01 December 2009

I am a statistic

It's really difficult to identify how many medical mistakes occur each year, even during hospitalizations. There was a study published in 2000 by the Institute of Medicine that estimated that 98,000 patients die in American hospitals each year due to medical errors. But these numbers are really difficult to substantiate -- and nobody has a clue as to how many survivable medical mistakes occur.

I know that I have made incorrect diagnoses on more than one occasion (hello, that is why we have 2nd opinions...), but I do not believe that any of my errors have directly led to the death of a patient. The closest I came was during residency, when I forgot to order DVT (deep vein thrombosis -- blood clot in the deep veins of the legs) precautions in a new stroke patient. DVT precautions haven't changed in the past 15 years -- compression stockings and/or compression boots (boot thingies that inflate and deflate, squeezing and relaxing the calf and thigh muscles). If for some reason these methods are unacceptable, then the docs use low-dose blood thinners.

Well, I forgot to order the compression boots, and in the middle of the night on this patient's 4th post-stroke day, she suddenly developed shortness of breath and low oxygenation. Not only had she developed a DVT, she had also developed a pulmonary embolus (PE) -- when a piece of the clot in the leg breaks off, moves upstream in the venous system and ends up in the lung(s). Thankfully, the patient survived, although her stroke recovery was not very good (and unrelated to the DVT/PE, most likely). However, I never forgot DVT precautions on any patient thereafter.

This leads to my recent hospital experience.

Post-operatively, I was given SCD's (the compression boots) and compression stockings. However, I literally couldn't stand the damn squeezing of those boots -- inflate, deflate, inflate, deflate. It was making me crazy, to the point where I literally ripped them off my legs. I told the nurse that I refused to wear them, that I couldn't stand it. I have no idea if she passed on this incident to the neurosurgical PA's or not. If she didn't, then she should have ("bad patient in room 3004 is NOT cooperating with the DVT precautions"). If she did report it, nothing was done about it, and something should have been. That leads to the reason why my hospitalization was 14 days instead of 5 or 6.

You see, I developed some mild right leg pain on day 5 or 6, but on day 7, my right leg began to hurt like hell -- worse than my back post-op and worse than the left leg pre-op. It was a different pain, sort of crampy, and drawing up. I told the nurse who passed it on to the neurosurgical PA. The leg wasn't swollen when compared to the other one, but the PA ordered an ultrasound to rule out a blood clot. "Just in case."

Now we all know how hard it is to get any useful information about a test from a technician. Try asking the MRI tech what your MRI showed, and they always say something like "the radiologist has to review it first." I wasn't going to accept any answer like that from the ultrasound technician. So I played the doctor card -- I said that I fully well understood that a physician would provide the final reading of the ultrasound but that I also knew she did this day in and day out. She actually capitulated and told me that yes there was a clot extending from the calf to the lower thigh in the right leg. Fuck, I thought. Fuckfuckfuck. Literally, by the time I got back up to my room, the nurses and the PA already had the final reading which was still "clot."

One treats clots like these with blood thinners, to prevent spread of the clot or pieces breaking off and lodging in less pleasant places. I was started on a drug I'd never heard of (Arixtra), which was supposed to get me fully anti-coagulated within 24 hours. "Fine" I thought. At that point I was placed on bedrest, which was not much more activity than I was actually doing. Except bedrest meant no bathroom privileges, and I had to use the dreaded bedpan. 'Nuff said about that.

Later that evening, around 11 pm, I awoke with left-sided chest pain, shortness of breath, and heart palpitations. I knew exactly what was going on, and for the first time, being a doctor was a major detriment. You see, I realized that a chunk of the clot had broken off, traveled up through the venous system and ended up in my left lung. Nobody could poo-poo me, or say "everything'll be alright", because I knew exactly what a pulmonary embolus was and that I was in danger for my life. They put me on oxygen which thankfully made the oxygen saturation of my blood go from about 84% on room air to 100% on oxygen. Someone finally got an IV in me and they gave me morphine which helped the chest pain. I was transferred to an intermediate care unit, which they do for all patients with pulmonary emboli (the blood clot to the lung). I called TheHusband and tried to minimize the situation. However, he consulted the University of Google ("blood clot, leg, lung") and found out a lot more than I wanted him to. He then spent a sleepless night.

I remained on the Arixtra and Coumadin (warfarin, aka rat poison) was added -- it is the only effective oral blood thinner available on the market. Eventually I had 98-100% oxygen saturation on room air, and the blood was thinning out nicely, so I was finally discharged, about a week after I should have been.

So even though I am a doctor, paranoid to the max about medical stuff, was being taken care of by an experienced medical team and an excellent neurosurgeon, I am also a medical statistic. A medical mistake. And because of my inability to tolerate the compression boots, I almost died, and now I'll be on blood thinners for the next 6 months at least. But I am grateful and thankful and lucky and happy to still be around...


Eric said...

Just... wow. I'm really, really glad you're alright.

(And please do what your doctors tell you from now on!)

Janiece said...

Doctors are such CRAPPY PATIENTS.

But I'm awfully glad you're okay!

Tania said...

Some of us were terribly worried about you. Glad you're doing better, silly patient.

Anonymous said...

I hated the compression boots too! Horribly annoying and I can totally sympathize. However, all I did was bitch and moan a lot; didn't have the nerve to actually rip 'em off. I might have gotten them off a tad bit sooner than what they were scheduled for (I can whiiiiine, I mean ta tell ya, I. Can. WHINE.) but still did wait until the nurses did the removing.

Nawty Natalie. Don' do that again. ;)

Jim T said...

Glad to hear you're OK! Those things are scary.

My wife had a PE back in April (and is now OK). She eventually had to let me know that it really, really bothered her that I kept saying I was going to, e.g. go refill her rat poison prescription.

TheHusband said...

Great, glad everything is getting back to normal!

How about going in the kitchen and makin me uh samwich?

neurondoc said...

When I say that I couldn't stand it, I really mean that I literally could not stand the feeling of the compression boots. Due to other medical reasons, my legs are hypersensitive to certain sensations -- I can't even stand wearing regular knee socks. So while I was a bad patient, it really was because I was going CRAZY with those things on me.

Jim -- Glad your wife is okay. TheHusband better not start that crap with me, or I'll belt him with my walker. :-) (Glad you stopped by, long-time-no-see!!!)

TH -- no.

Someone asked me if I am going to sue the doc for negligence or something. The answer to that is no. It was a mistake, simple and pure. And I would recommend him to anyone who needs back surgery, because he knows what he's doing, is kind, personable (yes, yes, a neurosurgeon), listens to the patient, and (at least to this point) seems to have fixed me.

MWT said...

Glad you're still around. :)

I guess now you know what the boots are good for...>.>

Carol Elaine said...

Very, very glad you're still with us, neurondoc. No more becoming a statistic, ya hear?

TH, don't make me come after you. Git your own damned sammich!

Lorraine said...

Oh so glad to see you're back to your spunky self. It's scary how easy it is to have a major medical problem due to left hand-right hand not shaking.

Is the lung pain completely gone, then? Or is the PE just going to gradually disappear?

neurondoc said...

Chest pain and right leg pain are both all gone. The blood thinner will allow for my own body to gradually break down the clot, which takes a few months. The shortest amount of time that I will be on Coumadin is 6 months.