Patient Advocacy and An Ovarian Mass

Yes - I (Antra) am now the patient. In September of 2018, an ultra-sound of my pelvis revealed a mass/cyst (it’s both) the size of an orange in and around my left ovary. I was immediately referred to a GYN/ONC who basically told me that based on my symptoms, family history, and the ultrasound findings, the odds were 80% benign, 20% Ovarian Cancer.

This is where the rubber meets the road folks. I left my career as a surgery nurse in December 2017 to become an RN Patient Advocate, and I never saw this coming. Now I am the patient and let me tell you…I walked into that first appointment thinking I knew what I was doing…NOT SO MUCH. Thankfully, I had Ciera (my business partner and registered nurse patient advocate ) and my husband with me. While Ciera took notes and recorded the entire appointment, I sat there dumb-founded. I was astonished at my loss of all logical sense, especially when it came to the big C word - Cancer.

TIP: Always, always bring someone with you to take notes, ask relevant questions, and provide support. I promise you won’t hear or remember everything.

I left the appointment with dozens of questions that I should have asked, and I had pretty much made up my mind that I was going to have a total hysterectomy with removal of the left ovary, left fallopian tube, uterus, cervix, and right fallopian tube. The doctor would spare the right ovary as long as he didn’t find any cancer.

How did I feel? Scared, panicked, anxious, overwhelmed AND ok, positive, strong, calm. I guess a range of human emotions is what I felt.

What was I going to do? I was scheduled for (in my mind) a big procedure. Most of my lady parts were coming out and I was compelled to get going as quickly as possible. After I left the office, I thought to myself, “What happens after I have all these organs taken out? I mean how does this affect, say, my sex life? Is this the only option? What if I just had the ovary removed?” So many questions, all calling for my attention. I couldn’t even put them in a logical sequence. My head was spinning…

My epiphany two days later was, “Holy shit! I really don’t know what all my options are.”

TIP: Unless you face immediate/imminent death, do your best to explore all your options. Just because you have been presented with a treatment plan doesn’t mean it’s right for you.

I had twelve days to become truly informed and that is what I did...

WARNING: This may be TMI. If you are faint of heart - get over it. We are going to talk about vaginas, hysterectomies, ovarian cancer, treatment options, patient advocacy and I might throw in hemorrhoids, because lots of people have them and no one wants to talk about them.

Remember the TMI warning? It’s about to get real.

There were a lot of examinations, testing, and scanning.

All this testing began when I went to see my GYN doctor because I had this very clear, slightly pink vaginal discharge. Not normal, but I thought it had something to do with my Mirena IUD or that I was beginning menopause. My doctor did a vaginal exam, ran some tests like a CBC, CMP (if you don’t know what these basic tests are: a teacher of mine always says “Look it up”, so go look them up), and a pregnancy test. My uterus was slightly wonky (my words) on examination, and she felt an ultrasound was in order.

The ultrasound revealed a suspicious mass/cyst on my left ovary. Frankly, after delivering two babies and enduring annual exams my whole adult life, the vaginal exam was fine (I don’t love it, who does??), but the rectal exam is another story. I did survive it! My doctor could feel the cyst/mass there as well. I will say, while it may seem obvious that he would be doing this exam, I was surprised at things you don’t know until you experience them first hand and that exam really upset my hemorrhoids.

Another example: Anyone familiar with the cancer marker CA-125 blood test? Gynecology and Cancer, are not really my wheelhouse. I’d heard the term and vaguely knew what the test was for, but I had no idea what the results meant. I did some research. According to The Foundation for Women’s Cancer:

The CA-125 can help the clinician define the nature of the problem and it is used as a tool to follow the treatment of ovarian cancers. Normal (or thereabouts) is 35 units with most healthy women having values less than this. Above 35 units it is more likely that there is trouble brewing in the body. If 35 is the “normal” level, mine was 53.9. This is not a definitive test for cancer, but it can provide some helpful information when ovarian cancer is on the table as a possibility. I found it somewhat hopeful that my level wasn’t in the hundreds- this seems to be more predictive of cancer, but not always.

The CT scan was easy, the only thing is: why is it needed? What does a CT scan actually do and what does it tell you? What are the risks of being exposed to radiation during the scan? Why contrast during the scan? What is the contrast? Can you have an allergic reaction to the contrast? So many potential questions that might occur to you as you do your research!

