when expectations don’t meet

spending a week in neurosurgery has taught me a couple of things. first, it is very important to wear your helmet or seat belt. secondly, always, ALWAYS take blood pressure control seriously.

finally, i learned that the expectations of patients and their families are very different from doctors’ expectations.

as you would have probably guessed, the majority of patients in the neurosurgical unit either suffered a stroke or were involved in a motorvehicle accident. most of the time they don’t return to their premorbid state. an elderly man who used to ride the motorcycle to the coffee shop to meet his friends in the morning is left bed-bound. the woman whose 2 brothers died of heart disease in their 40s will no longer be able to plait her daughters’ hair.

to the families of those patients, simply getting their loved ones stabilised – off oxygen and drugs that maintain blood pressure, started on feeding through a nasogastric tube – does not constitute recovery. in neurosurgical terms, all they need is nursing care and that means they’re ready to be discharged home.

yesterday, the son of one of my patients waited for me for several hours just so he could ask about his mother’s prognosis. she had a stroke about a month ago and while the surgery to evacuate the clot went successfully, she was bed-ridden and dependent on ryles tube feeding on discharge. he wanted to know why she was discharged eventhough she was unable to walk or care for herself. how can that possibly mean she’s recovered enough to be discharged?

i had a very hard time explaining that what doctors consider as a satisfactory outcome may not meet his expectations. he wanted his mother back the way she was before the stroke. it wasn’t going to happen. her condition might improve a little, but she isn’t likely to walk again, or be able to speak well once more. we discharged her in the condition we felt was the best we could help her achieve, regardless whether that condition was what her family expected or not.

he wasn’t the first. over the last week i’ve had countless family members come up to me and ask what the chances were that their mother, brother, son would walk again. would speak again. would eat, laugh again. i could never tell them. the truth is, even the consultants probably don’t know. to say otherwise would be a lie. i can’t even tell them if their loved ones’ condition will improve.

it was a very tiring week and i am physically exhausted from looking after a large number of patients with heavy needs even if i did share the load with 2 trustworthy colleagues. but more than anything i am emotionally exhausted from having to face my patients’ families, to not be able to tell them when their relatives will recover, to say that i cannot be sure if they’ll ever be the way they used to be.

medicine is so hard.