Monday, March 15, 2010

Whatever Happened to True Informed Consent?

Have we ever really had it? I once again find myself caught in the paradox of modern medicine. Edmund was chewing a carrot last Tuesday, when he decided to start throwing a screaming fit. This led to a coughing fit that carried on for quite some time. He was breathing alright the whole time, but I could tell something was still in there that he couldn't get out. So after a lot of coughing and a few back blows to try to get it out, we headed to the ER to have it checked. As it turned out, Edmund coughed a piece into his lungs - well his bronchial tube. They ended up putting him out and used a tiny little scope to see where the blasted carrot was and retrieve it. As you can see, it was blocking quite a bite of his space! So again, I find myself amazed by the things modern medicine is capable of and incredibly grateful that we have such access to it for situations like this.

These are sideways, but the left top is the carrot.  The right is after it was cleared.

Why though, does some of the unnecessary accompany the necessary? Consider the following:
  • When the nurse initially saw us, she said the doctor may or may not take x-rays because food doesn't always show up.
  • After the x-ray technician took Edmund (and Dennis with them) down to get x-rays, the doctor came to explain that they may have to use the scope to get a better look and that the scope can also remove the object at the same time.
  • After the doctor actually saw the x-rays, she came back to say that carrots don't show up on x-rays, and they would need to use the scope. Because of a raspy sound in his voice, she already knew it was in his lung.

So why did we have x-rays taken in the first place? If food doesn't usually show up on them, and the scope than see and treat the problem, then why are we paying for x-rays and why was my son unnecessarily exposed to radiation!?
After the procedure, the "surgeon" showed us what he'd found and said they'd keep Edmund overnight. It very much seemed like a, "well, it's late enough. I want to get out of here. My nurse will see you in the morning." I wish I had my wits about me enough to ask the right questions. I was busy thinking, "How is this going to work? What about my daycare kids?" instead of what I should have been thinking, "Why do we need to stay? What exactly is the risk? Are there other options." I blame myself for that.

At the same time, why are we always approached with a decision already made for us? Why can't the surgeon, doctor, nurse, whoever, explain everything and ask us what we'd like to do? We should have been told that they got it out and because there was irritation, there is a _______% risk of swelling. However, we have given him medication to help with that and I recommend giving him Ibuprofen at _______time just to continue to reduce the risk and alleviate any discomfort he may have. We can keep him overnight or I'd recommend keeping him overnight, just in case, but it's up to you.

Just lay everything out there complete with percentages and recommendations and let people decide for themselves. We believed Edmund was fine, and that, as long as the risk of some side affect was extremely low, we'd all be much more comfortable at home and save a lot of money in the process.
But no.  We stayed.  Poor Edmund had a stupid IV in all night which he HATED. We were uncomfortable, and all they really did was give him Ibuprofen in the morning. So, sometime soon we will be getting a ridiculous hospital bill. I'm guessing it will cost us 2-3 times what it should have and wipe out this year's health savings account.
My take away: One of these days we'll learn to ask more and the right questions. One of these days we'll stop being afraid to follow our instincts and say no. And regardless, I continue to be incredibly grateful for the ways medical technology does, has, and likely still will help us, especially Edmund. Without it, we wouldn't still be enjoying the privilege of raising him:)


Stephanie B said...

Hey guys, I'm with you in the whole "give me all the information and data and percentages and chances and let me make the decision." Bravo. And with time, we all learn what to ask and when. And as you say, it's a bit of a balance between what medicine can offer, and whether it should. Love you guys and your little one.

michelle said...

Sorry to hear about your ordeal at the hospital, but very thankful little Edmund is okay =)

cachet said...

wow! i'm so gald he's ok too, I had no idea!

i share your same sentiments, and in the heat of the moment like that, no one can blame you for not asking the questions. I have BTDT, too. (HUGS)

Dennis, Heidi and Edmund said...

Krista, What's BTDT? We tried to ask questions. We did ask some and ,relatively, we were a bit aggressive about it. Obviously not enough though:)