Informed consent

Charles H. Halsted
Davis, California, USA

 

Autopsy at the Hôtel-Dieu (1876) by Henri Gervex

Outlined by the glimmer of eastern sun, the head nurse says: “One of your patients passed around four. His body has been sent to the hospital morgue.”  You are the intern, first up on the ward to see all the patients ahead of your team. After four years of schooling, six months on the job, you know what to do: preserve life, prevent death, unless it’s too late.

You must meet with his family, tell them the news, get autopsy consent to learn why he died. When you sit down in private with three grown orphaned children, you find they have no plan
what to do. His two daughters want him buried intact. The oldest, his son, says “So what if he’s gone?” His dad, a chronic alcoholic, was always drunk, seldom home.

About this time, your chief resident calls: there’s been a screw-up, the autopsy’s been done.
He tells you to keep this news to yourself; you must get the son to sign the post-hoc consent.

This after-death outcome is not in the Oath. “Abstain from wrong-doing and harm” applies to the sick, not the dead. Which is more harmful: telling them their Dad’s body’s cut up and now gone, or stating a potential truth so the son will sign the post-hoc consent form?

They argue, the daughters remorseful, the son angry, unsure of his role. You decide on a time-worn approach passed down from interns before. You acknowledge their loss, then calmly advise: “As an alcoholic, your Dad was more likely to have had TB. It could have infected you all. Only an autopsy can tell.”  Your advice permeates the room like stealthy fog. Finally, dead silence is broken when the son stands up, grabs the form from your hand, signs.

 


 

CHARLES H. HALSTED, MD, is a retired Professor Emeritus of internal medicine. His education includes BA Stanford University (1958), medical school at the University of Rochester School of Medicine (1962), internship and residency at Cleveland Metropolitan General Hospital (1962-66), and gastroenterology fellowship at Johns Hopkins Hospital (1968-70). He taught and practiced at the University of California Davis from 1974 until his retirement in 2016.  His formal poetry education consists of eight consecutive on-line courses from the Stanford Continuing Studies program. His published medical poetry appears in Blood and Thunder, Chest, Medical Literary Messenger, Sisyphus, Snapdragon, and Hektoen International.

 

Summer 2018  |  Hektorama  |  Education