9 pm Negligence

My readers, however many of you there are out there. I have spent the last few months in work purgatory, so many apologies for not writing for a while. I will get back to work now on a more consistent basis.

Someone I know died this week. And I was especially touched by her death in many ways. For one, it was a preventable death brought on, at least in part, by negligent health care provided by doctors and nurses (both responsible in this case- but mostly the doctors). I was also touched by how the various members of her family coped with this death.

For starters, the recently deceased was 89 years old, lived independently with her 90 plus year old husband, and in almost every way defied the odds and the norm of what the lay person thinks of "elderly" in that, despite her dementia and quirks that was assuredly due to her age, she was one of the most spirited, self-sufficient and remarkable people I have ever met. She always wore a smile, and despite a memory that failed her, she knew her family well and remembered what they meant to her. Last week she had hip pain and was found to have a small hip fracture which was supposed to be an easy repair but ended up being a larger repair once the orthopedic doctors took a look inside. The surgery went quite well and she was walking, talking, complaining, and acting very much herself by a few days after the operation.

One of the more common post-operative conditions, especially in elderly patients, is one of ileus. Here, the motility of the bowel slows to a halt, and the result is one of what we docs refer to as pseudo-obstruction (pseudo in that the bowel is not actually blocked or twisted, but instead is so slowed or dilated that the end result is the same). And that result is nausea, vomiting, abdominal pain, and a general state of misery. The standard of care for such a state is to give medications for nausea, and place a nasogastric tube from the nose to the stomach which decompresses the stomach of food and air refluxing backwards up the bowel. This tube is placed for comfort, but more importantly to prevent vomiting which inevitably comes with ileus and obstructions after enough time. In all patients, and especially the elderly, vomit can easily pass the epiglottis and travel down the bronchus into the lungs- an event called aspiration. There the acid mixed with food causes a burn called chemical pneumonitis as well as bacterial pneumonias. The end result can be very bad for the lungs.

So on the third day after her hip repair, the beloved great-grandmother, grandmother, mother, and wife developed an ileus and vomited 3 times. Sometime that day her son, who luckily was there visiting, began to advocate on her behalf for something to be done. An IV bag ran out. The bed was not cleaned. And the vomiting continued. Despite promises from doctors, trained, board certified MDs, to place the tube, one was never placed. At 7pm, she vomited and aspirated into her lung a good deal of her vomitus. She was intubated in an intensive care unit an hour later when I found out what had happened, and then died of complications stemming from this by midnight. Just like that- a woman who successfully underwent a big operation, carefully performed by watchful, skilled physicians died from medical neglect just days later.

Now the question is what her family is to do with that anger. Do they bottle it? Do they sue the hospital? I will devote my next blog to lawsuits and medical malpractice, every doctor's nightmare. For now I'd ask you to think about how enraging it is when a life is on the line, and you trust people to cherish that life, and not treat it like a nuisance in a workday- and mistakes happen and the life is lost. There's no making up for that mistake. Money, apology- maybe they help, but they do not heal.