Ultrasound: I cannot state clearly enough how important it is to do your best to understand what your tests mean. I thought my ultrasound was just fine, but when I called an organization dedicated to helping women with gynecological issues, I found out that perhaps my ultrasound was missing some information that could be predictive of ovarian cancer and could help drive the best course of action. Who reads the scan? What information is needed to help the doctor make the best care decisions (I mean we were talking about removal organs here)? I requested a new ultrasound and picked a radiologist specializing in women’s health to re-do the scan. Trust me- I had my first ultrasound report (for comparison), CT scan, and my list of questions regarding the missing information, in my hands, when I went in for this second scan.

TIP: Bring your pertinent medical records with you to any medical appointment. While I would like to think that our electronic health records would make it easy for healthcare providers to access our information at the time of an appointment, this is not usually the case. Have the hard copies, including any scans or imaging, in your hands just in case. This saves a lot of time and you will get more out of your appointment.

TIP: Know why you are having any tests done, understand the benefits and risks associated with them, and remember you have the right to consent or decline any test. You also have the right to ask for a repeat test if something seems amiss. Try your best to understand what the results mean. If you don’t understand, it is your right as a patient to ask until you do understand.

TIP: Be informed! This is absolutely necessary. How you go about it is up to you. Whether you get curious and ask a lot of questions of your healthcare provider until you feel satisfied or spend hours in the archives of a medical library or seek out a second option, do what occurs to you to do.

TIP: Most healthcare providers want to give the best care possible. I am not implying that doctors do not know what they are doing or do not want the best for their patients. Quite the contrary. I have felt so grateful to have the doctors I do on my side and I know that while they give me the best possible information as they understand it, it is still my right to question and go after more information, should I want it.

How did I feel? I didn’t sleep so well, but a very lovely friend told me sleeping was highly overrated, which I thought was brilliant. I can function and be tired at the same time. Who knew? Look, I was scared shitless. I melted down, I got busy, I got reflective, and I melted down some more. But I knew that whatever, ultimately, happened was totally out of my control. So I had a crash course in getting comfortable in the unknown.

A few days later the CT scan came back clean! No lesions, tumors, or enlarged lymph nodes were seen on the scan except the orange-sized mass on my left ovary, of course. Again, not a guarantee, but it was still really, really, good news.

So how does one become informed?

As an RN Patient Advocate, I work with a lot of clients. Sometimes they want me to help them find a retirement community or a rehab center for mom or dad. Sometimes they want me to be at all their medical appointments to take notes and ask questions. Sometimes they need someone to coordinate their care so all their healthcare providers are on the same page and some want me to help them figure out what their best treatment options are.

I learned a doozy on this one as I started to gather information to educate myself on the course of treatment and my options. Here are some tips.

TIP: What “Informed” looks like for each one of us is unique and individualized. This is so important. Go sit in the medical school library and read peer-reviewed journal articles until you are blue in the face or get very curious and ask your doctor a lot of questions or feel good knowing that your doctor has your best interest at heart and will take outstanding care of you. Hire a patient advocate to do the work for you (nice plug right? See how I snuck that in there?) Or, use your network of people and build yourself a team to help you figure out what it means to be informed. It does not matter how you go about becoming informed, as long as it is what feels right for you and at a bare minimum know why, what, how, who, benefits, risks, alternatives.

For me, it looked something like this: First and foremost I had to slow the urgency train down for two seconds. I have a friend who reminded me that my surgery was scheduled two weeks out - I had time. I did not need to have a decision right then and there. That was so helpful because I seemed to get some space and perspective from this slowdown. Of course, you might not want to slow the “urgency train” down in a true emergency.

Second: Researching and learning all about treatment options post-surgery (if it turned out to be cancer) could go on the back shelf. No need to even go down the “What if I have cancer, then what…. chemo, radiation, more surgery rabbit hole…” until I knew what I was dealing with. No need to knock on that door. This seemed to create even more space to think straight.

The bottom line? Ask for help and have a support system in place if you can. This is where my advocate was really helpful. Having her to lean on and to bounce thoughts off of was invaluable. The fact that she is a nurse is also very helpful because she speaks the medical language and understands what everything means. Not to mention the fact that she attended almost every appointment with me!

I called on my peeps who have access to medical libraries and had them find me the latest research using keywords like ovarian mass, borderline ovarian tumor, ovarian cancer, hysterectomy, and oophorectomy (go look that one up).

