Birds In Spring: Hospitals – Good Places Where Bad Things Can Happen
We myeloma patients spend a lot of time in and at hospitals.
Hospitals are places where wonderful things happen – lives are saved, the ill are made well, and worn-out bodies are restored – much due to what the cliché refers to as “miracles of modern medicine.”
There’s another side to hospitals, though, that demands wariness and requires that you pay the greatest attention to what’s going on around you. Pat Killingsworth wrote about one aspect of this last week in Pat’s Place: Poor Communication Can Cost A Myeloma Patient Time And Money.
When you are the patient, however, it’s often just not possible to always be alert. And it may not be enough anyway.
Because I am living with multiple myeloma, I have spent many more days as an inpatient than I ever contemplated in my previous “healthy” life – probably somewhere approaching 100 days at this point. Then there are the countless days as an outpatient for procedures, tests, or some radiology demand.
The problem with hospitals, and it’s not talked about enough, is that for all the good they accomplish, they also do bad things to unsuspecting patients, and even to suspecting ones.
These bad things even have a name. They are called “adverse events.”
An adverse event in a hospital is something harmful, even fatal, that happens to you while being treated, and is unrelated to your reason for being in the hospital in the first place. Sort of like being in the right place at the wrong time.
Lest you think this is not a big problem, you should think again.
A recent report in the journal Health Affairs found that adverse events occurred in 32.3 percent of hospital admissions. That means that for every three people hospitalized, one is going to have something happen to him or her that’s not good, that has nothing to do with the underlying medical problem, and was caused by an egregious mistake or bad practice. It includes exposure to a pathogen/infectious agent, something that is of great concern to those of us with compromised immune systems.
I think that’s astonishing.
The joke you hear about this is that a hospital is no place for a sick person. It’s no joke.
If the statistic reported in Health Affairs is correct, I’ve probably been fortunate.
That doesn’t mean I haven’t had close encounters with adverse events.
The day in 2006 when I went in for a lung biopsy, it was Linda, my wife, who staved off potential harm to me when she had a brief conversation with the anesthesiologist scheduled for this procedure. I was but minutes from being whisked away to the operating room. I’d already been drugged up and was well on my way to la-la land.
Linda asked him what kind of anesthesia I would be getting, and he responded that it was going to be a spinal – that is where they inject a numbing agent into your spine that blocks the nerves from sending messages to your brain. You feel no pain. It’s commonly used and preferred in many cases because it doesn’t bring as many risks to the operating table that general anesthesia can.
Messing with the spine of a myeloma patient, however, is generally not a good idea. Those of you with the disease who have had to confront spinal deterioration brought on by myeloma’s attack on bones know this full well.
When told that it was to be a spinal, Linda looked at the anesthesiologist and said simply, “You know he has multiple myeloma, don’t you?”
The anesthesiologist was taken aback and turned to my thoracic surgeon, saying, “He has myeloma? I can’t do a spinal on him.” Fortunately, the anesthesiologist recognized right away that the plan to do a spinal was inappropriate and perhaps dangerous to my well-being. Hastily, the operating team regrouped and changed to a general anesthetic.
Adverse event avoided.
It wouldn’t have been, though, had I not had an advocate in the operating room.
From the experiences I’ve had, I think that for the most part things run pretty smoothly in hospitals, and one gets appropriate care and treatment, without the prospect that something will go wrong. It doesn’t take much to throw the system off-kilter, though. A crush of patients with complex and demanding needs can get those with “everyday” problems pushed aside for a while.
As an inpatient, you need to keep your wits about you as best you can. And ask questions. When a nurse shows up with a new IV bag, for example, it doesn’t hurt to ask what it is, what it’s for, and why you’re getting it.
The unfortunate truth is that no amount of personal diligence is going to protect you fully from system and human errors and failures that are generally the root causes of adverse events – the ones that are preventable, at least. Sometimes, adverse events are unexpected, arise from the unknown, or are related to new technologies and treatments.
When you step over the threshold into a hospital and become a patient there, you’re rolling the dice to a certain extent. It helps to keep that in mind.
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Excellent reminder to be as diligent as possible. I'll never forget the student nurse who brought me my pills one night. One was a strange shape that I was sure I had never taken before, and I pointed that out to him. He insisted it was mine, but I insisted that he double check. Sure enough, it belonged to another patient. A small mistake compared to many, but we avoided any complications that might have occurred and hopefully he was jolted into being more careful. Hospital care has saved my life, but it is a little scary......a roll of the dice, like you said.
Checking the bag brought in from the pharmacy for bone hardening meds, I noticed it was Zomata not Aredia, which agrees with me better. It was corrected after the order was checked. It is never rude to ask questions about procedures. Even if you get an impatient response, though I never have, it's your body.
