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The patient is a 45 year old woman who presented at the Emergency room at St Martha’s hospital with acute abdominal pain and some rectal bleeding. Pain medication were given and a lower GI series of test were ordered.Test indicates a blockage in her Transverse colon which could be cancerous tumor or non-cancerous Polyp. A gastroenterologist named Dr. Smith was consulted and evaluated the Patient. Dr Smith recommended a Colonoscopy to evaluate and possibly treat the patient. A colonoscopy was performed a day later and a sizeable Polyp was removed; a Pathology report was ordered to identify if the Polyp was cancerous or not. The report confirmed the the Polyp was precancerous. The patient’ medical history contained nothing remarkable. She came through the anesthesia without incident and the likely prognosis of a complete recovery was excellent.
Mary R and her husband and their two daughters were visiting United States from Thailand. Robert R works for a large oil company headquarters in the US and they come here from time to time mixing business with some sightseeing. Robert R is the medical power of Attorney.
It was decided to keep the patient overnight from observation with the likely discharge in the morning. Slightly after midnight the patient began to complain of acute abdominal pain, the night nurse noted a drop in her blood pressure (65/45) the patient became less responsive and was
taken to the ICU unit. Blood work indicated a very elevated white blood cell count and anemia. The patient was given blood transfusion with a signed permission from her husband.She was also put on antibiotic and given medication to increase her blood pressure. Because of the pain the patient was heavily sedated and put on the ventilator her immediate critical situation was somewhat stabilized.
A perforated Bowel was suspected as the cause of the event. A general surgeon was contacted to consult on the case and evaluate the patient treatment. Doctor Johnson’s evaluation confirmed the opinion by the medical residents and the staff that the patient was septic and that without the surgery the patient will die. Dr Johnson felt that is was quite likely that the patient would require at least a resection of her Colon but also could end up with a colostomy. Dr Johnson felt that the surgery needed to be done right away.
The husband was contacted by the staff and a meeting was held with Dr Johnson and the resident of the case. All the possibilities were discussed with the husband. His response to request to fill out paperwork for the surgery shocked the Medical Team. Robert R was not sure if his wife wants the surgery. In his country having a Colostomy was not acceptable, both in his religion and his culture. He would not be able to take her home in the condition to her relatives and friends, She would nt want to live with such daily reminder f her sorry condition. If DR Johnson could guarantee that he could simply repair the perforation without giving her a Colostomy that he would give consent for the surgery. Dr Johnson said that he could not agree to those terms because he would not be able to determine that until he was performing the operation. His job was to save the life of his patient and not with one hand tied behind his back.
Without the doctors assurance the husband is unwilling to give consent to the surgery. Robert R is willing to voice his contempt for the hospital and threatened to sue the hospital for ita failure to provide a high quality healthcare. He also accuses the hospital of treating his wife with such little regard because she is of a different race and culture.
Dr Johnson has requested and ethics consult to make recommendations about how to proceed and how to get some resolution about the case, DR, Johnson wants a committee to meet right away because time is of the essence. Right now Mary R’s condition is stable but it could change at any time.
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