When is a spade not a spadeBMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7178.256 (Published 23 January 1999) Cite this as: BMJ 1999;318:256
- P J Tomlin, retired anaesthetist, Downton
I was visiting professor of anaesthetics in a hospital outside Britain when I was asked to see an emergency admission with a severe haematemesis. The patient was elderly, wasted, disoriented, somewhat dehydrated, hypotensive, and tachycardic. He had a chronic gastric ulcer. He had been an inmate of the local mental hospital for the previous 20years. He was a Jehovah's Witness. His medical superintendent left the decision about blood transfusion to his wife who was on her way in. The surgeon would accept my decision about whether to operate or not.
I telephoned the chief administrator. He would not give permission but would consult the minister of health (it was that sort of country) as the state was legally responsible for the patient's welfare. Within 10minutes (it really was that sort of country), …