Thursday, January 18, 2007

The patient is the doctor and the family is the law

Well, sounds now like Castro had a bout of diverticulitis. But no, a Hartmann's procedure wouldn't do for his majestic colon. He had to have a one-stage resection and anastomosis. And lo! It leaked, providing a wonderful natural experiment which supports the way surgeons are trained to deal with severe diverticulitis: resect and divert. If he'd listened to his doctors, he'd be back to his usual mischief by now.

BTW, sutures don't "burst." Anastomoses leak. This one leaked because Castro is elderly, and they likely had to place the anastomosis in an infected field.

Ok, the family was the law in Dr. DeBakey's case. Dr. DeBakey was DNR and suffered a dissecting aortic aneurysm. He had a note in his chart that he did not want surgery for the dissection. But....later, he became unconscious. Then the family was able to take over, and lo!, he had surgery. Excellent surgery, advance directive be damned. He lives to get back to his usual duties. He was lucky in a lot of ways I won't go into. I'm glad he had an excellent result.

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