In our darkest time: The role of faith

I've given short shrift in the blog to the role of faith in physical healing and emotional healing after loss, as this reflection by Dr. John James on the recent story by Cori Liptak made me realize:

I liked the story you sent out today about cancer victims/survivors sticking together. Many of us in the Christian faith community ask why there must be suffering and the story you passed along answers that question. Suffering is essential so that we understand the suffering of others. Once I recovered from the acute grief of loss of my 19-year old son to medical errors, I came to a new understanding of what my faith expects of me and where God was during my son's days of dying. God was there in those who came to us in our darkest time and showed uncommon compassion. No one really wants to be there when a child is dying, but God puts them there nonetheless.

And so it happened not long afterward that good friends at church lost a daughter to an accidental overdose of therapeutic drugs. And not long after this a co-worker lost her son for the same reason. Having experienced the loss of a child, I was able to listen to their grief, their doubts, their "what ifs," and their hopelessness. Because of my suffering I was able to minister to them in ways that someone who had never lost a child could never hope to do. It is promised to us that we can turn all things to good if we love God. I would never wish the death of a child on anyone, but even this can be made the basis for a good purpose in life.

I've concluded that his world was created intentionally as an imperfect place where suffering abounds. My faith tells me that we are to love one another, but there would be no need for love if there were no suffering. Suffering is the vacuum into which the Breath love enters to lessen the suffering. Unfortunately, the Christian faith community has come to suppose that by sufficient praying and righteous behavior all will go well. That is obviously not the case, but my fellow Christians keep at it supposing that somehow God is delivering specific blessings when in fact, God expects loving responses to others, and assumes that we are prepared to suffer and carry our cross as life hands us suffering.

John wrote the book "A Sea of Broken Hearts" after his son's death due to medical errors. His comments about the beneficial effects of suffering reminds me of an observation by Rabbi Harold Kushner in his book, "When Bad Things Happen to Good People." Rabbi Kushner's young son Adam had progeria - a rare, debilitating and fatal illness. Rabbi Kushner said the suffering certainly deepened his own spirituality - but that the rabbi would gladly give up all that gain to have his son back....

Advice to those who’ve experienced a tragic loss: Faith, and praying with others in your community, can strengthen your purpose in life.

Read another story on the healing role of faith.

She kept the remaining ones: A fatal fentanyl patch drug error

After an accident several years ago, a woman got a prescription for fentanyl patches to treat her chronic pain. She didn't use all the patches, and kept the remaining ones.

Years later, her six-year-old daughter complained of neck pain late one evening. The foster mother gave her an appropriate dose of ibuprofen, and placed one of the left-over fentanyl patches on her neck to treat the pain. The next day, the girl was found unconscious in bed, and was pronounced dead by the time she arrived in the hospital’s Emergency Room.

Mike Cohen's advice to parents: Discard unused prescription medication after you're done with it. Ask your pharmacist about the safe use of fentanyl patches. Don't share fentanyl patches with anyone else.

Read another Fentanyl story.

Thanks to Michael Cohen for the source story in his ISMP Medication Error Report Analysis, published in Volume 43, Number 9 of Hospital Pharmacy.

Before he raced off to work: Perceptive listening about ventricular tachycardia

Dr. Bernard Lown describes how he found "The Hidden Clue:"

A college president consulted doctors over a decade for ventricular tachycardia, a very serious heart-rhythm disorder. He had been hospitalized in many of this country's leading centers and more than a dozen different medications had been tried, all to no avail. On his first visit, I asked at what time of day the arrhythmia occurred. He responded that it was almost consistently in the morning, before he raced off to work. When questioned further, he stated that it happened between about 7:30 and 8:30 am.

After gathering more information, I told the patient that his problem would be solved if he set an alarm clock to 5:30 am and as soon as he awoke, took a double dose of an anti-arrhythmic medication before going back to sleep. Following this counsel for the next eight years, he was totally free of arrhythmia.

It is astonishing that no doctor had tried to identify the precise time the arrhythmia occurred. Taking a much larger total dose of the same drug at intervals around the clock, as he had been told to do, provoked many adverse symptoms without containing the arrhythmia. The reason for the failure was straightforward. His evening dose had dissipated by early morning. The morning dose was taken too close to the onset of the disordered heart rhythm for the drug to have reached an effective therapeutic blood level. Furthermore, he needed a higher dose at that time to prevent the arrhythmia from breaking through. No amount of technical wizardry could have resolved his difficult problem. The solution would never have been unearthed without the information the patient provided.

