Monday, May 9, 2016

Even In An Emergency, Doctors Must Make Informed Consent An Informed Choice - Health Affairs

My dad is a wonderful man. In his working years, he was a tax accountant who served on the board of the Bronx River Neighborhood Center and shared his passion for tennis by teaching young men who lived in the South Bronx to play. He retired early to introduce others to meditation and other stress reduction methods that he had found helpful, and he ended up as a volunteer community mediator.

In October 2013, just a few months after giving up playing tennis, my eighty-eight-year-old father was diagnosed as having stage 4 prostate cancer. He responded well to the hormone treatments, but by May 2014 his prostate had gotten so large that he had difficulty peeing. Although he liked saying, "I don't like to brag, but I have a HUUUGE prostate," this condition had become dangerous: The blockage began to cause kidney failure.

My dad's urologist gave him two choices. He could either live with a catheter (a tube inserted into his bladder) for the rest of his life, or he could have surgery to trim his prostate to create a channel for the pee. After hearing that sporting a catheter would end his ping-pong career and that he'd only have to spend one night in the hospital, my dad overcame a long-standing fear of germs and elected to have the surgery.

Since my mother's immune system was shot from having chemotherapy for lymphoma, my twenty-year-old son and I were the ones who accompanied my dad to the hospital. I am not a clinician, but I have worked for the Agency for Healthcare Research and Quality for almost twenty years, and I felt well equipped to be my dad's health care proxy. He checked into the ambulatory surgery unit early in the morning and was soon taken away for the surgery.

Immediately after the surgery, my dad's urologist told us that it had gone well. The following morning, however, he informed us there was too much blood in my dad's pee. My father had to stay in the hospital an extra day so they could flush the blood out while the catheter was still in place.

On his third day in the hospital, my father was pronounced ready for a "voiding trial." They pumped a liter of fluid into his bladder, removed the catheter, and waited to see if he could pee. However, my dad felt no urge to go. Even after drinking cup after cup of water and sitting with a handheld urinal for several hours, he couldn't get anything out.

It was early that afternoon when I noticed that he was having some difficulty speaking. He was clearly trying to say something but couldn't come up with the words he was searching for.

I pointed out the problem to the urology nurse practitioner. "Dad, what are you trying to do?" I asked him.

"Well, I'm trying to…" His words trailed off. "You see, I'm making an effort… I'm really…" He couldn't say, "I'm trying to pee."

The nurse practitioner suggested that we call the stroke team. While I didn't think my dad had had a stroke, I knew I might be attributing the symptoms to other health issues, which frequently happens to stroke victims in hospitals. So I agreed, and the nurse called in the stroke team.

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