Botched surgery not cut-and-paste issue

Question: “A friend of mine underwent a botched intestinal operation, which has left her an emotional ruin. She seems to have resigned to fate and would not seek legal redress nor psychological counselling. How do we help her out of this torturous condition?”

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You have given us scant information about your friend to enable us to give an informed opinion on the next steps. What, for example, does a botched operation mean to you?

Is it the same thing as a surgeon would call it or is there a difference in opinion on the matter between the surgeon and you, friends and members of the family?

It might, for example, be that your friend came to the surgeon with advanced disease of the gut and that when the surgeon entered the abdomen, it was found that vital or organs such as the aorta had been invaded by the disease to the extent that it was not possible to proceed with the operation and the whole procedure had to be abandoned. This type of situation is not uncommon but leads lay people to conclude that the surgeon had failed or as in your case, botched up the operation.

On the other hand, it is possible that a new complication arose during surgery that made it impossible to proceed further with the operation. To give an extreme example, the patient might have suffered a heart attack during surgery making the whole process too complicated to proceed with.

In both examples, the information given, or not given to you as a friend, as opposed to next of kin, might be inadequate for you to hold an opinion on what steps to take next and indeed whether to proceed with counselling or even litigation in the case of your pal.

You do in your question raise the important question of what leads to medical litigation in some cases and not in others. Many patients sue for lack of accurate information from the treating doctors.

It is a frequent finding that many doctors find themselves sued by their patients not because they are bad doctors or did anything wrong, but because they failed to communicate with their patients and their families.

A doctor who is too busy to explain to his patient and the family that this or that is to be expected during and or after surgery is more likely to be sued than one who explains truthfully some of the benefits and limitations of the surgical and or medical procedure.

Time and again we come across instances where the doctor is sued because he did not tell the truth about his qualification, experience, or even complexity of the case and when things go wrong, he tries to cover up with lies.

Gone are the days when doctors behaved as though they were demigods and their patients a bunch of fools waiting to drink from the fountain of wisdom of the doctor. Patients have the right to know and to be always treated with respect. Access to accurate information on their condition is the right of all patients.

Truth and trust are at the core of the relationship between the patient and his doctor. The next, rather simpler question you ask relates to the need for counselling or otherwise.

This is a matter to be discussed between the patient and his doctor and must involve the family and other caregivers. It is also a matter that could be discussed against the facts and the nature of the surgery that was done. If, for example, what you called botched was a surgery that involved advanced cancer, the type of care required would have to include considerations on the possible outcome of the disease process, which could include imminent death.

Many relatives go into states of anticipatory grief where they begin to mourn their loved ones even before death. Expert counselling may be helpful in such situations.

Another fact worth considering is that of the mental state of the patient who underwent the operation. Depression is a common condition that affects 20 percent of all.

Any type of trauma, including the trauma of what you call a botched operation increases the chance that your friend (or any other subject of surgery) has developed a depressive or other mental disorder that could benefit from evaluation by a psychiatrist.

Some of the symptoms of such a condition could include what you describe as resignation to her fate and a lack of interest in her welfare, be it litigation or counselling.

Only careful evaluation by a doctor will help you decide which is which. As you can see, the matter of the relationship between the doctor and his patients is complex and demands careful consultation before litigation, or even deciding on the type of therapy.

Dr Frank Njenga is a psychiatrist and mental health consultant. [email protected]