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Consent

Posted Mar 04 2013 10:26am


Before every test, procedure or surgery, your doctor makes you sign a waiver. They usually do this immediately before the procedure, when the IV is in and you’re a moment’s away from the actual test. The doctor tells you the risks involved in whatever you’re doing and then you sign your life away. In most cases, the risks are pretty minor. In an endoscopy for instance, there’s a rare chance of reflux disease, vomiting, or GI bleeding. I don’t know why they make you sign this so late in the process but it doesn’t matter, I always sign it without reading. If it brought the sedation quicker, I would sign my house away.

I don’t remember signing consent before my liver transplant and I don’t remember my doctor walking me through the complications. I’m sure they did make me sign my house away, though, just in case insurance decided not to pay. There are so many complications and so many risks involved in the transplant that I’m sure they presume you consent to everything that might happen. And even with a myriad of scans, images, and tests to help the surgeons out, they never know exactly what they will find until they open you up. I imagine at that point it’s too late to sign consent.

When my surgeon opened me up three years ago, he saw a severely sick and useless organ (you can view pictures here for those interested). Him and his team were monitoring my vitals, my medications, my breathing and everything else that I can’t even properly describe or imagine. The surgeon had to evaluate how best to get the organ out and put in the donor organ. And during this process, he chose to leave a single bile duct from the old liver to connect to the new donor liver. The surgeon evaluated that duct and thought it was good enough, even preferable to leave it in. And there are many benefits to doing this during the surgery. For one, it makes the surgery much less complicated for the surgeon. It also supposedly helps with recovery. And there is a ninety percent success rate with leaving that bile duct inside.

I think if the doctor woke me up during the surgery to ask for consent for this, I would’ve refused. For those brave enough to look at those pictures of my liver, I don’t think I could imagine saving anything from that hideous rock. More so, I know my luck and I would definitely fall into the ten percent of those that don’t do well with this type of surgery. And that’s exactly what happened. Over the past three years, my bile duct became sicker and sicker and eventually started to close. It’s not clear whether the bile duct still had PSC or if it just degenerated over time, but eventually it became so sick, we had to remove it anyway. 

I’m not mad at my surgeon or blame him in anyway. He made a decision three years ago that has caused countless complications and issues and leaves me where I am today, going through rejection and recovering from another liver surgery. He is an expert in his domain and made the best decision for the surgery, even if it wasn’t the best decision for me per se. I would still go to him for the transplant and he performed my most recent surgery also.

Sometimes the risks are so rare that you’re doctor hands you a consent form and you sign away. Sometimes the complications are so vast that they don’t show up for three years and still effect your life years after that. I’ve never feared going into a surgery because I knew what was happening and that it was needed. But the moment the surgery is finished; the fear kicks in and honestly, it’s still there today.
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