Life in The Deadly
World of Medicine
by Joseph T. McFadden, M.D., F.A.C.S.
Most people reacted with astonishment and doubt when the numbers
were first made public more then five years ago. The reports claimed
100,000 to 300,000 preventable deaths every year in the medical
system of the United States. As would be expected, the same reaction
came from the public at large and from patients and doctors alike
to this startling news. Impossible! Unbelievable! Surely these figures
can't be right! And who says so, anyway? So you look to see who's
talking and find the facts even more sobering. The tabulations were
coming from reliable and important sources such as the Institute
of Medicine of the National Academy of Science, and the New England
Journal of Medicine among others, and continue to do so.
But wait. As a practical matter an accurate count would be impossible
across the vast territory of the medical world. This you know and
so does everyone. But now you realize something else, too. There
very likely has been overlap in the various tallies, but whatever
the real figures might ultimately prove to be, something really
is amiss, the numbers entirely too big, and these initial reports
are a warning of worse to come and a cry for action. Until these
reports, the public had been unaware or at best only vaguely aware
of this sleeping dragon. Unless one of these tragedies has happened
to a friend or a member of your family, you might be quite skeptical.
You have to be shown the real cases.
Here is an example. Mrs. John Simmons arrived at the hospital about
nine a.m. in a happy mood. Her husband would go home today if his
improvement continued as expected. She took the elevator to the
fifth floor and greeted the huddle of nurses as she passed their
glass enclosure, tiptoed down the hall to her husband's room, and
slipped into the open door. A scream broke the silence of the ward
and Mrs. Simmons ran down the corridor shouting, "Oh my God! No!
The nurses rushed to the room and found Mr. Simmons corpse white
without a pulse or signs of breathing, and lying terribly still
in his bed sheets soaked in blood. Frantic resuscitation attempts
were futile, and no one in the room could deny the awful truth.
Mr. Simmons had bled to death. He had been alone for at least two
hours without anyone looking in on him.
What happened? Mr. Simmons was not expected to die, but he was
sick enough to require massive doses of antibiotics. Frequent injections
damaged the usable veins in his arms and he had been given a subclavian
line. "Subclavian" means under the clavicle, or collarbone. The
line is a tube (catheter) sewn into a vein, its farthest end threaded
down into the central venous system of the body almost to the heart.
The insertion of a central venous line is for long-term treatment.
Fluids containing drugs and nutrients are fed through it toward
the heart. This saves having to puncture the patient for each dose
of medicine or bottle of sustaining fluid.
Mr. Simmons had responded to the antibiotic treatment fed through
his subclavian line, and the doctor had written an order the previous
evening for the tube to be removed in the morning. Nurse N. came
into his room before seven a.m., tired from a night on duty, and
harassed by having too much to do and too many patients to watch.
She shut off the pump, disconnected the warning beeper, and grasped
the lower end of the fluid line to remove it from the hub of the
apparatus. A voice from the intercom demanded her immediate presence
back at the nurses' station. The night supervisor, the authority
to ordinary nurses, was in a hurry to go off duty. The supervisor
terrified Nurse N., who was a peaceful and somewhat whiffling innocent.
She dropped the fluid line and ran to the desk.
Half an hour later, Nurse N. went off duty crying, the victim of
humiliating verbal abuse. The night supervisor had discovered an
infraction in record keeping and blamed the problem on the young
nurse. Meanwhile, Mr. Simmons wiggled restlessly and the loosened
tube end slipped out of its socket. He bled quietly from the open
end of the line and lost consciousness. Mr. Simmons never called
for help. He died at the worst time of the day, when the nurses
change shifts. In this daily seven a.m. ceremony, nurses who have
been on duty all night turn over the patients to the crew arriving
in the middle of heavy hallway traffic. The scene is edgy in an
air of confusion. He died because no one was watching him.
This unfortunate mishap is not recounted here to diminish the
reputation of the modern medical system. We have the best the world
has ever known, praiseworthy for its miraculous accomplishments.
Attention to the flaws can only improve its services to humanity.
But despite concerted efforts, no authority or organization has
been able to eliminate the fatal faults in the system. If the doctors,
hospital industry, insurance industry, and the drug empires can't
control the damage, then only patients and their families are left
to confront the problem.
