Mr. M was a 60 year old Asian male who was diagnosed three months ago with cholangiocarcinoma- cancer of the gallbladder bile ducts. He was brought into surgery one week ago, because the CT scan suggested that it may be possible to remove the tumor. The surgery was proceeding fine until the surgeon attempted to remove the tumor from the inferior vena cava. At that point, a small hole opened in the IVC, and Mr. M began hemorrhaging. By the time the surgeon got control of the bleeding, Mr. M had lost almost 2 Liters of blood. The surgery could not be continued. He was brought to the ICU.
Three days later, our team was discussing whether or not to bring Mr. M back into the operating room. Our chief resident was adamantly against it- she thought he would die on the table. The attending surgeon was playing devil’s advocate, arguing for one side, then refuting his argument in the next breath. He was typically a decisive decision maker – but not this time.
He sat in silence for awhile, then said, “You know what it is? Mr. M doesn’t have insurance. He’s worked hard his whole life, raised a family, but has never been able to afford health insurance. And I never want to be accused of giving this man less treatment because he cannot afford to pay. And if it were my father, I wouldn’t do the surgery- it’s 50-50 that he dies on the table. But his family at least deserves the option.”
We talked to the family. The surgeon explained the issue, outlined the possible risks and benefits of surgery, and told them what his choice would be. In the end, they agreed- better to have 1-2 years with Mr. M than to risk losing him in the next few hours. It was the best outcome to a bad situation.