OSCE stations › Postponing cancer surgery because the last ICU bed is reserved

Full access · Communication · Ethical issues: DNR, capacity, surrogates, refusal · 12 min

Postponing cancer surgery because the last ICU bed is reserved

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Mrs. Elena Varga is a 71-year-old retired pharmacist, 64 kg, with a resectable pancreatic head cancer. She was scheduled for a pancreaticoduodenectomy (Whipple) this morning. Because she has heart failure with an ejection fraction of 35%, the team planned ICU care for her first night after surgery.

Overnight the ICU filled with critically ill emergency patients. One bed remains. Under the hospital's written surge policy, the ICU director has kept it for the next emergency, and all elective cases that need an ICU bed are postponed today. Her surgeon has booked her for Thursday, three days from now, with an ICU bed reserved, and judges that a delay of days does not change her cancer outcome.

Mrs. Varga and her son David are in the preoperative area. They have not been told.

Your task: explain the postponement and agree on a plan with them.