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By Joseph D. Stern, MD

My patient had arrived from another hospital in the middle of the night. He was a wiry older man, restless but alert. He had a blood clot compressing the dominant hemisphere of his brain. He did not speak or move the right side of his body but fidgeted with his left hand and leg: pulling at his IV; removing his oxygen tubing and the ECG contacts pasted to his chest.

He did not seem to understand what was happening and could neither assent to nor refuse the surgery I was recommending. Yet just hours earlier, he had been his normal self.

His wife, whom I later learned was developing dementia, accompanied him in the ambulance. She was frail, thin and appeared disheveled and confused. She knew little about his medications and medical problems and didn’t know if he was on blood thinners. Still, given his rapid decline over a few hours, I took him to surgery. The craniotomy went well and he seemed to recover smoothly.

…continue reading ‘Moral Distress in Neurosurgery’

Thumb image via article/ Kim Ryu

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New York Times

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