Great Geigerisms 1.18

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            Memorable Mandy Moments/Great Geigerisms
                          Episode 1.18
                        Informed Consent

Geiger and Shutt are telling Ned and Sylvie Tannen about his condition:

ST:  I don't understand.  I thought is was his heart.
AS:  The CAT scan showed a lesion.  That's why we gave him the
     angiogram.  Mr. Tannen, you have a large aneurysm located at
     the base of your brain.
NT:  That's like, what a, like a bubble?
JG:  More like a balloon.  Pressure inside the artery forces a weak
     area to bulge out.
AS:  Under normal circumstances I would operate, but in your case,
     the size of the aneurysm and the risk of hemorrhaging are too great.
ST:  What?  What are you telling us?
AS:  You couldn't survive the procedure.
ST:  And if you don't operate?
AS:  Given the size and the location of the aneurysm, if it
     ruptures, the likelihood would be um... it will kill you.
ST:  Oh dear God!  Dr. Geiger, what about his heart?
JG:  This condition also means you're no longer a candidate for a
NT:  You said I couldn't live a year without a transplant.
JG:  I know.  But um...  donor hearts are hard to come by.  The transplant
     committee would never give one to a patient with an aneurysm.
NT:  So, between my head and my heart, I've got between five
     minutes and a year live?
AS:  That would be um... one way to put it.

Shutt walks in to Geiger's office:

AS:  Jeffrey!  Jeffrey!
JG:  [from behind the door, scaring AS]  What?
AS:  I can do it.  I can save him.
JG:  What are you talking about?
AS:  Mr. Tannen, page 143.  [hands JG a bound journal]
JG:  Suspended animation?
AS:  Yeah.  Problem is I would have to freeze him down to 68
     degrees.  Now with a weak heart like his, it would probably
     fibrillate.  Can we restart it?
JG:  Not a chance.
AS:  Maybe we could uh... get a donor heart with a promise of
     curing the aneurysm?
JG:  Curing him with this?  That's some promise.
AS:  I don't want to just let this guy die.  Now there's got to be
JG:  How... how aggressive to you want to be here?  [AS shrugs.]
     I could do a cardiomyoplasty.  Maybe strengthen his heart.
AS:  He'd never survive two anesthesias.
JG:  One anesthesia, one procedure.

Shutt and Geiger pitch it to the Tannens:

AS:  We operate simultaneously.
ST:  Wait, wait, wait.  You want to freeze his body?
AS:  Not frozen.  It's called hypothermia.  [AS explains.]
NT:  [to JG]  And you want to do what?
JG:  It's called a cardio-myo-plasty.  Basically I take a piece of
     muscle from your back and wrap it around your heart.  Now the
     muscle functions as a heart muscle and helps it pump.
NT:  [to AS]  So, you want to freeze me, and [to JG] you want to
     take a piece of muscle out of my back and wrap it around my heart?
JG and AS:
NT:  Have either of you ever done these operations before?
JG and AS:  [they look at each other]
AS:  But we can do it and it can save your life.

At the risk management meeting to discuss whether or not these procedures
should be done:  (RMM=Risk management member)

AS:  It's his only chance.  Removing an aneurysm of this size
     without the hypothermia would be impossible.
JG:  And the heart wrap is necessary to survive the neurosurgery.
     It's the only way to protect the heart after we stop it.
DG:  I think the concern here is, what if this isn't successful?
     I mean, we would look like voodoo witch doctors.
AS:  Oh, is that right?
DG:  It's borderline cryonics, Aaron.  Hypothermia, stopping
     cerebral blood flow, and this heart wrap.  You should at least
     train these muscles with a pacemaker.
JG:  There is not time to train.  This patient has a leaking,
     vascular aneurysm.
DG:  I understand that, but this is so radical.  It's so futile.
JG:  Are you saying you would never consider a futile experimental
     treatment if it were the patient's only hope?
     [Grad, remembering Mr. Ellis' treatment with malaria, is silenced.]
RMM: The problem is with these two procedures.  There's no escaping
     the publicity.  In success, we're miracle workers.  In
     failure, we become Frankenstein's castle.
AS:  So what?
RMM: So, we're already considered miracle workers.  We have nothing
     to gain here.
JG:  Well, here's an extremely radical thought-- Shouldn't the
     issue be what the patient has to gain?  [Silence.]
PW:  He consents?
AS:  Yes, he does.
RMM: Get it in writing.

After removing the muscle from Tannen's back and putting slush
ice on the heart:

JG:  Mr. Tannen is now in cardiac arrest people.  We're on a clock here.

Later, Shutt finds the aneurysm:

AS:  Got it.  Jeffrey, he's all yours.
JG:  Let's start rewarming him and wrap the heart.
     ... Get ready to come off bypass.  [JG tries two times to
     shock NT's heart with no results.]
     One more time...
CS:  This is gonna work.  [JG looks at her, then at AS.]
JG:  Clear... fire.  [NT's heart begins to beat.]
     Nice job.  [to AS smiling]  He's back.

In post-op recovery, Geiger and Shutt try to revive Tannen:

AS:  Ned.  Ned.
JG:  Can you move your fingers?  [no response]
     How about wiggling your toes?  [no response]
     Try.  [NT moves his toes.]
     That's it!  [JG smiles.]
AS:  How about your name?  Do you know your name?  [no response]
JG:  Should I give you a hint, Ned?  [NT's eyes widen.]
     Oh boy!  [JG smiles and shakes AS's hand.]

Geiger and Shutt run into Tannen's room where Camille is holding
Sylvia Tannen:

DN:  His pressure dropped like a stone.  Looks like he had a
     massive MI.  Time of death-- 5:35.
JG:  [Walks over to ST stunned.]  Mrs. Tannen.  I am so sorry.
     I'm so sorry.
ST:  Thank you.  I know you both did everything humanly possible.
     I will never forget, because of you, I know he died with hope.
     I will always be grateful.

Sitting in Shutt's office:

AS:  We killed him.  Diane Grad was right.  We said all the right
     things to Ned Tannen.  Explained all the risks.  But our tone,
     our body language, everything that oozed out of us, told him
     to go for it because we wanted to go for it.  Suspended
     animation, a wrap around heart flap.  We wanted him to say
     yes, Jeffrey.  He had maybe a year to live to be with his
     grandkids and we took that year.  I got to do a suspended
     animation procedure.  You did a heart flap.  We took that year.
     [Geiger sits in silence, tears in his eyes.]

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