legends · 4 min read ·
Consent Form
A consent form lists an unusual risk, and the surgeon sees a second set of instruments on the monitor.
**Northgate General Hospital — Consent to Surgical Procedure**
**Procedure:** Laparoscopic cholecystectomy
**Patient:** Anna Moreau · **DOB:** 04/02/1979
**Surgeon:** Mr. J. Tennant
*Please read this form carefully before signing. You may ask questions at any time before the procedure.*
**Known risks:** bleeding, infection, injury to adjacent organs, bile leak, anaesthetic reaction, and, rarely, conversion to open surgery.
**Less common risks, listed for your information:** persistent sensation of presence in the operating theatre after discharge; unexplained counting of sounds; the patient may hear their own name spoken by a voice they do not recognise.
*Patient initials:* AM
· · ·
The form had been handed to me by a nurse I didn't know, in a corridor on the second floor, with a clipboard and a biro that had chewed marks at the end. I had been waiting two hours. My gallbladder had been giving me trouble for a year, and the consult had gone smoothly, and I had thought nothing of the form until I read the last paragraph.
I asked the nurse what the less common risks meant.
"They're standard," she said. "Some patients get a bit of a fright under anaesthetic. It's all in the leaflet."
I looked at the leaflet. It did not contain the paragraph.
"Can I speak to Mr. Tennant?"
"He's in theatre," said the nurse. "He'll see you after. Please sign where it says."
I signed. I initialled the last paragraph, because it was the only one I had questions about, and I wanted to be able to say later that I had read it.
· · ·
**Handwritten amendment, added in blue ink, initialled AM**
*Patient asks to be told if the sensation of counting continues after discharge. Patient should not count back from ten in theatre.*
· · ·
**Nurse's note, 06:52, Pre-operative Ward 2B**
Patient awake and calm. Asked me to confirm the counting was not part of the procedure. I said it wasn't. She said she could hear it in the room, very quietly, and that it was counting the staff. Anaesthetist confirmed the patient was not receiving any counting protocol. Patient asked for her consent form to be reviewed again. Form is with the surgeon.
· · ·
I went under at 07:40. The last thing I remember is the cold of the operating table through the thin gown, and a voice above me, which was the anaesthetist's, saying quite clearly, *Ten. Nine.*
I did not count back. I wanted to. I could hear the numbers coming down like a lift, and I knew that if I joined in, I would be let down at the right floor.
I didn't join in. The numbers stopped at six.
· · ·
**Operation notes (Mr. J. Tennant, dictated 09:15)**
Laparoscopic approach. Port placement uneventful. Gallbladder inflamed, adherent to the duodenum. Dissection proceeding.
At 08:22 the theatre monitor showed a second set of instruments on the screen that were not in the room. They were moving on the far side of the abdominal cavity, very carefully, lifting the peritoneum away from the liver at exactly the points I was about to cut.
I stopped. I told the team to stop. The anaesthetist said the patient's heart rate had dropped to 40, then risen to 110 in under a second, and the counting had started again.
Nobody in the room said anything for a time. The second instrument on the monitor completed its movement, placed its tip against the duodenal wall, and held it there. Then it withdrew.
I finished the procedure. The gallbladder came away cleanly. The duodenal wall was intact. The second instrument was gone from the screen. I have never seen it before and I hope not to see it again.
· · ·
**Discharge summary (Northgate General, 2 days post-op)**
Patient recovering well. Wound clean. Patient reports the counting has stopped.
Patient asked us to note that she has been hearing her own name in the ward at night, in a voice she thinks is the anaesthetist's. She says the voice is not asking her anything. It is counting her in, one number at a time, from the bottom of a long stair.
Patient asked to see her consent form again before discharge. We have returned it to her. The paragraph about counting has been initialled once more, in blue ink, in a hand that is not hers.
*Patient should not count back from ten. Patient is reminded that the procedure was successful, and that the counting was never part of it.*
· · ·
Anna Moreau's discharge letter has been sent to her GP. The form was filed in her notes.
Yesterday she rang the ward to ask whether anyone had checked the operating theatre's monitor. The nurse who took the call wrote down what she said, and then wrote the time, and then wrote, underneath it, the number she had reached counting the staff at the desk.
*Eleven.*