4:30 and the day is going almost too well.
Until I hear a scream coming from a patient room.
"You amputated our mother's LEG?"
"Well, not me, personally. But, yes, your mother needed emergency surgery. It's unfortunate, but, I promise you, without that surgery, your mother would not be able to survive. The infection was too profound. ... But I was under the impression you knew about the surgery."
"You think I would have gone to work today if I knew about this surgery? I would have been right here, with my mother! I did not know a thing about this surgery!"
"I was told we had consent..."
"Not from me, you didn't."
"Hey, med student, the patient with the leg amputation-- you informed the family and got consent, right?"
"Oh, I got consent, absolutely. But I forgot to call the family. Is that okay?"
"Not really, but first-- who did you get consent from?"
"The patient. Obviously, right?"
"The patient-- who has at least some level of dementia?"
"No, no, she totally understood what I was saying. I explained everything, answered any questions, and she signed the papers. I thought she totally knew what happening."
"Did she ask any questions?"
"And she signed the paper, with her name?"
"Well, it was sort of a squiggle, but it looked like her name, yeah. I just thought that was her signature."
"And you didn't call the family?"
"We were rushing her into surgery-- I barely had time to talk to her before transport came-- and I had three other patients to write notes on-- I was going to call them later."
"They missed the surgery. It went well, but-- you have to call the family if the patient is having surgery! What do I tell this woman's daughter?"
"But they had to do the surgery no matter what-- it was an emergency."
"I know. But how would you feel if it were your mother?"
"I don't know."
"Okay, I'm going to talk to the family. Even when families are difficult, we really want them on our team, and we really want to take pains to keep them in the loop when someone is having surgery."