If It Can Happen To Me...
In my book, Predatory Medicine-Redux, I documented, from a physician's perspective, what can go wrong when an individual comes in contact with the healthcare system. I recently had a personal encounter with the healthcare system that nearly did me in. This experience validated what I described in my book.
I recently developed a prostate problem and went to see a urologist-a new physician for me. He determined I needed a TURP (transurethral prostatic resection) which is a procedure to remove excessive prostate tissue that restricts urine flow.
All seemed to go well until a few weeks after the procedure the urine flow became restricted. The urologist determined I had developed a "stricture" or scarring of the urethra, the tube that transports the urine from the bladder to the outside. The immediate fix was to dilate the urethra. This procedure is quite crude and probably has been performed since the time of the ancient Egyptians.
As I lay prone and exposed on the examining table the doctor takes a firm device similar to a large golf tee and after a brief warning to expect some discomfort jammed it forcefully into my urethra. Thus, at the expense of considerable discomfort, the stricture was opened. He then performed a cystoscopy (a special scope to allow the doctor to directly view the urinary tract and bladder) to inspect his handwork and passed a catheter to make sure the passage was opened.
As you might imagine, I was quite relieved to get out of that office.
The next day, which was a Friday, at around 9:45 PM, I suddenly developed uncontrollable shaking and a feeling of malaise and knew something was wrong. I immediately took my temperature which was only 99 degrees. However, within a half an hour my temperature was 103.4 degrees.
I called my urologist's office and was informed he was not on duty and another urologist was "on call", but they refused to connect me because they had instructions only to forward calls from the hospital. I knew I was potentially in serious trouble and decided I needed to go to the hospital emergency room ASAP.
I woke my wife, got my stuff together and arrived at the ER around 12:30 Saturday AM. Since I was a former staff member my admission to the ER was expedited. Fortunately, the ER doctor on duty knew me and that helped considerably.
After the doctor's evaluation and lab work the diagnosis was confirmed-I had sepsis from my urinary tract and needed immediate and intensive treatment. The hospital had a protocol for this serious condition which consisted of high doses of strong antibiotics and copious intravenous fluids. The doctor stated if I had waited another eight to ten hours before coming to the hospital I would have been in an extremely serious condition.
For the rest of that day (Saturday) I felt ill and had spiking fevers. I made several observations that first day that support my thesis that a patient needs to be aware of what is going on when being treated for a serious, or even minor illness. I noted the nurses were very pleasant and attentive but their routine was regimented. About every six hours they would take my "vital signs", the blood pressure, the pulse rate, take my temperature, and obtain my oxygen saturation. They would also perform a physical assessment which was rather perfunctory: they would inquire if I had any pain; ask me to squeeze their fingers and push against their hands with my feet, thus checking my strength; they listened to my heart, lungs and abdomen, usually through my gown, which is a no-no as I pointed out in my book on page 35.
After several of these assessment and getting to know the nurses I asked about this exam. They confirmed these specific maneuvers were dictated by the computer and had to be checked off as completed. To me, this is a serious lapse of what should be done to accurately and meaningfully serially evaluate a hospitalized patient.
Next, the doctor on duty finally arrived around 10:30 AM. This was a "hospitalist" or a physician hired by the hospital to efficiently care for patients. My impression of this system is described in my book on page 112. He queried me about my situation (he did not take any notes) then performed a "physical exam" which was quite similar to the nurses evaluation noted above. The main difference was he looked down my throat with the light on his i-phone. This encounter took around ten minutes.
By early the next morning, Sunday, I was feeling better, the fever was gone, and my appetite returned. However I had an uneasy feeling. When the nurse arrived at around 6 AM I asked her to weigh me. On admission I weighed 85.5 kilograms. About twenty-four hours later I now weighed 95.5 kilograms which means I had gained over twelve pounds! I knew copious fluids were part of the protocol for sepsis, but I thought this was excessive, especially since they were not measuring my oral intake. I asked when the doctor would be making his rounds and she replied she thought around 9 AM.
The same hospitalist arrive around 11 AM. He inquired how I was feeling. I replied I was feeling better, but was concerned about my fluid balance. He gave me what I interpreted as a irritated look and replied, "I didn't memorize your fluid balance." He then walked to the computer in the room and accessed my records. His attitude seemed to be more compliant when he saw the numbers. He stated, "Well, it looks like you are way ahead in fluids, around 5 liters. I guess we should discontinue your I.V.s".
The reason for grave concern is that over the years of my career I have occasionally been called to the Recovery Room or the surgical floor for a patient in severe respiratory distress and shortness of breath because they were given too much fluid in a relatively short period of time. This can cause congestive heart failure or build up of fluid in the lungs, even in young people with normal hearts. So, because of my medical knowledge I believe I avoided a potential disaster.
The next morning (Monday) when I awoke around 5 AM I immediately noticed my left hand was dusky and swollen as was my left forearm. The I.V. had been inserted at the bend of my left arm on admission. Although the I.V. fluids had been discontinued I was still receiving antibiotics through this I.V. It was obviously not functioning and due to the swelling around the entry site the last dose of antibiotics was given into the tissues and not into the vein. The nurse was notified and changed the I.V. This should have been detected during the administration of the last antibiotic dose which was around 2 AM.
I was discharged later that morning. The first thing I did when i got home was to weigh myself on my bathroom scale. My usual weight on that scale is 179 to 183 pounds. I now weighed 197 pounds. I pondered what to do, but since I felt well I decided to limit my fluids and observe. The next day I weighed 192 pounds and felt fine. By the end of the week I was back to my usual weight.
So, what are the lessons that can be learned from this experience?
1. Being sick can be hazardous to your health-the cure should not be worse than the disease.
2. Relying primarily on computer programs, protocols, and algorithms can be hazardous to your
health.
3. "Modern technology" is no substitute for clinical acumen, common sense, and attention to
detail. Over-reliance on technology can cause clinicians to look but not see and listen but not
hear.
4. Anyone entering the healthcare system must do whatever they can to protect themselves
from the inherent risks of that system.
My experience, as outlined above, clearly demonstrates that even an individual with a wealth of
medical knowledge is not immune to complications of medical care, but in my case did prevent a potential disaster(s). If it can happen to me it can happen to anyone.