I've had at least two doctors try to give me pain medications I'm allergic to, and also antibiotics. Though we fill out forms with our allergies, doctors are only people and can make mistakes. They have favorite drugs they use for certain problems. I also avoided being given intravenous dye for an xray by reminding the technician that I have MM. So, pay attention, ask questions, stay alive.
Julia Munson
Scary stuff! I ran into a lot of this sort of thing caring for my mother at one of the so called "top hospitals" in the country. Remember no matter what their reputation it all comes down to human beings following safe guard procedures if they have them in place and try not to go alone so you have another set of eyes and ears. If you are taking someone with you who isn't all that well versed, tell them what you want them to check and be clear. Even if they aren't totally grooved in, often just the asking and double checking will make all those involved take a second look.
What you all describe do not appear to be "unrelated to your reason for being in the hospital in the first place. They are mistakes in your treatment. Add those to the 32% adverse events and we're running a much higher risk of harm. Is there a good list of self preservation tips that would help us protect ourselves from all of the threats we face when we enter the hospital?
That has happened to me, too, when I was getting a monthly IV of Aredia. One time I was being hooked up to 2 bags and when I asked why two, the nurse said that's what I always have received. When I told her I've had only one before, she checked the bags and then realized she had the wrong Craig. Her eyes widened and she had that "OH ****" look on her face. I double check everything now: shots, pills, IVs.
I worry about this all the time. I am very lucky to be alert and on the ready while dealing with my myeloma. However, having been hospitalized in the past with other ailments, I know for a fact you must have someone with you or be able to speak up when things don't sound right.
Most medical procedures are a unique experience to us the patients, while they are routine to medical staff, and there lies the problem.
Unlike commercial pilots who treat each flight as a new experience: reviewing flight plans, examining the equipment, reviewing procedures -- medical staff, for the most part, get lolled in the routine trap, which can blind one to mistakes, oversights and errors.
Thanks to you all for writing in. The stories you all tell of errors/mistakes are certainly troublesome, I'd say. In 1999, the Institute of Medicine put out a report about medical errors, citing two major studies, that said that at least 44,000 and perhaps as many as 98,000 people die in hospitals each year as a result of preventable medical errors. These are most likely to occur in operating rooms, intensive care and emergency departments. Some places are better than others. U.S. News & World Report just put out its annual hospital rankings issue, and the hospital at Memorial Sloan-Kettering Cancer Center, where I've spent considerable inpatient time, is rated "superior" in keeping patients safe. That is, in protecting patients from accidents and medical errors. That's encouraging. Even so, as Lori says, you shouldn't go alone into the hospital world if you can help it -- a second set of eyes and ears, from someone not afraid to be your advocate, can make a big difference.
Kent -- that's an interesting point you bring up...not only do hospital patients have to deal with these "adverse events" but, as you say, there are the medical errors that can occur. The best self-preservation tip I can think of is to have an advocate with you at all times -- someone who will ask questions and speak up on your behalf.
This is a great topic Lou - Thank you for tackling it.
When I took care of my Mom, I eventually built spreadsheets and checklists for her caregivers. I had a sheet for meds which they had to initial when they gave them. I had sheets to track her input AND output if you know what I mean. When we got to the hospital, one time the ER doctor said "omg - you are more organized than the ER here!" to which I replied "I don't know if you want to brag about that!". Every question he had was answered on the sheets, which had been prepared in a folder form them to ... keep!!
In my opinion, a good business, and a hospital should run according to this, includes checklists. They would probably eliminate 100% of the problems but would take time and money to develop, so they don't want to do that.
I am tempted to have the words Multiple Myeloma on my forehead when I go for tests. Last time I had a CAT scan the guy was about to inject me with something and I said WHOA there ... you do know I'm a MM patient right? I mean, I'm in MY HOSPTITAL with MY RECORDS and where MY ONC works ... so what are you injecting? Just asking - not being rude. He said oh, well, wait here. After 5 minutes he came back and said, well, so glad you told me that. Let us proceed without that injection. Really? No kidding!!
Checklists. I am thinking we should develop our own for MM patients and evolve it and share it.
Oh - and on a side note, when I went in for my ASCT the nurses laughed at me when I sprayed everything in my space with vinegar and hydrogen peroxide (one after the other) which apparently kill most germs and such.
So you need to be in control as you said. Too bad, but true.
I can relate. I had some complications going through my second stem cell transplant and had to be hospitalized. Once there, my luck did not continue as I picked up 2 viruses which took me to the edge of death. These viruses are present all the time, and for most people are not a problem, except when your immune system is compromised. The diligent work of doctors and staff saved my life and I will be eternally grateful. But I will also be more aware of the potential risks going forward.
Hi Mike...the great risk of a hospital-acquired infection is a big concern for those of us with compromised immune systems...hope you are doing well these days...
Thanks Lou. I'm doing much better and now about to embark on subq velcade as a maintenance therapy.
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