Find smart people to read the material and summarize it for you at a 5th-grade reading level. I am not kidding. I consider myself of average intelligence and, normally, I can read through a research article and get the basic points. However, when you are the patient it is not that easy. I found it very hard to be objective. Any bias I had towards articles I thought was in my favor, I kept while articles with opposing views went in the garbage. How is that for being informed? So, while I read a ton, I had to stop and put it in the hands of someone who could be more objective and make it easy to understand. Once you go into “analysis paralysis” all bets are off. Plus, I got a visual “Decision Tree” out of it!

Be wary of Dr. Google. Use credible sources. Remember CBC and CMP? I like www.mayoclinc.org for things like this. Pretty straightforward information from a reliable source. There are, of course, many other good sources out there in cyberspace along with some not so good sources.

Talk to people. I talked to my primary GYN/ONC doctor, a Radiologist who specializes in women’s health imaging, my naturopathic doctor, several other naturopathic doctors (in and out of state), a naturopathic oncologist, women who have had hysterectomies and even a foundation dedicated to helping women learn about hysterectomies and oophorectomies. Get a second opinion from a different doctor if you need to, there is nothing wrong with this at all.

Finally, if you love your doctor (and you will know by how you feel when you’re with him/her) then have a very honest discussion about what you would like to see happen. I have to tell you, I took my doctor’s recommendations very seriously because, at the end of the day, I would not be making a very informed decision without him. I just think that while it is, ultimately, my decision, I would prefer that we come to a decision together.

So, there you have it! For me, I felt like I did due diligence and the funny thing is, I still had no idea what I was going to do. Two days before my proposed surgery as I was putting on my underwear, it occurred to me what to do. At that moment, I just knew. It didn’t seem to have anything to do with how much research I did. I just knew that robotic surgery with a full hysterectomy (please save my remaining ovary if possible) was the thing I knew to do.

I did it. I went in for surgery not even remotely anxious, drifted off to sleep to Fleetwood Mac, woke up six hours later to find out I had some sort of ovarian cancer. I had extensive bruising (from my duke-it-out session with my team-mate The Robot). During recovery, I did not think much about the cancer diagnosis. Too many unknowns and why go there? I had other stuff to concentrate on. Mainly getting back to normal.

I guess the thing I most want to share is the emotional/mental side of my experience with ovarian cancer. Of course, there was the initial shock and disbelief, which is why I didn’t really hear a thing the doctor told me at my first appointment. Thank-goodness for my nurse advocate. Then it was “urgency” to get the tumor out ASAP even though I was booked for surgery three weeks out. I mean, I heard cancer and all I could think of was “I am going to die”. Once I got off the urgency train, I felt at a total loss about how to become informed about my proposed surgery so that I could make the best decision for me. I have been a surgery nurse my whole career, I knew very little about cancer. The overwhelm was intense and when that passed, I got busy. I felt really good on surgery day. I did not feel particularly scared and, I swear, it was because I made a very informed decision and had a strong intuitive feeling that I was making the best choice for me.

After surgery, I was told I did, indeed, have a rare ovarian cancer, but I did get to keep my right ovary and I wasn’t going to have to deal with surgical menopause on top of everything else. I was groggily happy about that. Two weeks of post-operative recovery did not seem to give me time to think about the pathology or staging. Good news there too, since my recovery was rough and painful. At my post-op follow up I had good news yet again because all the pathology reports came back negative and the tumor was caught in an early stage. The funny thing is, I didn’t really hear this good news until later because the only thing I seemed to focus on was my doctor’s recommendation for adjuvant chemotherapy. But even before he could get the word “chemotherapy” out, I said no. I said no because based on what he told me about the rare type of ovarian cancer I had, the recommendation for chemotherapy came from how they treat the 85% of epithelial ovarian cancers, not the 0.1% that was my cancer. It just did not make sense to me and I tell you my body knew it too. I could, literally, feel all the cells in my body do a happy dance when I said no to chemotherapy. This is not to say there is anything wrong with choosing conventional treatment or chemotherapy. It matters most what your inner wisdom tells you to do. That’s it.

So, say you are going to turn down conventional medicine’s treatment options. Then what?

What are some other options?

