A Funny Thing Happened on the Way to the Morgue

[BloodNGuts]

Today in OR where I work a patient was brought in urgently from the ER in need of a bowel resection. After the patient was opened, she coded. After the necessary attempts to revive her the code was called. The weird thing is that the surgeon continued to do the bowel resection. Isn't this a criminal activity?? Due to the fact that the patient had been in the hospital less than 24 hours, she is automatically a coroner's case. Any organs taken from her body after the code was called would go to the pathology department not to the coroner. When the coroner receives the body he/she would assume that the code happened after the bowel resection occurred instead of before as it actually happened. If not down right criminal activity it seems to me that this was ethically wrong. Is there any valid reason why a surgeon would continue to perform any procedure, especially one where organs are removed (except for organ procurement, obviously) after a code is called?

[elcue]

Have never heard of such a thing in approx 23 years in OR! (and way too many intraoperative deaths) Very strange.

Please let us know if you learn more about this situation. Linda

[DutchgirlRN, ASN, RN]

Not funny ha ha, funny queer, as in very weird. I just can't comprehend why you would perform a resection on a corpse

Me neither, certainly is weird!

[BloodNGuts]

Will keep everyone posted as more info comes in

[DutchgirlRN, ASN, RN]

I'll be anxiously awaiting hearing what comes of this. Very interesting....Thanks for sharing. Don't forget now...You promised to come back and let us know!

[BloodNGuts]

I didn't forget. I have a few more details. I was not actually involved in this incident so the information is coming in an ongoing basis. The specimen that was removed as a part of this bowel resection was not sent to pathology, it was trashed. We NEVER trash bowel. I am seething because I just feel something is wrong with this picture. I took it upon myself to call the coroners office. I am waiting for a call now from an investigator. Will let you know what their opinion is.

[elcue]

re: "the specimen that was removed as a part of this bowel resection was not sent to pathology, it was trashed."

yikes!! that's just not right. if someone on our staff threw that out, she'd be in for a world of hurt. we have very specific rules about what must be sent to pathology, regardless whether the surgeon wants to send it or not. something seems very fishy here.

linda

[DutchgirlRN, ASN, RN]

I was not actually involved in this incident so the information is coming in an ongoing basis. I took it upon myself to call the coroners office. I am waiting for a call now from an investigator. Will let you know what their opinion is.

I truly understand your upset but since you were not actually involved in this incident how can you take it upon yourself to call the coroners office? Wouldn't they consider this second hand information? I don't think I'd stick my two cents in with the coroner. Leave it to those who were actually involved. I hope it does come back to hurt you in some way. Please be careful and let us know what the outcome is in regards to the surgeon. Very interesting story.

[BloodNGuts]

Actually, the investigator that I spoke with was very accommodating but unable to answer my question as to the legalities. Apparently when a patient has dead bowel they are not considered a coroner's case and the coroner did not have this patient. As to whether this came back to hurt me, I am fed up with the things that go on in my facility that no one reports. If I felt there was some criminal activity going on, even if I'm not directly involved, hell yes, I am going to report it.

With all of that being said, there is conflicting information now about the whole scenario. It appears that the bowel may have already been open so merely closing it would not have been the wrong thing to do. The scrub involved did not really want to talk about it and the circulator was just not sure but felt that something was wrong when the surgeon asked for a stapler after the code was called. I still seems that there was perhaps something not quite right about the situation but since I was not directly involved I have done all that I can do.

Just a side note, I am one nurse who has been burned so badly by a multitude of errors and poor judgment on the part of others in the OR that I am very actively seeking to leave direct patient care. The organization where I am employed presently and have 10 years of service has become too much of a liability and I can't take the mental stress anymore. I don't want to give up my benefits after 10 years of service so I am seeking a position, any position, out of direct patient care. It is unfortunate that it comes down to this and I am seeing nurses with way less years in leaving direct patient care sooner and sooner. Who is going to take care of us when we need it?? There won't be anyone left. Just pencil pushers.

[Jolie, BSN]

What does the surgeon's operative note say? Does he indicate that a tissue specimen was removed and discarded? If not, I would strongly suspect that he was trying to hide something.

I cannot fathom the OR staff willingly going along with discarding a tissue specimen in the trash. I can' help but think that in the hospital where I last worked, the staff would have fished that tissue out of the trash after the surgeon left the room and sent it to pathology.

His behavior is certainly questionable, as is that of the OR staff.

[EricG]

If you weren't in the room and not a part of the OR team, I would advise against conjuring up any conspiracy theories that could come back to affect you in some regard. It could be as simple as the surgeon didn't want to close the abdomen post-code with open bowel. It's obvious you haven't been given all the facts surrounding the situation. If something was inappropriate, surely the people actually in the room (circ, scrub or anes) would have felt the need to fill out an incident report or speak to their managers/supervisors.

What is the preliminary COD?

[medsurgnurse, RN]

Now that we have the rest of the story re: you were not in the room. Why ruin this doctor's career ( and life) based on hearsay? If those in the OR feel something is wrong let them report it.

[bifurcated]

No, the surgeon continued to work after the code was called. The patient began coding before the actual resection had occurred. That's why I'm so confused. Even for teaching purposes, it doesn't seem ethical to continue a procedure on a corpse.

Again........... no reason to do the bowel resection..... your obviously still bothered by this (as are a few of us;)) have you talked to anyone else about this? If not, you need to.