Post-operative complications

Since I came on the medicine service, my team has been taking care of a man who because of one of his unfortunate afflictions I will call Mr. Scrotum. Mr. Scrotum is a 70-something man who came to the hospital with an infected prosthetic knee joint. He had surgery to clean it out, then came to our service to get medically stabilized prior to beginning physical rehabilitation. Unfortunately, Mr. Scrotum had some post-operative complications, including some wacky mental status changes and a fairly reversible kind of kidney failure.

Mr. Scrotum's medical course, while not ideal, is a fairly common one. His family, however, is exceptional. Although Mr. Scrotum has full mental capacity, he defers to Mrs. and Daughter Scrotum for all of his medical decisions, and I imagine it has quite a lot to do with how unbelievably exceptional they are.

Mrs. Scrotum is the kind of person who, after she is served lemon butter instead of parsley butter with her lobster at the club, asks to speak with the manager; has the waiter fired; writes a series of angry letters; forms a community coalition; hires a lawyer; and still isn't satisfied after she wins, because it's the principle of the thing. Her daughter is the same way, only with younger, sharper teeth. It is really very unpleasant to be regarded daily by these people with such spectacular anger, distrust, and paranoia.

Understand, now, that I do not take the Scrotum family personally. To me, their collective affects speak of nothing so much as abject terror: They are so, so afraid of losing their beloved Mr. Scrotum. In a flailing attempt to gain control over something that threatens to take him from them, they scrutinize and question what they do not understand. Any barrier to their scrutiny is seen as an intentional, adversarial move-after all, it's far more satisfying to have someone to blame when bad things happen than to just chalk it up to bad luck.

If we don't take the time to help the Scrotums identify what they are feeling-fear and frustration-and to explain to them why we are doing everything we do, we run a great risk of making them feel that we are not on the same team as they are. It's that dynamic that results in lawsuits.

Ironically, the time that we could spend talking with the family once a day-which indeed is a pretty big demand on any doctor's schedule-we spend trying to cover our asses in case this situation does end in a lawsuit. We call consults, we call attendings, we have bitch sessions. If we could swallow our pride, answer questions for 15 minutes a day, and remember how little control this family feels they have, I think we could avoid a bad outcome, psychosociolegally speaking.

At least, until he dies. At that point, no explanation will alleviate their grief, and anyone who can possibly be blamed will be. I just pray it doesn't happen in our hospital.