Poker face

How do you maintain a straight face while taking consent for a "no hope" operation ?

Its not easy facing the relatives you know. As much as how you feel like telling them the whole truth , you have to remain positive and reassure them elegantly.

5 am this morning - we received a phone call from the surgical team. 66y year old indian lady - who has chronic liver cirrhosis ; bleeding away from her varices in the ward. Her haemodynamics were very unstable and she is bleeding from all her orifices. They were resuscitating her by pushing in blood and fluids to accomodate the loss. They now want to open up to find the bleeder and hopefully cease the cause.

She arrived at the OT almost immediately - Very bloody indeed. The Sengstaken tube which was inserted a few days earlier during OGDS was refluxing blood out. A quick check on her pupils showed it was fixed and dilated ! Triple inotropes are on but her BP is so low that when you palpate for her pulse - it was so weak! What are we doing here??... Of course , the surgeon wants to continue as they cliamed that the patient never had any collapse episode - and i was entrusted by my senior to take High risk Anaesthesia consent from the family members.

"Saya Dr. M , Anaesthetist. Emak awak dalam keadaan yang sangat tenat. Pendarahannya tidak berhenti-henti dan kita perlu operate dia segera sebagai cara terakhir... "

When maybe you wanna say..
YOur mum is in a very - very critical condition. I'm not sure if she is still alive at the moment..

" Saya minta kebenaran untukberi bius dari awak bagi operation dijalankan. RIsikonya amat tinggi dan berkemungkinan besar jantungnya boleh berhenti semasa operation dijalankan. Namun demikian , kita akan cuba segalanya yang terbaik. Tapi saya ingatkan di sini , risikonya terlalu tinggi dan semua ahli keluarga perlu faham tentang keadaan kritikal ini."

She'll definitely die on the table. No two ways about it...

FAcing the worried faces of the relatives is a big challenge. Its not easy for them to consent for a big decision like this. And at all times on our side , we have to remain cool and not too pushy about it.

"Kita doakan sama- sama ya.. mana-mana yang terbaik..."

And true enough , the mother of 5 and grandmother to 8 was pronounced dead at 7.20 am. The bleeding was uncontrollable and her heart could not keep up despite the massive transfusion - replacing blood for blood...

And the hysteria outside the OT when it was declared to the family....