Mrs. Johnson refused to have her second leg amputated. She lay on the hospital bed with her one prosthetic leg leaning against the wall, the straps dangling; the dark skin of the prosthetic leg matched her skin color. The leg almost looked life like.
Her other foot had now become necrotic and odorous from her diabetes. “Mrs. Johnson, there is lots of infection in the foot, no amount of antibiotic will cure the infection.” It was my 3rd day repeating the same line. A series of opinions, from the vascular surgeon, the orthopedic surgeon, the internist and me did not dissuade her. “You understand that you may die, if you do not have the surgery.” I repeated.
“Yes’, she answered weakly.
Exacerbated with her response, unable to have her understand the gravity of the situation, I took a few moments to explore her decision. “So, why do you not want to have your infected leg amputated, even if it could save your life?”
“How will I move around?” she said, as if she was in denial.
“A wheel chair or possibly another prosthesis.” I responded quickly.
But, she was a grandmother and an independent willed woman, and her mind was made up. Her daughter sat silently at the bedside, as if they had had this conversion earlier amongst themselves.
I paused. Maybe, I should have explored further, but I ended the conversation.
The next morning, I did not find Mrs. Johnson in her hospital room. I searched the computer, and saw she had been transferred to the intensive care unit. Her blood pressure had become dangerously low due to sepsis from the infected foot. She was intubated (a tube in her lungs to breathe for her) and may have had a stroke. The very consequences I had feared.
There are times when patients make decisions that make doctors uncomfortable; decisions the doctors would not make for their child or elderly parents. Those situations require time and unearthing for the root cause of the decision. Mrs. Johnson and I were not able to do this fully.
In such conversations, as doctor’s we make one point clear. The doctors are back seat drivers, presenting the possible routes and navigating the path. The patients are in the driver’s seat.