I grew up with a mother who rarely took me to a doctor. Instead, she would slather comfrey salve over every cut, bruise, belly ache, or any other ailment that popped up. She was a believer in that green, stinky salve and she used it a lot. As a child, I would get bronchitis quite often, and went to the doctor once: when I was blue and having trouble breathing. Bless her. She tried all sorts of herbal enemas, teas, or any other naturopathic treatment for bronchitis, but this one time I needed antibiotics and as a result, I grew up with a bit of skepticism for this kind of medicine.

Ironic that I became a surgery nurse! How conventional can you get? The thing is, there is a wide world of exciting therapies outside of conventional medicine.

For me, it made sense to find a naturopathic oncologist because I was interested and curious about some of these “outside of the box” treatment options. So how do you find an integrative practitioner who specializes in cancer?

As a nurse advocate, I help my clients find doctors all the time. I have a process to find a doctor best suited to meet the needs of my client. Typically, if I am doing a “blind” search because I did not get a reputable referral to start with, I look up:

1. Education

2. Board certifications

3. Professional organizations

4. Involvement in research

5. Publications

6. Sanctions and/or disciplinary actions filed

7. On-line reviews - I consider this when many people have taken the time to write a review, either good or bad.

This process of vetting a quality medical doctor is made fairly simple with the Internet. It’s not as easy with Naturopathic doctors.

Funny side note: I have found some outstanding physicians using these criteria and you would think I would use the same process I use for my clients on myself! Nope, that urgency train again. I found a medical doctor in California who looked great via her website. So, what did I do? I called the office and made a long-distance “telemedicine” consultation for a whopping $600.00 for 45 minutes without looking at any of the above-mentioned criteria. It was my husband who said I might want to practice what I preach. Oh yes, that’s right, I am not dying right this minute, I have some time. I came to find out that not only did this physician have scathing on-line reviews, but she also had a formal sanction filed against her, no formal training in oncology and she was fairly pricey. Lesson learned.

There is such a thing as a naturopathic oncologist. But first, what is a naturopathic doctor and how are they trained?

Naturopathic Medicine combines the wisdom of nature with the rigors of modern science. Naturopathic physicians are trained as primary care providers who diagnose, treat, and manage patients with acute and chronic conditions while addressing disease and dysfunction at the level of body, mind, and spirit. They look at the “why” of disease or root cause and treat their patients from a holistic perspective.

Naturopathic medical schools accredited by the Council on Naturopathic Medical Education and require four years of post-graduate in-person education. The first two years of naturopathic medical school mirror conventional medical school with courses like anatomy, biochemistry, histology, pharmacology, and pathology. In addition, naturopathic topics are covered including counseling, botanical medicine, physical medicine, nutrition, and homeopathy. The combination of naturopathic and conventional learning provides the most comprehensive holistic medical education. Graduation from an accredited school and successful completion of board exams culminate in licensing as a naturopathic doctor. In addition, some students choose to continue with their education with a two-year post-doctoral residency. All residencies emphasize clinical practice and also include opportunities for continuing medical education and naturopathic research.

And a naturopathic oncologist?

Naturopathic Doctors (NDs) trained in integrative cancer care can play an important role in the support of people diagnosed with cancer through recovery and remission. They provide evidence-informed guidance on the safe and effective use of natural and supportive therapies when combined with conventional treatment. Combining naturopathic and conventional medicine supports the best possible outcomes for patients. Goals are to improve quality of life, manage side effects, help with recovery, prevent a recurrence, and provide education for a healthy lifestyle.

Naturopathic physicians who meet standards established for advanced experience and knowledge in cancer care are eligible for board certification in Naturopathic Oncology (FABNO: Fellow of the American Board of Naturopathic Oncology). Qualifying doctors must pass stringent examinations that demonstrate competence in both naturopathic and conventional oncology. These naturopathic physicians meet the highest standard of the profession as specialists in naturopathic oncology.

You can see that these doctors have some rigorous schooling and stringent exams to pass to become qualified to practice naturopathic medicine/oncology. Finding one who meets these qualifications wasn’t easy. I had to dig around a bit and piece it together to get the full picture. What I found very helpful though is that most ND FABNO doctors (naturopathic oncologists) will give you a free 15-20 minute consultation. I loved this, as I was able to either chat with them on the phone or see them in person. This is something I have not had much luck with when finding a medical doctor. Free consultations don’t seem to be a thing in traditional medicine. In any case, I interviewed six naturopathic oncologists and found the right one for me, in my very last interview. How did I know? He had all the aforementioned qualifications, but more than that: this is key so remember it!

