It’s 0830 and I’m going to see Mrs Bailey, a lady who is on today’s orthopaedic surgery list and is due to have her knee replaced.
Throughout the clinical years of medical school, we are taught that you gather an awful lot of information about a person from just looking at them. It’s a skill that doctors develop throughout their training and it means that before you even speak to the patient, you can deduce a great deal about nearly all of their body systems, mental state etc… etc…
The thing that immediately strikes me about Mrs Bailey is that she’s fat. Not fat as in she has “love-handles,” not fat as is she has a “bubbly personality,” not even fat as in she has a “middle-aged spread.” I’m talking seriously obesity.
From my point of view as an anaesthetist, fat people are difficult because being obese make general anaesthesia far more difficult (and therefore more dangerous) in so many ways. Everything is trickier with obese people. From the little things like the fact it’s harder to find a vein to site a cannula and the blood pressure cuff often doesn’t fit around their arm to big things like they have a small functional residual capacity and desaturate in seconds and fat necks mean that airway obstruction is much more common and more severe. Off the top of my head I can think of at least a dozen ways in which it’s harder to give an anaesthetic to an obese person.
But, at the end of the day, Mrs Bailey needs her knee operation. She’s been waiting X number of months for it and I’m sure having chronically painful arthritic joints must make life a misery. I’ll have to do the best I can for her.
I walk up and speak to her and ascertain her medical and anaesthetic histories. I explain what an anaesthetic involves and let her know what to expect before and immediately after the operation. I always ask my patients if they have any questions or if there’s anything they’re unsure about or particulary worried about.
“There is one thing,” she says. “It’s about my weight.”
She looks down at the floor then brings her eyes up to meet mine once more. “I know I’m big… I know I’m too big.” At this point, she’s becoming visibly upset. “I’ve been trying to lose weight, I really have. I’ve lost three and a half stones in the last six months. I know I need to lose more but I want to ask you, doctor. Will my size affect the anaesthetic?”
And I’m caught. Should I be honest and tell the truth and probably upset her more just before major surgery? Should I lie to try and spare her feelings? If I decide to be truthful, how truthful should I be? Does she really want to know the details? Should I gloss over it and not acknowledge it as an issue? Should I ignore her question and try and change the subject?
If you were me, what would you say?