Tuesday, September 18, 2007


Me: You're definitely declining a blood transfusion.

Patient: Yes.

Me: Even if it will save your life.

Patient: Yes.

Me: You're sure. You understand everything that I've said and told you.

Patient: Yes.

The patient looked at me, and I at him. He had come to the hospital after passing large amounts of blood after a bowel movement. So far, all non-surgical treatments had failed, and we had decided to go to the OR and surgically remove the bleeding colon. It was only a matter of time before he would essentially bleed to death.

The complicating factor in this case was his absolute refusal to consent for a blood transfusion. He was already at a disadvantage due to his heart condition and smoking history, but his massive blood loss compounded those factors into overwhelmingly poor odds.

But you have to respect a patient's wish. And even if it means this patient might die, I had to respect his decisions and uphold them. I thought about asking my patient-

Anesthetist: [yelling] HEY DOC!

I immediately snapped out of my daydream. I looked up, surprised.

Anesthetist: Stop for a second, let's check to see if he's got a rhythm.

I had been pumping away on my patient's chest, lost in thought, recalling the last conversation I had with this man before coming to the OR. I looked around and regained my bearings.

The case had gone fairly well, we were able to remove the colon and stop the bleeding, but as we were about to start closing the abdomen, the patient's heart went into a pulseless arrhythmia. There was no doubt that this was brought on by the low blood volume exacerbating his previous heart history. We had immediately started cardiac resuscitation. And while performing chest compressions, I had become absorbed in my own thoughts.

I stopped what I was doing and we all turned towards the monitors.

No rhythm.

I stepped down as a fellow resident stepped up to resume chest compressions. We had been doing this for 20 minutes, and I was drenched in sweat.

We all stood helplessly, hoping that the patient's heart will regain function.

Anesthetist: [asking one more time] No transfusion, right?

I solemnly shook my head. There was no guarantee that a blood transfusion would help my patient, but it would definitely help stack the odds in his favor. But I had to respect his wishes. So I did what everybody else in the OR was doing: watching the monitors and praying for a miracle.

We stopped resuscitation about 15 minutes later.
He was pronounced at 3:19 AM.