The world of medicine is like a bubble. A lot of people THINK they know what goes on there, but unless you're down in the trenches it's unlikely you do. So here is my semi-anonymous blog, here to tell you what really goes on in the life of a medical resident.

Sunday, September 25, 2005

Medical Errors

We all know they happen. Hell, we hear enough statistics on the subject. But actually seeing one is a completely different story. I'm doing obstetrics and gynecology right now. One day, I was assisting a surgeon who had been on call the night before. When you're a big, important attending physician, 'on call' usually means that you get to sit at home and when something happens the senior residents phones you and tells you about it. Unfortunately for him (and later, for his patients, as I'm getting to) he had been called into the hospital to actually perform a surgery. A woman had shown up in emerg with ovarian torsion-- basically, the ovary had twisted back onto itself and choked off it's own blood supply. If it's not corrected very fast, not only will the ovary die but the dead tissue can make you go into shock. So it was a real emergency. The surgery took nearly three hours, so this surgeon didn't get to go back to sleep. And he had a full OR list (the list of people scheduled for surgery) for the following day. So I was assisting an exhausted surgeon. Luckily, the surgeries scheduled were pretty routine.

Or so I thought. The first case bled... a lot. Now, I'm no gynecologist, but the surgeon seemed to be having an awful lot of trouble stopping the bleeding. The surgery ended well, but took considerably longer than expected. We went to the lounge while the staff cleaned the room and set up for the next patient. The surgeon fell asleep. Like, dead asleep. He was obviously wiped. I don't think he was used to the feeling of being "post-call"... that state of terminal sleep deprivation that most residents are well familiar with. At that point, it hadn't even occured to me that the bleeding in the first case might have been due to physician error. Until the second case.

The second case should also have been routine. It was a healthy young woman who had come in for laproscopic investigation of infertility. Basically, she wasn't able to get pregnant, so the surgeon looks around her pelvis with a scope inserted through small incisions in her abdomen. The surgeon placed the first scope, the camera with the light attached, through the incision in her belly button. Then he cut a second small incision through the left side of her belly... in the previous laproscopic surgeries I'd seen, the surgeon uses the light in the abdomen to try to 'see' the blood vessels in the abdominal wall so that he knows where they are and can avoid them. He didn't. Whatever, I just figured it was a different technique. Until he hit the artery. Instantly, we could see the hematoma (collection of blood) spreading through the abdominal wall. The blood started spilling into her abdomen. There was so much of it, it was obscuring the scope... we couldn't see a damn thing. The surgeon tried for what seemed like forever to stop the bleed... he tried putting a stitch through it, cauterizing it, putting pressure on it... the damn thing just kept on pumping. In the end, he had to abort the procedure and just focus on damage control. What was supposed to be a day surgery ended up a week-long stay with an infected hematoma and several blood transfusions. The poor woman just wanted to know why she couldn't get pregnant, and she ended up very, very sick. Although it would be hard to determine how much of what happened was fluke and how much was surgeon error, I've already been told that there will likely be a lawsuit. Will it change the system? Doubtful. Doctors have always worked crazy hours, and been expected to perform perfectly with little to no sleep... sometimes to the detriment of their patients.


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