My patient, Charles Hirsh, a long and lean aging man, lay on top of his assigned hospital bed, waiting for a visit from the anesthesiologist in preparation for surgery to contain a terminal cancerous process and divert his stool evacuation. His wife, whose brown hair surged through a ring at her neck, sat near him across the bed from me when I walked into their room. I pulled a chair up to the bed as I came closer, though I stood at the bedside to take only a quick confirmatory history because Mr Hirsh’s chart notes described well his medical state and the surgical plan. General anesthesia for this surgery would be pretty straightforward.
That’s not what troubled them. Charles and Kara, as they had introduced themselves to me, were concerned about this major bowel surgery that would totally disrupt anatomic stool evacuation as well as food ingestion.
“Into a bag and out in a bag is the outcome?” Charles asked.
“This is palliative, but there’ll no longer be a growing mass,” I said.
“What do you think?” Charles asked.
“Is it worth it?” Kara added.
“Those are different questions than I anticipated answering pre-op.”
“These are the most important for us,” Kara said.
“I can’t predict the procedure’s success or benefits for you. If you’re not ready, you can delay surgery. It’s a big change.”
They had worries. Would he stroke-out? Would his heart survive it? What would life be like with this daily bag process? They also feared chemotherapy. “I don’t want to be that sick,“ he said.
The more I listened the more I heard their respectful reluctance.
“We’d rather not,” Charles and Kara said.
“That’s okay,” I said.
Sighing relief, both beamed gratitude.