how to avert a disaster

~one of my favorite winter images~
attribution unknown

True story:

A friend of mine posted a request on social media last week asking for prayers for her daughter, although she didn't offer any details. So, even though prayer doesn't seem to work very well for me, I called to find out what the problem was. It turns out her daughter was experiencing severe lower abdominal pain. Coincidentally, she developed a sore throat, leading to a positive Covid test...meaning she was on her own when it came to evaluating the abdominal pain.

Because of the Covid issue, no one laid a hand on the young woman's abdomen, instead opting for a CT scan of the abdomen...and then, deciding instead to get a CT with contrast...meaning a prep that would intimidate the bravest among us. 

My friend got the results of the scan over the phone...not from the doctor or the nurse, but from a receptionist who had no idea what the report meant except that it showed "a massive tumor that had to come out." And...oh, by the way...a urinary tract infection.

Wait. What? What kind of a tumor? Where? How massive is massive? The patient was sent home to wait for the doctor to call. He never did. A prescription for a ten-day course of antibiotics was called in, except that it only provided seven doses, and the pharmacist wasn't able to honor the opioid script for pain from the ER doctor. The PCP had to write it out. Calls to his office went unanswered. No referrals were made. No explanations were offered. No treatment was initiated.

"America's health care system

is neither healthy, caring, nor a system."

~Walter Cronkite~

Altogether, four days passed. During the entire ordeal no one laid a hand on the young woman's abdomen. No one took her history. If they had, they would have known that she was autistic. Confused. Terrified. She just wanted to get home to her mother. But her mother was at high risk for severe Covid infection, so she couldn't be there to advocate for her daughter. Not to mention the fact that she nearly lost her son to Covid last year. 

The plot thickens.

In desperation, the patient's mother put in a call to someone she knew well...someone she trusted: the pulmonologist who saved her son's life last year when he was in ICU with Covid, on cardiopulmonary bypass. She begged him for help. And he did. 

"To know even one life has breathed easier

because you were kind.

This is to have succeeded."

~Ralph Waldo Emerson~

He arranged a consult with a surgeon that afternoon. He read the CT scan himself and discussed the report with her in detail. The tumor was a teratoma so large they couldn't tell which ovary was involved. It was described as "larger than a baby's head." The UTI resulted from pressure on the bladder. Antibiotics and pain meds were secured. Surgery was scheduled. A potential disaster was averted.

This scenario highlights some of the reasons I retired from medical practice early. Not only is this level of care...or neglect...unacceptable, it is dangerous and cruel for a number of reasons:

• No one took the patient's full history.
• No one examined the patient.
• No one communicated with the patient or her family.
• Mistakes were made in prescribing.
• The patient was discharged without treatment or follow-up.
• The lack of attention and concern caused unnecessary mental and physical anguish for the patient and her family.

We are all probably guilty of similar oversights and errors at some point in our careers. We're only human. And, God knows, our offices, clinics, and emergency rooms are overwhelmed with the recent surge in hospitalizations for patients with Covid, flu, and RSV. I get it. You get it. There is just so much time in the day. Everyone is working against the clock. Doing their best...

...or not. 

This is what frustrates me. In today's health care system, taking shortcuts is seen as acceptable, even necessary, given the mandate to see more patients faster, in order to generate revenue for our corporate taskmasters. As physicians, we devote four years to medical school and three or more years to residency to become little more than remote triage officers. Technology outpaces touch. The patient's narrative is  driven underground. A diagnosis is missed. A patient suffers. A connection is lost. We have betrayed our sacred duty. According to Stephen Cope, Scholar Emeritus at Kripalu Center for Yoga and Health:

"Sacred duty is the thing

that if you do not do it,

you will feel a profound sense of self-betrayal."

~Stephen Cope~

The problem is not so much the inevitable shortcuts and slip-ups that we have come to expect, but the fact that they are excused, denied, or accepted as part of practice nowadays. That these practices have become the norm, and no one cares to make them right.

"We touch heaven

when we lay our hand on

on a human body."

~Novalis~

jan