The team decides to delay the surgery and gather more information to ensure that Harry understands the implications of a decision to proceed or not to proceed with surgery. Harry is asked to explain his preferences and concerns in more detail.

Harry: “I know I’ve got cancer and I do want you to make me better, but I’m worried my heart might give out in the operation, and if it goes wrong I might never be able to walk again. There’s no way I want to spend the rest of my life in a nursing home.”

Neurosurgical Registrar: “It’s your decision. You have to look at the risks and benefits of having or not having the surgery. There are risks on both sides.

You’re getting a lot of pain now when you walk and do other things. Pain killers can help make you comfortable, but it would be difficult in this situation to be pain free on movement and mobilising using medicines alone.

But more importantly, if we don’t stabilise your fracture it could suddenly get much worse, and if it damages the nerves you could lose control of your legs, your bowels, and bladder.”

Harry: “I just wanna go home and do normal stuff, you know, play golf, have a drink at the club, and do a bit of gardening”

Neurosurgical Registrar: “Despite the risks with the surgery, I think the risks of not having it are greater. In my opinion, your chances of going home and doing the things you like are overall better if you have the surgery.”