Yesterday’s author answered my questions through email and has given me permission to post his thoughts again.

The anesthesiologist suggested the epidural while I was in the pre-op room—when I got to the table I had to urinate so he had to wait until I was finished—while I urinated (I have prostate cancer so this is sort of a big deal) I said :”say—you guys know I have cancer in my back— don’t you?”—and then the room collectively said oops).

I have pieced things together since the event and it looks like the surgeon actually was thinking of epidural when I saw him in the office.
We talked about cancer and I told him I could not use succynylcholine and he asked me about Marcaine and I told him I had not heard of it—I guess he took that as a good thing because now I find out marcaine is an anesthetic used in spinals.

The MNP doesn’t get off the hook—when I went for the physical she asked repeatedly—in a sort of I can’t believe tone—”do you mean you have prostate cancer or metastatic cancer?”—I rattled off all I knew and I think she felt I was trumping her (maybe kind of like her dad does) and the conversation ground to a halt.

After I went to MNP, one week before surgery, I traveled to x-ray for chest film—I was really interested in knowing if meta had gotten to lungs yet so I asked the tech to ask the xray doc to look —the tech said no meta to lungs but the lateral view sure showed meta in back—which I knew anyway so I did not make note of it—-but why didn’t someone in OR look at it?

The surgeon is good-which means he is a huge money maker for the hospital so I doubt if he will take the fall—I am willing to bet that the person who did the history and physical (the MNP) will take the blame for the men in the operating room who failed to do their job.

I also think that Risk Management will run a little alogorithm and figure out that the chances of this happening again and actually ending up in a lawsuit are very slim—besides even if you kill a cancer patient the proximate cause of death will be mitigated by cancer so the money award will be lowered. Thus the risk manager will say to the CEO and Director of Nurses—we have bigger things to worry about–Doc In a Box is paying the bills and if we have to pay for his mistakes that is the cost of doing business. Welcome to the brave new world of mangled care.

—-End of submission—- My comments follow:
I have little idea as to how Risk Management works. It sounds as though the surgeon suggested a spinal even before the Xrays were done. He may have shared his thoughts with the anesthesiologist, who may have failed to check things out thoroughly at that point.

This is all speculation on my part, of course. Clearly someone dropped the ball, although I doubt it was the surgeon. The anesthesiologist went to med school too, and has just as much responsibility, if not more so, for providing safe and adequate anesthesia to the patient. This means either doing a thorough H&P or reading and verifying one done on his behalf.

In my experience, I’ve had quite a few patients go off to surgery. Sometimes the anesthesiologist comes the day before to check out the circumstances and meet the patient; sometimes they haven’t and I always wonder why they’d wait until the last minute to familiarize themselves with a patient’s situation.

Of course, for outpatient surgery, that’s more or less their only chance to meet the patient. But I would have hoped that they’d at least go over the patient’s H&P/chart.