I just knew he was the right doctor for me. I walked into his office and I just knew. Do you know when you just know? Have you ever had the feeling that you just know something is true for you? It was that feeling. I just knew. I also (now) know, you can never go wrong when you follow that sense. And what’s more, this is also key, once I jumped off the urgency train of needing to be fixed or cured of any remaining cancer (so I wouldn’t die), I saw that all the FEAR I lived with on a daily basis was not only what probably gave me cancer, but was also the thing that slipped away when I saw that I never needed fixing to begin with. That no matter what happens, I will always be ok. This does not mean I will sit around and eat Cheetos all day or I will never feel fear again, but I was compelled to work with this ND to make my body/mind healthy and strong. The gift in all this, for me, is that healing comes from a very different place than any treatment, therapy, or doctor. It comes from knowing and even if cancer comes back, I will always be ok. Whoa, that’s deep.

Back to the actual cancer:

Initially, I was diagnosed with a Sertoli-Leydig ovarian tumor that was the size of an orange. This tumor has gotten a lot of attention in its rarity. Sertoli-Leydig ovarian tumors belong to a group of sex-cord stromal tumors and constitute less than 0.5% of ovarian neoplasms? Rare indeed. These neoplasms are characterized by the presence of testicular structures that can produce androgens. My neoplasm must not have been functionally active in the sense that I did not start growing a beard. Thankfully, right??? Although I would have fit right in here in Portland, Oregon. In addition, my husband and brother-in-law think it’s wildly funny that I had “testicular cancer”. Anyhow, I digress. This tumor made several pit-stops before it made its final destination at the University of Michigan. A very fine pathologist here in Portland saw it first. It then went to MD Anderson (a top-grade cancer center in Texas), some sort of cancer conference in New York and then to the University of Michigan through my uncle (who is an experimental pathologist) and the University of South Western Texas for additional pathologists with expertise in ovarian tumors to examine. I mean, isn’t that what you get excited about if you’re a pathologist with expertise in ovarian tumors? By the way, my tumor went to the University of South Western Texas because I did some research on the Internet to find experts in rare ovarian cancers and found a professor/researcher at this University, emailed her to see if she was interested in examining my rare tumor and got a resounding YES! It turns out that the diagnosis of Sertoli-Leydig changed slightly. Apparently, I have a female adnexal tumor of Wolffian origin (FATWO) with a Sertoli cell overlap. This means there are some Sertoli like cells, but the tumor is not a Sertoli-Leydig. This tumor is even rarer, 0.1% of all ovarian cancers! Sometimes malignant and sometimes benign and as far as I can tell, about 80 known cases in the literature. The good news with this tumor is that the recommendation is to “watch and wait”. I am relieved I opted out of chemotherapy when it was recommended. In fact, the little research there is on this tumor says that chemotherapy isn’t effective.

Why am I telling you all this?

TIP: Let’s go over why it’s important to know your body.

In retrospect, I ignored a few things that might have gotten me into seeing the doctor even earlier than I did. Not sure it would have made a difference, but that is not my point here. Hang in there. I have been on a diuretic for high blood pressure since 2012, this means I pee a lot. At the beginning of summer 2018, I started peeing more than I normally do, like I remember one day at the mall (of all places) I think I counted ten trips to the bathroom (my teenage daughter was so annoyed). It was just that some days were normal peeing (a lot) and other days seemed over the top (more than just a lot). Also, I was eating so healthy (I cut out everything except whole foods) and I didn’t lose one pound. Usually, I drop weight immediately when I cut out crap. My belly was a pooch, I was so bloated. The thing is I didn’t feel sick. I guess that is why ovarian cancer is so deadly. You don’t feel sick until you are really sick. So, trust your intuition, your inner wisdom, your sixth sense. I trusted enough to know that when the gynecological stuff started to happen, while I thought it might be menopause or my IUD, I didn’t just brush it off. I went to see the doctor.

Let’s review the signs of ovarian cancer:

First and foremost: Trust your gut - if you think something is not right, even if you feel fine, go see the doctor.

1. Abdominal pain (not me)

2. Persistent indigestion (not me)

3. Loss of appetite (not me)

4. Bloating that doesn’t go away (me)

5. Urinary frequency (me)

6. Feeling full all the time (not me)

7. Alternating diarrhea with constipation (not me)

8. Persistent lower back pain (not me)

9. Sudden weight loss (definitely not me)

10. Vaginal bleeding (you will have to read earlier posts to know if this was me or not)

Treating ovarian cancer in the early stages is a much better prospect than treating it when it is advanced. I am sure all my doctors would agree.

