OB-Gyn: Day 19

Yesterday was (unexpectedly) my last day of my Ob-Gyn clerkship. We were in clinic after doing our morning hospital rounds. Two of the three patients I had prepared to see in clinic did not show up to their appointment (totally frustrating), but the one patient I did see was more than enough to handle.

The patient was a nearly 60 year old female with an incidental finding of microscopic hematuria and a pelvic mass. She is a chronic smoker (at least a 44pk/year history). She was completely asymptomatic...or maybe she wasn't. The reason I say that is because I honestly don't know if she would notice any changes to her body. She was very, as my attending described, "simple". She also appeared to be much older than her stated age. I attribute much of that to her chronic smoking. After taking a full history and performing a physical exam, we weren't too concerned of the mass on her ovary being cancerous, but we would like to take it out any way, to make sure that it is truly benign. You would not believe how difficult this was to explain to the patient. Suddenly, after the word "surgery" came out of our mouths, she burst in to tears, exclaiming that she doesn't want to die on the operating table. How do we get across the fact that every year in the US we perform over 600,000 of these surgeries and that there are very few complications? That the likelihood of death is almost zero? It was when these thoughts were in my mind when the daughter stuttered the words "a-a-and if s-s-somthing were to h-h-happen to --her when she's in s-s-surgery, w-w-who's liable? I-I-I mean, i-i-if she d-d-dies, I'm gonna s-s-sue e-e-everyone". Wow. Nightmare. Your risk of dying on the drive to the hospital is probably higher than it is of dying on the operating table. How do you explain that? How can you possibly dim down medicine and surgery to the point that people who have an IQ of 70 can understand? I felt so horrible, because I had no idea how I could explain it any simpler so as to put her mind at ease. The patient was sat there, on the examination table, crying her eyes out while her daughter was talking about suing us after she dies on the operating table. Not exactly helping the situation. I felt so horrible for the patient. How do you convince her that she will be alright in words that she would understand?...

I went to a review session last night and was told that we don't have to work any more this week, we can have the two days to study and revise for the shelf exam on Friday. So I better get to it. Apologies for skipping out on Tasty Tuesdays for two weeks straight; I know saying I'm busy isn't a good excuse because I'm just as busy as always. But I'll have a think and make something extra special for next week, promise! :)