A Night in the Hospital, From Both Ends of the Stethoscope
Just as the first coronavirus reports from China surfaced in late 2019, the medical world was celebrating the 20th anniversary of To Err is Human, the Institute of Medicine’s seminal report that opened our eyes to the extent of medical error. The news media jumped on the popular aviation metaphor that the number of Americans who die each year from complications from a medical failure is the equivalent of a jumbo jet crashing every day. These numbers are still difficult to quantify precisely, but we know they are not small.
The conversation has now been expanded to include all avoidable harm to patients, including those that are not faults per se. When I started writing a book about medical errors, I wanted to see both sides of the story. I relied on my own experience as a doctor, but I also interviewed patients and families to get a different perspective. But I quickly realized that the distinction between these two “sides” was rather fluid.
In the middle of writing the book, my teenage daughter had a stomach ache. My children know that fevers, colds, coughs, and sprained ankles do not raise my heart rate and that “if you are not bleeding or have cardiac arrest,” they should seek medical compassion from their father, a computer programmer. They often accuse me of completely ignoring their medical complaints, but as a family doctor, I know that most of the pains in everyday life get better on their own and are best left unnoticed.
But this time, suspicious of my daughter’s inability to find a comfortable position, I pulled out my stethoscope. When I heard complete silence instead of gargling bowel noises, I took us straight to my hospital emergency room. My correct diagnosis of appendicitis humbly saved me in the eyes of my daughter, even though she was ashamed that I had spoken to colleagues.
The operation was scheduled for the next morning, so I stayed in her hospital room overnight reading the pile of magazine articles I had checked for my book. Hospitals have always been a comfortable environment for me, but the familiar ward suddenly felt apocalyptic, with medical errors and damage lurking everywhere. The population of a medium-sized town crept in and out of my daughter’s room that night, each armed with potentially dangerous items that needed to be administered or liberated. And even if they all beat 99 percent, the denominator of “things” was so large that a certain mistake was almost guaranteed.
When the pediatric resident arrived at 3 a.m. to examine my daughter – after being examined by the triage nurse, emergency room, emergency room, operating room resident, surgeon, and the operation in attendance – I put my foot on Low.
“She’s on pain medication now,” I hissed, “so you won’t find any stomach ache. And the ultrasound already showed an inflamed appendix. “The resident eyed me carefully, clearly calculating the risk / benefit ratio in pressing her case with an ornery parent with sleep deprivation.
“But if you want to wake her up and stab her stomach and then come to the big conclusion that she has appendicitis and needs an operation, forget about it,” I snapped. The resident backed away and I slumped back in my chair to read another cheerful article on medical disasters.
The surgical team came by with a different option: there was only intravenous antibiotics without surgery. With antibiotics alone, there is a 50 percent chance of recurrence of appendicitis. This meant that surgery could be avoided altogether for half of the patients. But we had to make up our minds immediately so that they could know whether to book the surgery
I asked the resident of the practice how strong the data was. I wouldn’t make a half-hearted decision just because he was pressed for time to set the surgery schedule. He groaned mightily but stood by while I searched some studies. The data were preliminary but appeared encouraging.
Jan. 4, 2021, 10:31 p.m. ET
Just getting a flu shot reduces my daughter to a sobbing mess in my lap, even though she is a head taller than me. So I was sure that she would take the chance to avoid surgery.
It turned out that she had a completely different attitude. The experience of getting an IV in the emergency room was so miserable that she never wanted to repeat it. The certainty of the operation was far more appealing than the ability – however small it may be – to go over this again in the future.
The next morning, that dangling tail of the rest of the colon was successfully cut off. When my daughter came out of anesthesia, I asked her if she would like Toradol, the pain reliever the nurse was offering. “Tortellini?” she mumbled mistily. “Do we have tortellini?”
I was once again impressed by the wonders of modern medicine, knowing full well that I might have dug a grave for my child that evening instead of digging for tortellini in the freezer.
As a doctor, I am amazingly proud of the medical care our hospitals can provide. But during our stay as civilians, every aspect felt like damage waiting to happen. I’m sure I’ve disheveled a few feathers on all of my questions, but addressing the concerns of family members is part of the job – even if the family member is not a doctor and is not on the faculty of this facility, and it is no accident that he is writing a book about medical errors in bed.
It’s not comfortable to be the squeaky wheel. To be honest, it was exhausting to be on the lookout for my daughter around the clock. But once you’re on the patient side of the stethoscope, everything looks like a minefield.
Of course, to ensure safe medical care, the burden shouldn’t lie with the patient or the family. That is the job of the health system. However, as we know, the system has not yet reached flawless perfection. Therefore, patients and families need to stay engaged as much as possible.
The Covid-19 pandemic has certainly demonstrated the professionalism of healthcare workers. But even the most committed employees need extra eyes on site.
My advice to patients is to be polite but persistent. Don’t let unspoken anger put you off. Offer appreciation for things that go well – and acknowledge that everyone is working hard! – but plow forward. At the very least, ask what each drug is and why you are getting it.
And if you’re too nauseous, or too sleepy, or too feverish, don’t feel guilty for not interviewing every employee. Get the rest you need. Before you go to sleep, however, use leftover surgical tape to put a sign on your chest that says, “Wash your hands!”
It is the responsibility of the medical system to make health care as safe as possible. But patients and families shouldn’t be afraid to take on a clear role. Keeping those jumbo jets from falling out of the sky is a team effort, and the team includes the people on either end of the stethoscope.
Dr. Danielle Ofri practices at Bellevue Hospital in New York City and is a clinical professor of medicine at New York University. Her latest book is “When We Do Harm: A Doctor Confronts Medical Errors.”