This is in response to Kyle Barbour’s posted link about Medical/Cognitive Biases and Errors in Logic.
Here is the original article:
http://www.newyorker.com/reporting/2007/01/29/070129fa_fact_groopman?currentPage=all
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I had never been close to anyone who underwent a major medical procedure, until my friend Jaredan suffered severe injuries to his face and skull after being pistol whipped during a robbery of his home in April. It was then that I realized things like the importance of having an advocate to double check on everything that is going on – from medication to surgery – and also the reality of the lack of mental logic associated with interns and doctors who only have ‘book smarts’.
Three big instances stand out to me:
1) Jaredan’s cranial/facial reconstructive surgery was supposed to be on Tuesday, but due to a cerebral spinal fluid leak (out of his nose!) on Monday they opted instead to put in a lumbar drain (needle in the back) to drain some of the fluid and ease the pressure on the sinuses and cranial space. The hope was that the leak would seal itself up. (It did). The surgery was rescheduled to Saturday, but at 3am on Tuesday he was suddenly woken up and taken to be prepped for surgery. His very alarmed brother who was staying in the room called their friend Erin who was acting as J’s advocate since Day 1, and she ended up calling the doctors and hospital and everyone she could to figure out what was going on and keep Jaredan from being put under. It turns out that they forgot to erase his surgery from the schedule, so although the doctors knew they weren’t operating, the rest of the staff did not. Due to the drugs, pain, and general exhaustion, Jaredan did not think to contradict anyone, and would have been put under had it not been for his brother and friend. Thankfully they were able to pull him in time, and everyone was finally able to get a bit of sleep that day. Why everyone else thought he should have surgery despite the lumbar drain goes against logic. Someone in the hospital should have questioned why he was still on for surgery despite the change in his condition.
2) The resident who put in the lumbar drain was SEVERELY LACKING in bedside manner. Apparently he nervously waved the giant needle around in the room, asking people, “Is this the right one?” This needle goes into the spine, mind you, by nerves that if damaged, can cause paralysis. Even while heavily drugged, Jaredan was NOT happy about seeing or hearing this, especially when his leg started tingling when the resident hit a nerve. Thankfully he eventually put it in the right place, and it had the desired effect. **I am not sure why this man has yet to be reprimanded. One day the reckoning will come, I reckon….**
3) This SAME resident was the one who pulled the 50+ staples out of Jaredan’s scalp. Jaredan mentioned to me before his appointment (we saw the guy after a fire drill at the hospital) – ’look, that’s the resident that put the lumbar drain in’ – and we whispered about how we hoped we wouldn’t encounter him again. No luck. The man had a really gregarious manner, talking about how his girlfriend lives in the neighborhood where the attack occurred, and WOW he didn’t expect THAT to happen, all the while snipping the staples out as though they were being taken out of (unfeeling, non-human) stacks of paper. I thought, ‘ok, maybe he’s trying to distract Jaredan from the discomfort’, UNTIL he got to a tougher staple and to our dismay, PULLED the scalp over half an inch away from his HEAD, and as it turns out, reopened the incision that we had taken great pains to keep intact! Of course this was also very painful to Jaredan, but the man continued jabbering on, and finished up and tried to leave. I was shocked and tried to ask him about future care, like applying neosporin or mederma, and tips on how to shower, and the resident basically just said ‘oh it should be fine’. I am still furious with myself for not yelling ‘HEY!’ at the resident when he callously pulled on the scalp, the way I would if a dog were to grab my hand and try to tug on it. The fact that I had to tell him to get a tissue to put the staples on should have been a big red flag…
I think that it is not only the doctor who can have lapses in mental logic, but also the patient, who inherently feels that they have no place questioning what an obvious expert is doing to or telling them. I understand now why an advocate is so important – a second set of eyes, ears, and logic, who can ask the questions that the patient doesn’t, and make sure that even if the many staff members are not on the same page, someone DOES know exactly what is going on – they can be instrumental in preventing medical errors. Because you breaking down is a far more serious situation than your car breaking down when you trusted your ‘mechanic’.
Most people don’t have to have a multi day hospital stay in their lives, wish they had an advocate, or have to suffer through bad hospital food. And because it’s such a different environment from the real world, where things seem to be much more regulated and people come in to do weird things to you every few hours, it doesn’t seem like anything can be normal. But that’s not true. If the circumstances allow it, you *are* allowed to have people bring you the food you’re used to, or cook for you so that you don’t have to eat the hospital food. You *can* Skype with your friends and family who can’t make it to see you, so that they feel connected and can support you. Bringing in creature comforts to make sleeping easier, or so that you are not freezing when you go to the bathroom barefoot, is totally okay. Having people ‘take care of you’ is great, but Normality is the most comforting, and sometimes that can make all the difference in recovery.
Jaredan was so fortunate to have so many friends and his family helping him, caring for him, and sending him hundreds of well wishes this entire time. I really feel for those who are not as blessed, since, even with all the support, there were some hiccups along the way. Just the same, I can only hope he makes a full recovery, and that his vision returns to normal and that there are no future complications (or stitches accidentally left in his nose). (I now understand where all the storylines for ‘Scrubs’ come from!) I can’t wait to see him finally dancing again for the first time, at All Balboa Weekend!!