Consensual Acts

I am sitting in the corner of a hospital room with one of my fellow med students. In front of us is a 6 yr wearing spiderman slippers and with a toy car in hand sitting on the bed. Our Sr Resident is getting the child’s Mother’s consent for an emergency procedure. He takes the mother in layman’s terms through the procedure, through the risks and the complications. As I stand there I am struck by the fact that even though we are telling her all this, how much does she really fully understand it much less the patient himself what really happens in the OR. Does it matter that she doesn’t? Is it better that way?

What we tell the parents/patients: We will put you to sleep.

What actually happens: We will give you a drug that will put you to sleep to the point where you could stop breathing. We will somewhat forcefully at times jam a tube down your trachea. We will then strip you naked, possibly insert catheters in various orifices, strap you to a bed and contort your body into various random positions.

What we tell the parents/patients: We will make a small incision(s) here.

What actually happens: We will not only cut a hole we will stretch that hole to at times unbelievable sizes. We will then burn and force our ways (carefully yes) through various vessels and tissues until we get to what we want.

What we tell the parents/patients: Eg in correcting recurrent collapsing lungs: We will remove a bleb that is causing the problem and then use some surgical sandpaper to shave down the surfaces to prevent reoccurence of the collapse.

What actually happens: We staple the top of your lung and then we take what looks like steel wool and scrap your lung and the underside of your thoracic cavity (pleura and such under your ribs) until it bleeds. Then we force a tube in to drain the mess we made. We do this so your lung and the stuff around it scab and scar together.

What we tell the parents/patients: There will be students and Residents in the Room.

What actually happens: Someone from a completely clueless 23 year old to a 28 year old who may have never done this procedure before will cut, suture and dissect with mostly verbal instructions from the attending.

What we tell the parents/patients: You wake up in the recovery room feeling sore.

What actually happens: You wake up in the OR 9 times out of 10 coughing because there is a tube down your throat, with flashes in your eyes because of the lights, the promised soreness and a sudden awareness of being exposed to the whole world. But its ok you won’t remember it (BS, I remember it)

Surgery is barbaric. Its down right a lot like torture except with really excellent intentions. Its a total invasion of a person’s space, dignity and privacy. Its not that I am against it, heck I am living proof its worth it. But every consent I look into eyes of parents and children and am in awe of the trust that is placed in us, the medical professionals. I am also ever so slightly disturbed by what my fellow patients don’t know what I do. Somehow I feel as if we are misleading them, its not really a lie its just leaving out some of the less pleasant bits. Is it really true consent? But then again would anyone consent to having their child stripped naked, poisoned and their lung coverings scratched until they bleed?

It shouldn’t come as a surprise. I mean I have been consenting to all of this (minus the lungs and small bowel add allowing large men to hammer, jam and saw various portions of my limbs) for two decades. Its how causal it is, its how non-shocking it is because its routine. Whats a big, anxious, painful day for me the patient is just another day as a physician. Its how we causally toss around pharses like make an incision, excise, put you to sleep, when we ask for consent as if its the most normal thing in the world.

I hold their hands as they fall asleep, I speak kindly, I cover them whenever I can and I desperately try to remember that while this is just another assignment for me, its a really terrifying somewhat horrible experience for the patient. I see the fear and the trust in their eyes and I live in fear and awe of the responsibility placed in all of us.

I shudder a bit at signing my next consent form. I have always had a somewhat vague idea of what happens in the OR and enough experiences to put it together. Its not that I have a lot of new information its that I have now have series of vivid images. Next time they roll me into the OR I will be able to outline exactly what will happen after I drift off. I will be a bit self-conscious of my body, a bit more anxious about warm flush washing over my hand and utterly terrified if I find a single med student in the room

Maybe as much as I am firm believer in knowledge and the truth. This might be one of those rare times that its better that you as the patient just don’t know every last detail. At least for once in my life I kind of wish I just didn’t know as much as I now do.

Spiderman’s mom signs the green form. My SR pats the kid on the shoulder and tells him he will see him in a few minutes. I roll out and I say a silent prayer of healing for this child, provision for our surgery team for the next three hours and ask forgiveness for the almost lie knowing that its the best shot at saving this child’s life.