She never made it out of the hospital.
Her last words to her family were in pre-op, and she never woke up after surgery.
She was in her late 80s. Mechanical fall. Came in through the emergency department. Wasn't on call, but I was in town.
Periprosthetic fracture around her hip replacement. Vancouver B2. Comminuted and displaced. Surgery would be a revision of the hip and fixation of the fracture.
Went to see her that morning. Any movement and she was in pain. Lying still, she was comfortable. Conversational. Friendly.
Before the fall she got around with a walker. Short distances. Significant medical comorbidities. Cardiac risk factors and more.
I'm very pro-surgery for hip fractures. Displaced fractures hurt. Even when someone won't walk much again, fixing the bone can be the palliative option. Quality of life.
This one felt different. Went through her full history and acuity. My concern was she wouldn't survive the operation.
Talked with the hospitalist. The anesthesiologist called me. Both felt the same.
Leave the fracture and every movement hurts. Operate and we might lose her in the OR, or in the days after.
Met with the family. Went through all of it in detail. Told them that I usually recommend surgery for this in almost every case. But in this one I didn't think she would survive the operation or long after it.
She couldn't fully make her own medical decisions anymore. Her power of attorney was her son. The anesthesiologist and hospitalist also had a similar conversation with the family.
The answer was always the same.
We operated.
Rolled back to the OR at the end of my operative day. I felt like I was doing her family a disservice.
The surgery went smoothly. Old hip stem out. New modular fluted tapered femoral stem, with cables securing the fracture.
Walked out of that OR without the usual positive high.
She never woke up after surgery. Never had another conversation with her family. She died a few days later.
My job was to tell them the truth. Their job was to decide. After that, my job was to do the best operation I could.
"But speaking the truth in love, may grow up into him in all things." Ephesians 4:15
This week, tell someone the truth they don't want to hear. Then stand with them in what they choose.
The good thing is, the outcomes we'd rather forget are usually the ones that teach us the most.
What do you do when you can see the outcome coming and you're the one who has to carry it out?
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Good Thing Monday goes out every Monday. One story, one good thing.
Tell me your good thing this week. I read every one.