Gettysburg Medical News
The Clinical View
by P.E. Hoffsten, M.D.
30 January 2002

“DOCTOR, WHAT WOULD YOU DO IF THIS WERE YOUR FATHER?”

     It is 10:30 pm at night and we were just finishing the preparation for surgery to repair
a gentleman’s broken hip the following morning, the phone rang and it was his daughter calling from far away.  She had some questions about the anticipated care plan for her father.

       Her father was an elderly gentleman in his 90’s, who was living in the nursing facility where he required total care.  He was unable to bathe or cleanse himself.  He was unable to feed himself.  Because of osteoporotic disease, he was unable to walk, and was limited to a wheelchair for the last three years.  Somehow,  he had struggled to get out of bed and had fallen to the floor breaking his hip.  He had been brought to the hospital, evaluated and was being made ready to repair the fractured hip the following morning.  The daughter who was calling had visited him the previous month, at Christmas, but he did not recognize her and he was not able to converse with her.  He was in a substantial amount of pain and in spite of his dementia was still able to express himself making clear that he was in a great deal of pain and miserable because of it. The daughter’s first question was, “ Can my father stand the surgery?”  The obvious implication of her question was that her father would die as a result of surgery being performed. I asked the question in return whether she felt it was humane to allow him to finish his life with an unrepaired fractured hip.  A fractured hip is very painful and made more painful with any movement.  The person will remain in bed desperately trying to lie in one position to avoid movement and pain.  This soon results in malnutrition, terrible problems with bowel habits, a very high stress level from the continued pain and a mortality not soon enough.  I pointed out to her that not having the surgery would prolong his death but would not prolong his life.

       Her second question was, “Should he be transferred to another hospital to receive specialty care?”  From the fourth century, BC, the Oath of Hippocrates has provided a code for behavior of healthcare professionals.  Loosely translated, it states that a physician will follow that system of care most beneficial for the patient.  There are many considerations that go into the quality of a patient’s care.  Among these include the difficulty of travel, the knowledge that a local healthcare professional has of the patient’s wishes and characteristics, the technical capability of the surgical team, the care provided by the hospital staff, and the speed with which care can be delivered.  St. Mary’s Hospital in Pierre, SD, qualifies highly in all the above considerations.  Certainly there are other hospitals equally qualified and major referral hospitals with greater technical capability than we have in Pierre.  Open heart surgery, brain surgery, and kidney transplants are beyond the technical capability of our hospital but there are certain surgeries that are done every bit as well at St. Mary’s Hospital in Pierre as they are at any other major medical center.  One does not need to travel to a major referral center to have a hip repaired, a gallbladder removed, a hernia repaired, or surgery for an abdominal or  breast malignancy.  The orthopedic surgeon in Pierre, Dr. Steve Stout, does an outstanding job in dealing with fractured hips and the gentleman’s daughter was advised that the burden of travel, additional diagnostic workup at a new medical center and the inconvenience of distant care was not offset by any benefit that would come from a referral.

       Her last question was, “Doctor, what would you do if this was your father?”  I hear this question frequently.  I am not always sure what information is being sought.  One implication is that somehow I would treat my own father differently than I would treat hers implying that my father would get different and better care than hers.  Nothing could be further from the truth. Whatever I would advise for my own family, my colleagues, my dearest friends, is the exact same care that I would give to any patient that I ever cared for.  To behave in a different manner would be the grossest violation in the professional principals that govern a healthcare professional’s behavior.  Perhaps the lady was asking instead, what should be done.  She was already aware that we were planning to repair her father’s hip in the morning.  I answered her that the most humane and kindest act that could be done at this time was to repair the gentleman’s hip to provide him with what comfort as could be done under the circumstance. This is exactly what I would have done with my own father.

       The story is in the past now.  The gentleman did survive the surgery.  While he is still not coherent enough to recognize his daughter, he is able to answer questions regarding personal comfort and indicates that his hip is no longer painful.  He still requires total care, and has been returned to the nursing facility from which he came.  He still can’t recognize his daughter but she can recognize that his comfort was restored in the most compassionate and caring way possible.

       For future reference, it needs to be understood that a healthcare professional in Gettysburg and it’s excellent hospital, all the clinics of Rural Health Care, Inc. in Gettysburg, Murdo, Presho, Onida, and Highmore, the clinics and physicians in Pierre, and St, Mary’s Hospital in Pierre will provide the same high quality medical care to your loved one as they would to their own.  To do otherwise is the grossest violation of professional medical ethics.