Saturday, June 23, 2007

Mistakes, Mistakes, Mistakes

We expect a lot from our health care providers. Perfection, in fact. They are never allowed to make mistakes and if they do, we sue them for all we can get. We hold them to extremely high and sometimes paradoxical standards. For example, I want my surgeon to have a soft bed side manner but equally, I want him to exude the kind of confidence that would never make me doubt his competence. More so, I want him to be equipped with an ego that would not allow him to ever doubt his own competence. For one individual to possess the proper inner balance that would be required for both gentleness and a very high opinion of oneself…well, that would be a very unique individual indeed.

In short, patients and families often expect the impossible. There is nowhere to go from there except to anger and disappointment. The truth is, mistakes will happen in medical settings. Doctors are only humans, right?

There is a fine line between an honest mistake and unacceptable negligence. It is important to define these two for yourself. When a mistake is made, you have a choice on how you would like to handle it.

Example 1:

During one of my hospital stays, I was dreaming about water. I was all wet and couldn’t seem to dry off. Something wasn’t right and I eventually pulled myself from the dream into consciousness. Looking down, I could see something shimmering against the dull light from the hallway. I touched my chest and it was cold and sticky. I turned on the bedside lamp to discover my clothes were completely soaked in blood. Panicking, I buzzed my nurse. By the time she arrived, I had already figured out the problem. My nurse had come in while I was asleep to draw blood out of my Port-a-Cath and failed to properly clamp it off. The line to one of the main arteries in my body had been left open and I was drenched in my own blood.

Amazingly, this didn’t seem to have any negative consequences. Perhaps this is why I had no problem forgiving her. After all, it made a great story!

Example 2:

I had been waiting for lungs 5 years when I got a page at 4:00 on a Tuesday afternoon. They had lungs for me. My family and I rushed to the ER to begin a many-staged process leading up to the operating room. Eventually, we learned that the surgery was “a go” and we celebrated the arrival of my new lungs.

When I woke up, nothing was as I had been taught it would be. I was still in the holding area outside of the OR, not ICU. I was not intubated. I had an oxygen mask covering my face and I could barely breathe.

When the nurse saw that I was stirring, she turned on her heals and fetched my surgeon. He sat next to my head and spoke in a quiet, humble tone that I had never heard him use. He explained that I did not get my lung transplant. While I was under anesthesia, one team was working on me and preparing for the new lungs while the other team was off somewhere else getting the organs to bring home. As the story goes, the cardio-thoracic surgeon took too much of the “tubing” that is essential in properly connecting the heart and lungs. My new lungs simply didn’t have much “tubing” to work with and it made my team nervous. At this point, I had already been cut open and they were about to take the first lung out. The dilemma was this: close me back up and risk that my very sick lungs would never recover from the trauma or make do with the donor lungs and take on a much more difficult surgery with many complications to overcome. After much discussion, they chose to close me back up and hope that I could survive this set back.

Obviously, I did survive but not without repercussions. Before this incident, I was not on oxygen. Afterwards, I was quite disabled and relied on oxygen 24-hours a day. This was frustrating and cause for a few breakdowns.

Despite this unusual and disturbing event, I wasn’t angry with my surgeon. Partly, because it didn’t seem like his fault. Mostly, because he was so sorry. He didn’t apologize once and then give me a pep talk about how it could be worse. He apologized in some way, every time I saw him. Not just for a few weeks, but for a few years. He wasn’t being manipulative because he thought I might sue. He was sincerely saddened by what I had been through. This made all the difference.

Example 3:

A friend of mine had chronic sinusitis. He struggled with it for years and ultimately decided to have sinus surgery. While it is known to be a painful recovery, it is a common procedure and not one that he had many worries about. Unfortunately, my friend awoke from this “routine surgery” completely blind in one eye.

The records that were taken by the surgical nurse were upsetting. During the operation, no attending was present. The entire procedure was done by a young resident. Apparently, the resident found himself “lost” inside the sinus cavity and instead of stopping and calling in help he decided to continue poking around. He poked around so long that he eventually broke through the sinus wall and severed the optic nerves. The sinuses were never cleaned out and my friend spent the next few months visiting eye specialists who concluded that there was no way to repair the damage.

In speaking to other ENT doctors I’ve learned that it is not unusual for someone who is inexperienced to get lost inside the sinus. What is inexcusable is that the doctor did not call in an attending. My friend lost his eye because of one person’s unwillingness to ask for help. In this case, the doctors were sued. After a few years, my friend was awarded some money for his suffering. I think, if he had a choice, my friend would rather have his eye instead of the cash.

Example 4:

My friend’s grandmother, Elise, went in for a minor surgery. During the operation, her doctor nicked her bowel. While that is unfortunate, what is tragic is that he chose to pretend that it didn’t happen and he closed her up without addressing it. In the following months, Elise got sicker and sicker until the mistake was finally discovered. She spent the rest of her life going in and out of hospitals and struggling to manage all of the new health problems this created for her. Complications from this mistake finally took her life.

While it is an outrage that the doctor, who later admitted that he knew what he had done, ignored his mistake, I can’t help but ask myself some questions. If we lived in a society where we were more willing to accept the possibility of human error, would he have been more likely to admit his misstep? If he was not almost surely facing a malpractice suit, would he have been less afraid to confess the slip of his hand? I’m not condoning his actions but I am wondering where the line is drawn between “malpractice” and “reasonable human error”. I can’t help but wonder how differently things could have turned out if he had been willing to speak up instead of cover up.

The Verdict:

I used to be a student in cosmetology school. My hands would shake and I would feel sick at the idea of having someone's HAIR in my hands. What if I gave them a bad hair cut? How could I live with myself?? And, in fact, when I did ruin somebody's hair, I spent many sleepless nights worrying about her and wishing I could go back in time and fix it all.

That said, I can't even begin to fathom the feeling of having a life in your hands. I couldn't do it. As a patient, sometimes I forget to give my caregivers credit for the magnitude of what they do.

While it is true that we should hold our doctors to a high standard, when does that standard become too high and therefore counter-productive?

As a patient I must let go of unrealistic expectations…doctors are human. I also must take responsibility for what I can protect myself against. When and if honest mistakes are made, I must practice forgiveness. There is nothing to gain by hating them.

As caregivers, there must be a value placed on honesty and humility. I am much more likely to understand a mistake if it is approached directly rather than hidden or underplayed.

In many ways, technology has moved faster than our consciousness. We continue to carry the old perceptions of doctors as “gods” and infallible. Therefore, when they do fall, we are outraged and feel victimized. The truth is, we are living in a new age of medicine where much can be done and much can go wrong. There is a time and a place for lawsuits but there is also room for accepting the risks that come along with our “modern miracles”.


OB Doctor said...

These are some very sad and disturbing stories you have posted. I would like to leave just a couple thoughts: 1) a physician's ultimate duty is to his patient, not his pride, pocketbook, etc. 2) Although we like to blame individuals, many mistakes have more to do with a series of mistakes made by numerous individuals, or systems-level problems. 3) Atul Gawande's book, "Complications" provides fascinating insight on negative outcomes in medicine.

Midlife Midwife said...

Thank you for such a compassionate and honest look at medical mistakes. My biggest fear is knowing that I make mistakes, and that people's lives are in my very human hands.

Tiffany said...

Yes, I used to be a student in cosmetology school. My hands would shake and I would feel sick at the idea of having someone's HAIR in my hands. What if I gave them a bad hair cut? How could I live with myself??

I can't even begin to fathom the feeling of having a life in your hands. I couldn't do it.