Saturday, April 29, 2006

Finity

This is snipped from a comment made to one of my previous posts:

"A hospital emergency room sent my mother [she was not fat, quite thin and petit] home with a broken arm (in two sharp pieces) with no more than bandages and a sling. It took over a week to get an appointment with a real doctor in his office. As soon as he saw the xrays he had her in surgery as quickly as possible."

This is not the last time you will hear of such a thing. I decry it. Yes, hospital emergency rooms are overcrowded and the nurses, technicians, and doctors who work these probably often feel that they are merely pushing a boulder up a hill only to have it roll back down again after all that vain effort made to get it to the summit.

But there is no excuse sometimes.

They first arrived at the emergency room with a complaint of shoulder pain and a feeling of "whooshing" in the chest. Labwork, chest X-ray, and EKG showed nothing unusual, so they were sent home.

A week later the pain had worsened and radiated into the abdomen. A CAT scan showed an enormous aortic aneurysm that extended from the aortic root all the way down below the kidneys. The original aortic lumen was actually smaller than the secondary along some stretches, and the secondary had calcified somewhat. One of the kidneys was fed blood supply not solely by the original aortic lumen but by the aneurysm lumen also.

A vascular surgeon of national reputation was called immediately to Gore-Tex the aorta from the root over the arch and down. Coronary and carotid arteries were re-attached through the new Gore-Tex. The operation, which must have been spectacular, took eight hours. After being on a pump all that time the patient went into Torsades and had to be shocked once or twice; irritable cardiac muscle and all that. A second-degree heart block later came and went.

After that things went as well as could be expected. The patient was relatively young and had no prior health issues or history to cause worry. The chest tube came out, the pleural rub dissipated spontaneously. The new aortic valve sounded wonderful, and the patient was walking laps in the hallways. A supportive family was very gracious and helpful to both the patient and the staff.

Prior to the operation the patient was your typical walking time bomb and they could have dropped dead any moment if the aneurysm had ruptured.

I would not want to have been the ER doctor that sent the patient home the first time they presented, but I suppose they had nothing really to go on.

2 comments:

DisappearingJohn said...

That's the kind of story that scares the crap out of me as a new ER nurse.

So many of the veterans are so quick to call "drug seeker" (and so often right), yet I always worry if we'll be wrong once, with a fatal result.

Sounds a lot like the John Ritter story, although from what I've read (not much) they probably couldn't have saved him if he was disecting when he walked into the ER...

Hasn't stopped his family from suing, though...

Eli Blake said...

It's a tough job being an ER doctor. And they can make the right call 999 times, and then the thousandth time they call it wrong and end up getting sued.

Last year my daughter had a urinary infection. She saw the ER doctor and he gave her a prescription for an antibiotic. Then she got worse, and it turned out that the strain she had was resistant to the antibiotic. True, I wish they'd done a better job with their labs, and true, my other daughter has also been misdiagnosed in the ER (one time they said she had flu and it turned out to be strep throat.) But I don't blame the doctors for this kind of stuff-- unless its really gross incompetence (like what you are describing) I tend to give the docs the benefit of the doubt.

In fact, during my wife's recent surgery there were at least two things that went wrong-- first, she was in for four and a half hours (7:30-11:55), but the doctors never came to see me and after six hours(1:30), I went to the desk and they told me that the surgery was over more than an hour earlier and she was in the recovery room. I learned what was done by reading the report (which was conveniently next to her in the recovery room) and neither of us spoke to a doctor until 3:30 that afternoon when one of the doctors came to her room.

Then, last week when she had her staples out via her doctor here, he told her he'd hardly ever seen such a poor job of stapling-- she had staples even more than an inch away from where the wound was. Probably an intern (we were told that there was one present) did it or something. I'm sure this contributed to why my wife was in as much pain as she has been in for the past couple of weeks.

So, I'm not thrilled, but I understand that doctors have a tough job so we aren't all bent out of shape about it either.