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Sunday, September 13, 2009

When the Patient Has the Power

She's sick, but her religious convictions are stronger than anything medicine can offer.

She walked in, youthful in her mid-40s. Her referring doctor had told her she had a lung tumor, yet she was calm.

A doctor’s desk suggests the power of the physician. But when my patient spoke—“No blood; I am a Jehovah’s Witness”—the balance of power shifted. Her beliefs were as strong as my convictions about the importance of surgery. I explained that the mass in her lung would likely require removing half of the organ.

She nodded. “Okay,” she answered, “but no transfusions.”

She wouldn’t let me store her own blood, either. I had never given a transfusion for the procedure, but I always reserved blood. Still, I was young, brash, sure I could do it.

If she bled in surgery, could I keep my promise? Was my obligation to the morals of my profession—to save lives—or to her beliefs? What would her life be like if I removed her cancer, but gave a transfusion?

Finally, I decided to proceed.

During surgery, an artery split, spilling blood. Not much, but under the circumstances, a tsunami. My

finger closed the hole, giving me time to think. I applied a clamp and continued.

I felt like a pilot who had lost an engine and managed to land. She was okay, but the possibility of death had been present. I shudder still, thinking of it.

I inhaled, my assistant stopped sweating, and the anesthesiologist sat down. It was okay. The three of us felt as if we needed the transfusion. The rest of the operation was normal.

We surgeons have advanced technology, instruments and medicines. We’re competent. But patients continue to test us, to challenge our judgment as well as our skills.

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