Tangled Up in Blue

I was seeing a new patient the other day with regards to a hernia or a gallbladder or whatever and, during the interview, she related a history of having a "failed kidney" on the right side.

-Why did the kidney fail? I asked.
-When they were doing my hysterectomy, the "urether" got tangled up in some adhesions, she said.
-When was the hysterectomy?
-Oh lord, maybe 30 years ago.
-I see.
-They had to go back in and try to untangle it a few days later, but the kidney died anyway, she said.

Here's a translation: During her hysterectomy, the right ureter was injured and probably even tied off with a suture. She subsequently developed hydronephrosis and eventual right renal decompensation. The injury was probably not identified at the initial surgery because she returned to the OR a few days later for the "untangling". It's amazing what physicians could get away with back in the old days of paternalistic, ask no questions delivery of health care. Open disclosure, as more recent studies demonstrate, doesn't necessarily correlate with higher rates of litigation; moreover, it removes the unsavory taint of lies and distortion of the truth that can follow a patient around the rest of her life...