Unaccountable by Martin Makary

Author:Martin Makary
Language: eng
Format: epub
Publisher: Bloomsbury Press
Published: 2012-04-15T04:00:00+00:00

Mount Sinai

Mount Sinai Hospital on Manhattan’s Upper East Side was one of New York’s most respected medical facilities. Its transplant center in particular was famous, having accomplished many firsts in the field for its size and stature. It was considered by many in surgery to be the best liver-donor transplant center in America, a judgment that might have even been true—in the daytime. But at night it was a different story. Chasing profits like so many other hospitals, Mount Sinai chose to shrink nurse ratios from one nurse for every six patients to one nurse for every seven. And its unsafe overnight operation relied on only one intern. (In the hospital where I trained, the staff all knew the first-year surgery intern working the night shift on the transplant service was overworked and spread way too thin.)

Tragedy arrived one night when the intern on call for transplant surgery, just months out of medical school, was in charge of covering thirty-four complex patients. She was also on call for all transplant-related patients who came into the emergency room. A fifty-seven-year-old man, former New York Post writer Michael Hurewitz, came in. He had altruistically donated part of his liver to save his brother’s life a few days before and now was back in the hospital, vomiting blood. The overwhelmed intern didn’t know how to handle it. For hours she failed to call her senior surgeons to ask for advice. Tragically, Michael Hurewitz wound up choking on the blood he was vomiting and died. After his death, the transplant program shut down. A lamentable end to an important hospital unit—all because teamwork was poor and management had no good mechanism to elicit staff-safety concerns so that they could be corrected.4

The errors interns make generally don’t come to light. Every now and then, however, the patient is a journalist. Betsy Lehman was a Boston Globe reporter. She was killed by a mistaken dose of superconcentrated chemotherapy at Harvard’s famed Dana-Farber Cancer Institute. A young doctor there had accidentally prescribed the lethal dose.5 The death became a cause célèbre, and the institution nearly shut down in the wake of the high-profile tragedy. Similarly, when Libby Zion, daughter of a prominent New York journalist, died from a medical mistake committed by overworked interns, intense media scrutiny led to the passage of a law in her honor limiting doctors to an eighty-hour work week.6 When we residents heard about these high-profile medical errors in the news, we would roll our eyes, finding it odd that these ubiquitous events only caught the public’s eye when someone with a megaphone took notice.

We had deep objections to the way safety was marginalized in the giant health care system, but the alternative was not to practice medicine at all. Participating in the hazing of “being in over our heads” was the only way to become a surgeon. So we did it and deferred our deeper questions. Medical mistakes were common and the reasons we made them were many. That’s why we

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