Our patient was never going to wake up. He had an unrecoverable brain injury. The prognosis had become clear over time. As the patient’s attending physician in the intensive care unit, I arranged a meeting with his sister, the only visitor we’d seen for days, and explained. She was resolute. “He’ll wake up,” she said. “He’s a fighter. Do everything you can to keep him alive.”

The next day I told the social worker what the patient’s sister had said. “What about the wife?” the social worker asked.

That was the first I’d heard of a wife. A spouse is the official next of kin. No decision should ever be made without the spouse. But I hadn’t known she existed. I discovered that she visited the patient after her work shift, usually at 8 p.m. By that hour, our team was gone. The doctors on night duty were on for emergencies, not conversation. And so she was invisible to us.

How could we have missed this most basic and vital piece of information? It’s easier than you might think. The sister didn’t get along with the wife and apparently wasn’t moved to tell us of her existence. The social worker had been out sick, and his replacement assumed that we knew. And we had a concerned sibling at the bedside who fulfilled our mental checkbox for who makes an acceptable surrogate decision-maker.

We hastily called a meeting with the wife. She arranged to leave work early, and she met us in our conference room. Feeling a combination of shame and relief at the averted disaster, we apologized for not being in touch. We didn’t mention that we hadn’t even known about her. (…) Read Full Article Here

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