When I saw her during my daily inpatient rounds on Saturday morning she was surrounded by a phalanx of concerned family members. Despite the med adjustments, she was still experiencing intermittent low-grade chest discomfort. Her EKGs hadn’t changed and her cardiac enzymes were normal. I wanted advice as to how best to proceed with her, so I put in a call to our closest cardiac referral centre.
As luck would have it, my favourite cardiologist was on call. We have a very amicable working relationship, in part because I usually screen my referrals well. Most of the patients I send him ultimately prove to have significant coronary artery pathology. After I went over the details of the case with him he gave me two options: I could continue to manage the patient in our community and send her to his office in a couple of weeks for further workup, or if I was really worried about her I could transfer her to his coronary care unit via air ambulance immediately. It was a generous offer, particularly since her vital signs were rock-solid.
Deep down I knew I could probably soldier on with her a while longer, but my energy levels were low that morning and the thought of trying to unravel yet another medical mystery on what was supposed to be my day off was decidedly unappealing. I was still in the process of figuring out what to do when several of her relatives rushed to the desk to report she was having more chest pain. That did it. I told the cardiologist I’d make arrangements to have her flown down for admission to the CCU.
A week later she dropped in to see me at my office. “They didn’t think it was my heart,” she said. “In fact, they discharged me the next day. The cardiologist wants me to have a stress test in a few weeks.” I felt a sharp pang of guilt. Not only had I dumped on a colleague, I’d wasted already sparse health care resources by ordering an unnecessary air ambulance transfer. That week her discharge summary from the CCU arrived in the mail. The dictated note was polite, but reading between the lines I could tell the cardiologist was disappointed I had fast-tracked such a non-urgent case.
Three weeks later she had her stress test and passed it with flying colours. I promised myself I’d never bail out like a nervous rookie again. Nobody likes a sieve.
A month later I came in to do rounds on a Sunday morning and discovered a patient of mine had been admitted during the night with a diagnosis of pulmonary edema. Judging from the chart notes Mr. Trapper’s course in the ER had been fairly rocky, but things had settled down nicely since his transfer to the ward.
Mr. Trapper was an elderly bachelor with diabetes. He was a cheerful man who liked to crack jokes. When I went to see him he said he was feeling about 75 percent better. On examination, he still had signs of some fluid on his lungs. His EKG showed non-specific changes, and his cardiac enzymes were normal.
As I wrote out his new diet and medication orders I toyed with the idea of calling to request a transfer to the CCU. Although my patient had improved considerably, flash pulmonary edema can sometimes be associated with critical narrowing of a major coronary artery. In addition to that, diabetics are at higher risk for silent ischemia. Don’t be such a wimp, I told myself. Look what happened the last time you jumped the gun and flew someone out prematurely. Do you want them to think you’ve turned into Chicken Little? I decided to continue managing him at our facility for the time being.
By his fourth day in hospital Mr. Trapper was back to normal. A referral letter requesting outpatient investigations was faxed to the cardiologist. I wrote a prescription for his new medications and arranged for him to see me in my office the following week.
Before he went home I reminded him to call me or return to the hospital if he experienced any further difficulties. He thanked me, packed his belongings into a battered canvas suitcase, and departed.
Mr. Trapper had a massive heart attack and died alone in his cabin a few days later.
So Sue Me
A few years ago I was getting ready to start a shift in the ER when a Code Blue was broadcast on the overhead PA system. I sprinted over to the medical floor. When I got there, a wide-eyed ward clerk pointed mutely at one of the patient rooms. Inside I found three nurses frantically trying to revive an unconscious nine-year-old boy.
Before I had time to ask what had happened, he stopped breathing. I snatched a pediatric ET tube off the crash cart and intubated him. With ventilation his oxygen sats quickly returned to normal. His pulse and blood pressure held steady, so no chest compressions were required. Within minutes most of my colleagues were at the bedside. Together we formulated a differential diagnosis for the respiratory arrest, initiated a course of therapy and contacted a tertiary care centre. A few hours later he was en route to a pediatric ICU via air ambulance.
To our dismay he went into shock and died a few days later. The news decimated us. A pall hung over our hospital for weeks.
I don’t often attend patient funerals, but I felt an overwhelming need to go to his. Not surprisingly, the church was packed. The air was so thick with grief it was hard to breathe. I usually have a firm grip on my emotions, but when the deceased child’s classmates joined hands and formed a circle around his coffin, I cried.
A few months later I was doing some charting at a workstation in the ER when a briefcase-toting stranger sidled up to me.
“Are you Dr. Gray?” he inquired.
“Yes, I am. How can I help you?”
He fished a manila envelope out of his bag and handed it to me. “This is for you.”
“What is it?”
“Notification.”
“Of what?”
“You’re being sued for malpractice.” He flashed me a jagged smile, turned spryly on his heel and left the department. Talk about schadenfreude.
I opened the envelope. Sure enough, it was a lawyer’s letter stating the parents of the deceased child were suing two colleagues and me. Having never been sued before, I was stunned. I contacted my legal representative immediately. After carefully analyzing the case, my attorney came to the conclusion I had been included in the lawsuit solely because my name had been recorded in the boy’s chart. The fact that the only reason it was there was because I had voluntarily responded to the Code Blue and helped with the resuscitation didn’t seem to matter. Apparently, malpractice lawyers like to cast a wide net in order to improve the odds of ensnaring someone. I was advised there was a fair chance I’d eventually be “cut” from the case. There was only one catch – it would take at least a year.
The first six months were sheer misery. My appetite vanished and I lost weight. I couldn’t concentrate properly and I developed gruelling insomnia. I reviewed the case in my mind so many times it must have worn a permanent groove into my brain. I could understand the existence of the lawsuit, but why me? What would my family and friends think? What effect would it have on my career? I cycled endlessly between fear and indignation. Sometimes apathy would set in, leaving me feeling hollow and indifferent. I became moody and irritable. Even my kids noticed the change in my behaviour.
In time, the obsessive rumination settled. I started being able to go longer intervals without thinking about the lawsuit. My appetite and sleep improved, and my interest in hobbies slowly began to return. A new steady state was evolving.
Approximately 18 months after my initial notification I received a letter from my attorney stating I had been dropped from the case. No one on the opposing side bothered to apologize for needlessly putting me through hell for a year and a half. I guess my feelings weren’t very high on anyone’s priority list.