My worst nightmare is a catastrophic infection after minor surgery.
At no time did the doctors say "we can keeping cutting it away, but who wants to wake up like that?" After the second surgery, was there even a remote chance he'd survive?
I truly can’t imagine what that man and his family went through in that short period of time. Decision making I slow decline with weeks or months is hard enough.
If the intervention is unequivocally futile for preserving life it is permitted to not offer care, there are processes in place.
While unlikely, it is possible to survive necrotizing fasciitis and multiple debridements. Although it will come with many months of reconstructions, rehabilitation and pain.
We are legally and ethically obligated to offer heroic life saving measures if there is a chance of surviving. Quality of life is not a factor in our decision making process.
I do not know the exact discussion was had with this patient and their decision maker when incapacitated but it would be extremely unusual for a previously healthy 32 year old to decline heroic interventions, this is also a very rapidly evolving infection where you don’t have much time to think.
With that said I’ve also met 80+ year olds who want major surgeries that will leave them significantly impaired and almost certainly fail despite having time to think. At the end of the day patient autonomy supersedes our thoughts and opinions.
> If the intervention is unequivocally futile for preserving life it is permitted to not offer care, there are processes in place.
I want it to be clear that patients are not abandoned in these cases. Even in cases of serious incurable illnesses where death is imminent and cannot be prevented, there's plenty of things that can be done to provide comfort, manage symptoms and improve quality of life. Orthothanasia.
As an example this is typically something like not offering CPR when death is imminent for another reason.
I had a surgery last January, broken labrum on both hips, left was "ok" and the right was really damaged, still it was an arthroscopic surgery and I could go on with my life 2 weeks after, but... 3 weeks after the surgery my right hip was getting worse, way worse, the pain was like nothing I have ever felt, I couldn't sleep, I couldn't walk, I couldn't even touch my fucking leg that I felt a nuclear bomb going off inside of it. No fever, puncture was ok, nothing that could deemed it as an infection. I was in literal agony, not even the strongest analgesics worked. I did a blood test and the PCR was off the charts, "yup, that's an infection, it's 10 AM, don't eat anything, today at 17hs you go in surgery".
I had a toilette done, infection was cleaned off but still I couldn't even move my leg, I lost all the muscle. Fast forward today, I had the worst 7 months of my life, antibiotics for 6 months but wait, there's more... Both infection and the initial cartilage problem evolved into a septic arthritis, last week I went into surgery again to have my hip replaced by a temporary spacer while the biopsy is performed and I will go in again in a month or so to get my definitive prosthesis.
For those who want to know, the bacteria was a Pseudomona.
So yeah, don't fuck with infections.
I did find places like HN and other outlets really helpful, little bit sized opportunities to nerd out and connect, that were just small enough that I could keep focus during the worst of things.
Good luck.
I’ve broken my olecranon (the pointy bit of your elbow) and declined surgery. I set it myself. Glad I did. It hurt. It wasn’t pleasant. But to me the risk of infection from being opened up for something so minor was too much of a risk. If I had internal bleeding or something I would have gone for it but a simple broken bone (even a joint) isn’t enough for me.
Yes some people get infections after surgery. Most do not.
The COVID vaccine killed some people. Most were fine.
Don't make your medical decisions based on anecdotes.
A decade later I can’t do an elbow plank without some pain usually and I can’t put a lot of weight on that part of my elbow. My favorite laptop position is on my belly on the floor so it sometimes hurts too much to do that.
I don’t know if surgery would have helped but it’s annoying sometimes.
IANAD but I know my own body, I know when something is wrong, when something isn't working right, and sometimes kicking your body's a$@ is what it needs. Like doing a purge. Or fasting to shock the system.
Pain reduction isn’t the main reason to operate or the metric of interest, there are many ways to alleviate acute pain including casting.
Functional impairment (immediate and delayed) and reducing the risks of posttraumatic arthritis are far more important.
Joint infections (and pseudomonas in general) are an absolute nightmare as the joint space is not vascular.
Bone infections/osteomyelitis are much rarer and for the most part less catastrophic (although they certainly still can be).
As always patient autonomy is paramount and we all value risks differently. For myself as a young healthy adult (not an orthopaedic surgeon) I would rather accept the minimal risks of surgical reduction and fixation for a fracture needing one than risk needing complex reconstruction or joint replacement in 10-20 years which has much higher complication rates and longer recovery.
there will be a point where the risk of infection is far outweighed by the reward of surgery.
Short answer: What? No, no way.
Long answer: It depends, If you can avoid being opened sure, avoid it like the plague, I've learned that the hard way that no matter how much sterilization is done, bacteria is there, and if your body is cut there's a chance bacteria could get in, but there are cases when you have no other road, like my case. Last December I couldn't walk a single complete street, the labrum was damaged to the point that the only solution was an arthroscopy, there was no option for me to say no. My surgeon told me "patients get infected, shit happens", but on top of that I got extremely unlucky, I got the worst fucking bacteria in the universe, I had no fever and the needle that was inserted in my hip to test for bacterial growth yielded negative results.
Pseudomonas infections are rare in healthy patients and few antibiotics work.
how can you have a bacterial infection in your hip that doesn’t make it to the rest of your body?
Fucking Pseudomonas.
Wife had appendicitis, or what looks like it. She had given birth a few months before and it didn't really go well. She had to have emergency surgery, and was pretty close to snuffing it.
Anyway, that healed, but she had some persistent pain, but that could just be scar tissue being a dick.
fast forward a few months, she has text book appendicitis symptoms. Now, as she's a doctor, she knows what it is, I know what it is, but she refuses to actually go into hospital. I drag her arse to the GP, who looks at me and says: "why haven't you taken her to A&E" I told the GP, that the patient knows too fucking much and won't listen to a muggle.
The GP turns to my wife and says: "you and I both know you need to go to hospital"
She goes in for assessment. Cant see much on the ultrasound. Go for a slice and dice to section the appendix.
Puss drained, appendix Yeeted, lots of IV antibiotics. Looks like a rampant infection rather than a swollen appendix.
Important note: men, topology wise, you are a doughnut. There is a tube from face to arse, and everything is mostly sealed(lungs are excluded for simplicity).
Women, are not doughnuts, There is a gap between the ovaries and the fallopian tubes, which from what I recall is only really sealed with "mucus".
This means that bacteria can get in from the outside. The hypothesis is that either when my wife was being professionally fisted by the midwives, or when she was being crash sewn up to stop her bleeding to death after the baby was born, is when Pseudomonas got in.
Thus, in conclusion, Pseudomonas can get to fuck.
It genuinely touches my heart that even on HN there is concern for strangers.
I'm wondering if this was pseudomonas aeruginosa.
My cousin, an experienced surgeon, told me it'd be a quick operation and I'd probably be home in a few days. I spent over 40 days in the hospital due to a severe infection that ate through my abdominal wall and almost reached my skin. One week I was taking seven intravenous antibiotics at once. There was a moment where I became convinced I was going to die.
Especially I think most 'nasty' infections are actually caught in hospitals.
I'll spare you exact details, but each sample put under microscope had clearly visible bacteria.
It looks like any infection could spread around the body and it handles it well. By well I mean three days of fever got rid of it