off in PACU much much earlier than expected. The patient then looks me in the eyes and asks, "I thought I'd be under till the afternoon, why am I awake so early?"

In the past, I've tried to say something like, "I'm really not sure, I was too busy taking care of the breathing tube. You'll have to ask Dr. Thorax, he'll be by to talk to you later." But I feel like patients know that that is BS, and then they're just anxious about what you're withholding from them.

Even though we're physicians, I don't think it's our place to break bad news to people since our relationship with them is different. But I feel like I'm lying when I don't divulge what I know about them, and it seems wrong to know something so deeply personal about them that they didn't mean to share with you.

 

[pgg]

 

[dannyboy1]

Lots of narcotics. To PACU with oral/nasal airway. Leave before they wake up

 

[AdmiralChz]

Lots of narcotics. To PACU with oral/nasal airway. Leave before they wake up

Yeah, I hate to run from a problem but in this case it is better to hear bad news hopefully from an established member of patient's care team - typically the surgeon who has ideally seen the patient through the preoperative planning process. Regardless it's a crappy conversation to have with the patient, so I feel for the OP on this one.

I'm surprised your patient was that awake when you dropped him or her off in PACU. Next time maybe don't mention the time.

 

[pgg]

In seriousness, unless you can competently answer the obvious "what now?" followup question and explain the ensuing plan for chemo, radiation, or palliative care, and odds are none of us can or should, there's nothing to be gained by breaking vague bad news yourself.

 

[midazzoler]

To me thats the same principle as when I go do a pre op on an inpatient and the surgeon hasn't told the pt or family yet about the procedure. Even if I know, because I'm a doctor and it's in my training, it's not my job discuss the surgery or what it means for the diagnosis or treatment of their condition. That's on the surgeon. I'm willing to tell the pt that discussion will be coming or the surgeon may be concerned about x, y, or z if the patient pushes the issue. I'm also not above saying "I don't know" or "It doesn't look good but the surgeon will talk to you". It all depends on what the pt knew coming into the surgery and what they were expecting to find.

 

[deleted171991]

I'm surprised your patient was that awake when you dropped him or her off in PACU.

That's good anesthesia, in my book. Drapes down, tube out, patient able to move himself to the stretcher and ready to leave the OR in 5 minutes, pain-free, awake and even conversing, no oxygen needed.

I tend not to answer surgical questions either. I tell them that I don't know, but I am sure the surgeon will stop by soon, and offer to let the surgeon know that the patient is awake and waiting. In situations like this, the PACU nurses will also be proactive in getting the surgeon.

 

[Laryngophed]

I always tell them something like “Dr. X will explain the details of this to you once you are more awake and we are sure you will remember it. They are talking to your family now. You did well during my part and I don’t expect any issues for you from that.” Unless the surgeon specifically says “tell them x, y, and z” if they ask.

 

[dannyboy1]

That's good anesthesia, in my book. Drapes down, tube out, patient able to move himself to the stretcher and ready to leave the OR in 5 minutes, pain-free, awake and even conversing, no oxygen needed.

At least half of my patients can’t move themselves from the stretcher before the procedure, never mind after. Still the “medical clearance” will state that the patient has 4 mets....

 

[PainDrain]

I had to do this with a patient who was a physician, it still haunts me. “Why was my surgery only 45 minutes? Why was it only laparoscopic?”

 

[projectpat]

"The surgical team will be by soon to discuss the findings in detail. Everything went well with the anesthesia."
Nurse: "I need order!!"


Sent from my iPhone using SDN mobile

 

[fakin' the funk]

This happens all the time -- never had a situation where "your surgeon will speak with you when you're more awake" didn't suffice.

 

[Mman]

"you are just waking up from surgery" (push more versed)

 

[Planktonmd]

Yes I don't think it's wise for anesthesiologists to deliver this type of news and I consider that an advantage.

 

[Pooh & Annie]

How about BEFORE surgery delivering the “you’re pregnant” news? I had that once, completely unexpected apparently, elective procedure, and they still wanted to go. Almost wouldn’t take “no” for an answer. “Yes” obviously wasn’t an option.

 

[abolt18]

How about BEFORE surgery delivering the “you’re pregnant” news? I had that once, completely unexpected apparently, elective procedure, and they still wanted to go. Almost wouldn’t take “no” for an answer. “Yes” obviously wasn’t an option.

We had this happen when I was a student. Patient had been trying to get pregnant for 8 years without success. Had basically given up. To say the least, she was more than happy to delay her surgery.

 

[pjl]

How about BEFORE surgery delivering the “you’re pregnant” news? I had that once, completely unexpected apparently, elective procedure, and they still wanted to go. Almost wouldn’t take “no” for an answer. “Yes” obviously wasn’t an option.

That is a discussion I have had a few times. Much different than a poor prognosis when they are still dopey. Those get told Dr. X, MD-S will be by to see you when you are a little more awake, they are currently speaking with your family.

None of my pregnant patients have been happy about it initially. One was a false positive, and an extremely uncomfortable situation (spouse in military and gone until preop).