This calls for greater understanding of modern medicine, with its
wonders and dangers, from earlier times to the present day. No one
born since the end of World War II knows the grim limitations hampering
medicine until well into the twentieth century. The introduction
of sulfa drugs in the 1930s and penicillin in the early 1940s brought
the first real defense against one of the greatest threats to life,
infection caused by bacteria and other organisms. Since this beginning,
the continuing advances in technology and drug research have saved
countless lives and cured countless people.
The doctor at best only prolongs life and delays death. He diminishes
physical damage and alleviates suffering and anguish. His effectiveness
continues to grow as medicine adapts discoveries from the scientific
community to the struggle against disease. But slow as the progress
of Medicine has been over the centuries, the related social and
economic issues have become by comparison a deadly failure. The
intrusion of government into the social and financial problems of
medicine, the big business tactics such as the HMOs, the dictatorial
control of medical decisions by the insurance companies, all in
the wake of revolutionary medical discoveries, have swept the doctor
and his patients into a gigantic out-of-control industry where system
failures are taking a terrible toll.
The wonders of medicine are brilliant life-saving accomplishments
and the dangers are indeed deadly. We are familiar with the miraculous
rescue of patients from disease and death, and we look to the doctor
as someone much greater than ordinary, who can rescue us and can
be trusted with our lives. But in reality the doctor is just one
person in a gigantic system and he cannot protect any one patient
from its dangers. Many patients look upon a well-chosen physician
as a protector, and they consider the hospital a haven where nothing
can go wrong. On the contrary, regardless of who your doctor is
and how well trained he may be, the doctor alone cannot control
the daily events where mistakes occur due to faults in the system.
So, what happens when something goes wrong in our modern society?
The usual reaction is to find a culprit, place the blame, and seek
retribution. This attitude contributes to the enormous number of
malpractice suits against doctors working in a system over which
they have no real control. It encourages cover-ups, delays the rescue
of patients in trouble, and interferes with changes necessary to
prevent future accidents. It inhibits honesty and openness. People
cannot be expected to admit mistakes if punishment is to be the
reward. The military, the major industries, and other organizations
are now recognizing the fallacy of blame-placing. When the hospital
system makes these changes, prevention of mishaps will improve and
the damage will decrease. This would require reasonable and just
compensation to patients damaged in the system and in no way relieve
the doctor of his responsibilities to safety.
What can you do for yourself or for a family member as a patient
in this intimidating system? The answer is neither easy nor simple.
You have to cross barriers, some ages old, and some almost forbidden
by custom and tradition. You have to become an advocate and get
involved, and expect to meet resistance. You have to look for the
weak places in the system. For instance, the handling of medication
routines carries one of the major risks to patients. The responsibility
for drug delivery as well as general administering to patients in
a hospital is passed down from the doctor to people with less training.
In this system, every time a task changes hands, the potential for
error increases. The doctor orders the medicine and the nurse gives
it by whatever route. The nurses' aides and maids do menial tasks,
like bedpans and food trays, to free the nurses for more sensitive
duties. Orderlies carry the patients by wheelchair and gurney to
various places in the hospital. Each endeavor leaves room for error.
Who is in charge of an unthinking person doing menial tasks, and
who is in charge of an unthinking person doing dangerous and important
tasks? No one is in charge because no one in charge could possibly
see everything done by the personnel. In the system as it functions,
each person is in charge of his or her own activity, with commitment
to an assigned duty, but no one is in charge of the patient. The
person who can see the most and do the most to safeguard any one
patient is the person with an active mind at the bedside. Only the
advocate or the patient can catch the mistakes where they are most
likely to happen.
If the system is to be brought under control, the major offenders
such as errors, accidents, drugs, infections, and human foibles,
among other faults must be corrected. In the modern system as it
continues to develop, patients can no longer complacently regard
the medical scene with the attitude, "It can't happen here." It
does happen here, and patients and their families must learn to
recognize the dangers and how to avoid them. In this spirit, Navigating
the Deadly World of Medicine depicts a major human endeavor
blessed with astounding success and still fraught with great risks.
The cases and remedies are based on the author's years of experience
in the medical profession.