Today, I am close to the two-year mark of being NED - no evidence of disease. I am grateful every day for my health and I am also grateful for the journey I traveled as a patient. Getting the diagnosis of cancer was scary, heart-wrenching, and overwhelming, but I understand better why advocating for yourself or having an advocate at your side is imperative in our current medical system. Before cancer I knew that preventable medical errors cause a lot of very poor outcomes, but I did not understand how difficult it is to advocate on your own behalf when faced with a challenging diagnosis. This experience has taught me to better advocate for my clients and how to support the medical team so that patients do not suffer these poor outcomes. Patient advocacy decreases medical errors and is one solution in creating a healthcare system in which all people get the best care possible.

Are you Informed?

We are nurses. We have been nurses a combined 40 years, most of which has been spent

in the operating room. We are also patient advocates. All nurses are patient advocates. Whether you work in labor and delivery, the intensive care unit, in the community as a community health nurse, our job is to advocate for our patients. As nurses and advocates, we are always so surprised about how little people understand about what is happening to their bodies, what their health condition(s) are, and what they can do to heal themselves.

In the operating room, we are in the know- right? We get to see behind the “do not enter-

sterile area ahead” sign and understand the difference between, for example, a posterior total hip replacement and an anterior robotic total hip replacement. But what about the person deciding to undergo such a procedure? Which one to choose? Which has the best outcomes?

Which is less invasive? What are the risks of each procedure? What are the alternatives?

To illustrate, let’s take the commonly used form you sign right before you go to the

operating room for a procedure. A nurse walked into a patients room one day and introduced

herself and proceeded to “prep” her patient for surgery. One of the most important things we do in our interview and interaction with the patient is to confirm that the correct procedure is on the consent and reflective of what the patient says she/he is having done. On this particular occasion, the schedule told the nurse that this particular patient was going to have a total hysterectomy. The consent, however, said otherwise. It said a hysteroscopy. The two procedures sound similar, but they are vastly different. The former involves removal of (some or all) the uterus, cervix, both fallopian tubes, and both ovaries. The latter is a common procedure done to look inside the uterus to see what is causing the patient problems. You can see where the problem lies.

The conversation went something like this:

“Hello Mary (not her real name). My name is (fill in the blank) and I will be your surgery

nurse today. First things first, can you tell me what you are having done today?”

“I am having a hysterectomy,” she said.

“The consent says a hysteroscopy,” I tell her.

“Yeah- that’s right,” replied Mary.

“Well, this is actually a far different procedure than a hysterectomy,” I tell her.

The nurse goes on to explain the differences and Mary replies that she thought she was

having a hysterectomy, but she wasn’t exactly sure.

The story has a happy ending. The physician had another conversation with Mary about

the procedure, the risks, the benefits, the alternatives, and after all of Mary’s questions were

answered, the consent was corrected, and she had a successful hysterectomy. BUT... this is the problem.

Informed consent was put in place for a reason. It documents that the process of

communication between the physician and the patient took place. This means the patient

understands what procedure he/she is consenting to and what the benefits and risks are

associated with the procedure. Furthermore, informed consent also tells the medical team that the patient is informed, questions are answered and he/she is ready to proceed.

Why are we telling you this story? Because we want you to be informed about your health

and the care you receive in the system. Too many people suffer preventable harm simply

because they were not informed, or if they were, they did not understand and were too afraid to speak up. According to the Joint Commission (“Informed Consent: More than getting a

signature, 2016), communication issues are the most frequent root cause of serious adverse

events in the United States. The process of obtaining informed consent is an essential aspect of patient centered care and is central to patient safety. Since 2010, The Joint Commission’s database includes 44 reports of informed-consent related preventable harm events, including wrong-site surgery. While this type of injury is rare, it still occurs. Can you imagine waking up from surgery only to find you had been operated on the wrong side? Could this have been prevented prior to surgery if you had known to verify the consent, ask the relevant questions, and felt confident that your medical team was on the same page as you?

This is why you can see from the story of Mary, how things could have gone very wrong.

Be informed.

The Joint Commission, Division of Healthcare Improvement. Informed Consent: More than

getting a signature. Retrieved from https://www.jointcommission.org/assets/1/23/

Quick_Safety_Issue_Twenty-One_February_2016.pdf