Tell Me Where It Hurts by Nick Trout

Author:Nick Trout [Trout, Nick]
Language: rus
Format: epub
Published: 2014-04-17T16:00:00+00:00

From my perspective, true complications are the mistakes you never saw coming, or by the time you do, they are a speeding freight train that you can chase but rarely catch. True complications are like hurricanes. Every year we alternate between male and female names for the storms that whirl up the Atlantic from June to November. From time to time the havoc created is so memorable and cataclysmic, the name is retired, its legacy embedded in our psyche. The names of certain patients have the same effect, retired in my memory as a disaster. They barrel into your life, unstoppable and destined to cause mayhem and frustration. Through no fault of their own, the name will forever instill fear, disappointment, and permanent regret.

Of course there are some complications that are inescapable, unambiguous, entirely and irrevocably our fault and ours alone. The lawyers might prefer to impress us with their snappy slogan res ipsa loquitur, or “the thing speaks for itself,” but clinicians use the term iatrogenic—a complication induced in a patient by a physician’s activity, manner, or therapy.

Now, these are exactly the kinds of mistakes the sensationalists love to focus on, flinging accusations of negligence and malpractice. I’m talking about problems so detached from the original disorder that they can only be iatrogenic in origin, and arguably the most clear-cut mistake that can be made by a surgeon is leaving a sponge or metallic instrument inside a patient’s body. Coarse, cotton sponges are invaluable in virtually all surgical procedures to mop up extraneous blood and allow visualization of the anatomy. They come with blue metallic strips embedded deep into the material so that they are visible on an X-ray, and typically, in our packs, we start out with ten sponges, which I routinely count at the beginning of a procedure (it’s not a good feeling to go hunting for a missing sponge because there were only nine at the start). Recently I heard about one resident, battling his way through a bloody procedure, who sought an intraoperative consultation from an experienced surgeon operating in an adjacent suite. The surgeon joined the resident at the table, gave an opinion, and returned to her procedure, only to hear cries of dismay when the resident’s final sponge count did not add up. The resident was adamant that the original tally was ten and now he could only account for nine. The patient was closed up and while remaining under anesthesia, transferred to radiology, where an X-ray confirmed that the sponge was categorically not left inside the patient. The animal could now be woken up, but still puzzled by what had happened, the resident returned to the surgeon, once more seeking her opinion. Only now did he notice the bloody wad of a single surgical sponge stuck like bubblegum to the bottom of one of her clogs.

It has been reported that a foreign object is retained in a human patient in the United States once in every 15,000 operations, which means I should

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