Abdominoplasty, Anorexia and Ethics

[Halinja]

I'm a little disappointed in one of our surgeons. Today he did abdominoplasty on a 110 lb anorexic. Not even a recovered anorexic, but someone still strongly in the grip of the disorder. The pt doesn't even want to eat a cracker with the oral pain meds.

It feels so wrong. The pt already has a hugely distorted body image. By doing the surgery he has played into the pt's delusion. Reinforced it, even. And on a different level...the pt apparently hasn't eaten for two weeks. The patient's body was just put under the tremendous stress of major surgery. How is the patient going to heal when the body has no fuel in reserve, and the patient won't take in any fuel?

Disappointed may be a little bit of an understatement...

[Halinja, BSN, RN]

Lord help me, I am not sure why I'm doing this post. I should just let it drop...

I don't remember her height now. In fact, the further I get from the case, the more patients in between, the fuzzier it gets. She was about my height, which would give her a BMI >18, possibly about 17.5 depending on how accurately I'm judging her height. Technically a anorexic can be diagnosed if their weight falls 25% below 'normal', otherwise it can still be concerning but just be an eating disorder. Her diagnosis was anorexia nervosa. Again, that was from the chart, not from me.

There are a few answers I have that I didn't necessarily share. (We start to get close to violating patient privacy) There are a lot of answers I just do not know. Did her psychiatrist know she was having the procedure? I don't know. Was the surgeon aware that she hadn't eaten in two weeks? I don't know. Was the patient and family being honest or investing a little drama into things when they said she hadn't eaten in two weeks? I don't know. Was the anesthesiologist fully aware of all facts in the case? I don't know.

I do want to bring up one little fact. I'm on allNURSES, where we often come to vent, to share a case that puzzles, to just complain occasionally to people who might actually know what I'm talking about. I don't recall saying the procedure was unsafe, just that it SEEMED wrong. TO ME. My personal feelings.

TiredMD: You said you genuinely wanted to know. Well....I doubt any of us will really know, unless the case reappears, which I genuinely hope it doesn't. I hope the patient is happy and healthy and lives a good life. I hope this surgery makes her feel better about herself. (I wonder what she's going to think of that whopping big scar?)

You made a statement about a few simple questions making us feel threatened. (a somewhat agressive statement in itself) I reviewed your posts and found two questions. The questions were "Are you the OR or clinic RN for this surgeon?" The other was "is she very tall?" I am an RN that provided direct patient care. That will have to suffice for the first question. The best i can answer you on the second is above, in the comment about BMI. The rest of your posts were not questions but statements...value judgments. I'm thinking it wasn't the questions that rankled, but the value judgment statements.

"I find it unlikely..."

"I find it more likely it is a post op nurse who made assumptions about a patient's background, rather than possessing real knowledge"

"I'm amazed you would take a story like this at face value."

" the story just doesn't add up in my head. "

"honestly, I'm still not buying..."

Do you really think a PACU nurse has no 'facts'? I would never accept care of a patient without a thorough report, a review of history that is relevant to patient care (which I believe A.N. would definitely qualify), and a thorough review of the chart. I would consider myself negligent if I skipped any of those.

Now...I'm a stranger, you don't know me, you don't know my attitudes towards fact or fiction. But on my side of things, I am pretty sure you were not at the facility, had no contact with the patient or relevant MD's, nor had access to her chart. You are entitled to your opinion, as am I. But one of us has more facts and less assumptions on their side of the equation.

Just curious. What is your main purpose for cruising and posting on a board that is for nurses?

[BBFRN, BSN, PhD]

(((Halinja))) I hope everything works out OK with the patient. thanks for the added details.

[Virgo_RN, BSN, RN]

I have seen open heart surgery performed on people of advanced age with many comorbidities. Granted, OHS is not cosmetic, but for some people who have it done, the likelihood of making it off the table and going on to live a meaningful life is very low. And yet, these surgeries do get signed off on by everyone in the chain. Just makes you go "Hmmmm".

My point is that while I agree with TiredMD that we should not take everything at face value, I can also vouch for the fact that questionable surgeries are not the rare bird that s/he seems to imply, even in reputable, award winning, not for profit facilities with strong ethics committee involvement.

I'd like to think that there was more to this case than meets the eye, and not make the assumption that the surgery was inappropriate and done out of greed, but my cynical side will not let me.

[Shenanigans, RN]

I'm aware of local doctors Rxing those weight loss drugs meant for the morbidly obese pt to those with anoxeria and other eating disorders where they binge, and even to pts who have no weight problems and a 20 minute walk 3x a week would help.