here is Dr.H's response to the surgeon in philly's ideas

October 20, 2005

Shlasko put in the Broviac that fell out so I am hesitant. Vanoker is the

surgeon that left her NPO in the hospital with tenuous IV access and never

came to see her. He did not make a decision as to what he would do with her

until I called and harassed him in the OR from Hawaii. Neither Dr. Chen nor

Dr.

Suarez is capable of calling the shots related to the glucose-insulin

management necessary for transitioning her from TPN to the OR, the OR back to

TPN

and TPN to J-feeding. Kathy Chen is a good doctor and should not be put in the

medical legal position he would be putting her in. Dr. Suarez freely

admitted that Madison was beyond her ability to manage.

Thinking about it, it makes sense NOT to do all the procedures together

because of the very prolonged anesthesia time and the issue of clean vs dirty

surgery especially with the inject-a-port in place. Kathy made her feelings

very

clear when she indicated that the surgery should be done in NY. Her last

statement was â€˜She would be on the Surgical serviceâ€™. To me that meant

that

Kathy could not assure us that what was requested by any one of us would be

honored.

Think about this. Lets say that the first day she was in the hospital she

had been on the surgical service and she had had a problem with her BS. You

will remember that no one could get a surgeon to answer pages or questions.

None of the pediatrics housestaff could have ordered anything for her with out

a surgeonâ€™s ok. Vanoker did not understand the uniqueness of her metabolic

situation from me and I am sure will simply NOT be responsive enough to Kathy

Chen either.

I agree that it would be easier if you were at home and/or if I were at

Cornell, but the most important thing is that the attending of record will

listen

to me. Dr. Spigland and Dr. Greenwald in the ICU at Cornell will do that.

The long surgery will be the second surgery. I would rather have her blood

sugar dynamics stabilized before having her under anesthesia for >4 hr.

Recommended Posts