Balls and Walnuts
more than you ever wanted to know
Trouble either way
From the first clinical rotation in med school, we’re taught, Do the right thing. It’s an obvious lesson, but it’s the sort of thing which bears endless repetition, since human nature seems bent in the opposite direction. See the ER consult now, or sleep a bit more until they page you again? Check those stat labs, or go home five minutes sooner? After a while it becomes reflexive; you do the right thing without even listening to what your body wants to do.
Those are the easy decisions.
But then there are the questions that have no right or wrong answer. Operate now when the patient is unstable, and the risks necessarily higher? Or wait until the patient is stable, but take the chance he could get worse during the time it takes to stabilize him? It’s one of those decisions that could trip you up no matter which way you fall. You need a crystal ball or a reliably prescient gut for questions like this. And no one’s gut is that prescient.
Reminds me of the painting I had up in my private practice office: carnival fortune teller, dead eyes suggesting she’s an automaton, catering to three twins, each of which has fingers crossed behind his back. People would ask what it meant. I’d say, “I don’t have a crystal ball.”
Ultimately, I tend to use the same thought process I do whenever a parent says, “You’re only taking the adenoids out? Why not take the tonsils, too, while you’re at it?” This only comes up if I have already decided the tonsils aren’t causing problems. In essence, the parent is asking me to take out the tonsils to prevent a future problem. Same way a general surgeon doing an exploratory laparotomy will usually take out an appendix whether it’s hot or not.
My thinking: why incur additional risk now for something that might become necessary in the future? In twenty years, I’ve only been wrong once. So we had to put someone to sleep two times when one time might have served. Balance that against all the unnecessary operations I would have done, had I been more aggressive.
But the stakes are low in that scenario. Much tougher to know what to do when someone’s life is on the line and will continue to be on the line whether I opt for path A or path B. It could go either way, and the only way to know, truly, the right thing to do, is to have access to that damned crystal ball.
D.
Considering the problems I’ve hsf eiyh ‘pody-op’ csre, I’d push for both tonsils and adenoids gone, so I wouldn’t need to undergo risky after care again. Just as I will only undergo a pancreas transplant if I can do it at the same tume as the kidney.
sorry for the typos, your journal layout makes it difficult to catch. 🙁
Yah, blame Word Press 🙂
I don’t agree. It might make more sense if you knew that recovery from adenoidectomy is 1-3 days, while recovery from tonsillectomy and adenoidectomy can be more like 7-14 days, with a LOT more pain and a LOT more risk of post-op complications. Makes no sense to do it just because it might be necessary in the future.
IDK. One post op event would have either killed me or turned me into a vegetable had my mother not been there. Due to using the wrong blood sugar monitor, I was given three times too much insulin, and post op care only called for a follow up test 3 hours laster. Mom was up for all four of those hours doing bood sugars on me – I needed IV glucose every hour.
That’s the most dramatic incident, but I have had too many problems in post op to not seriously consider wanting to minimize my visits there.