Frequently a patient not only tells what is wrong but provides information suggesting how best to manage the problem.

Advice to patient and patient advocates: Be sure you have a doctor who asks you enough questions to perceptively diagnose your condition.

Read more from Dr. Lown's essay, "The Hidden Clue," in The Lost Art of Healing.

Prime time for medical error: The doctor’s daughter in the night shift

Seven-year-old Jacquelyn Ley was in the hospital for surgery for her shattered elbow. After surgery, night nurses gave her morphine via a pump, inadvertently setting the dose much too high. Luckily, her mother was there, spending the night in her daughter’s room. She noticed that Jacquelyn was barely breathing, and could have died.

Jacquelyn was lucky because her mother was there and because she knew her stuff: Dr. Carol Ley is Chairman of the Board of the University of Minnesota Medical Center and director of occupational medicine at 3M Company. Dr. Ley says, "the night shift, with its hand-offs and staffing issues, is prime time for medical error."

Advice: Get a patient advocate to be with you in the hospital.

Read another of our night-time stories, or read Max Alexander’s source story in the June 2007 Readers Digest.

First thing in the morning: A Hero Mom and a leukemia drug overdose

Her four year old son Michael had just been diagnosed with leukemia. After he spent five days in the hospital, his mother brought Michael Koster home and filled two prescriptions for him.

That night, as Pam prepared to give Michael his first doses of the medications, she read the directions from the bottles and thought something was odd, she told ABC News.

"I said, 'This doesn't seem right,'" Pam said she recalled. Checking with the local children's hospital, she says her fear was confirmed: the pharmacy had mixed up the instructions on Michael's medications, advising Pam to give her son a much larger dosage of a powerful drug, Dexamethasone, than the hospital had directed and to give him much less of a second drug, Methotrexate, which was key to curing his leukemia.

"I went to Walgreens the next day, first thing in the morning," Pam told ABC News. "The pharmacist who filled the prescription was there. I asked to talk to him specifically. I showed him the labels and said, 'This isn't right. I want you to pull what the hospital called in and show me what you did.'"

The pharmacist said he did not have the paperwork handy but would look into the matter. At first she resisted, Pam said, but eventually gave in after being promised the store would call her later that day with more information. The pharmacist's supervisor called her that afternoon, Pam told ABC News. Pam says she admitted the error and vowed to bring it up at the store's next staff meeting.


In fact, as Dr. Marlene Miller at Johns Hopkins Children Center in Baltimore reported today, children with cancer often get the wrong dose of chemotherapy or are given the drug at the wrong time, and many require treatment because of the errors. She and her colleagues studied 800,000 errors, of which 310 involved kids on chemotherapy. Of those mistakes, 85% reached the patient, and one sixth of those were serious enough to require additional care.

Advice to parents of children getting prescriptions: Check the label carefully, and if you find an error, show up and tell them so.

Read another of our children’s overdose stories, or read the source story by ABC’s Brian Ross and Justin Rood.

Thanks, Kim Slack and Joe Brownstein.

He saw God: A Painkiller Drug Overdose

Bradley Weafer, a 38-year old former social worker, received an overdose of ketamine, which is also used as an anesthetic, after undergoing back surgery in Vancouver, in Canada’s British Columbia.

He was supposed to get three milliliters an hour of the drug. Instead he got the whole 500-milliliter bag in five minutes. When the nurse went back to check on him after setting up an intravenous drip, she found him unresponsive and making jerky motions.

In court, Bradley recalled being sucked into black tunnels. It was hot and scary, he said, adding he saw his life flash before him, felt being born and placed in his mother's arms. He also said he saw God. He also testified he had suffered brain damage, and a psychiatrist and other witnesses supported his claim.

Now, six years later, the judge has ordered the health system to pay $63,000 in damages to Bradley for psychological trauma and damages.

Advice to patients on IV medications: Ask the nurse, or have your advocate ask the nurse, to verify and explain the pump settings for intravenous medications.

Read another overdose lawsuit story, or read CBC News’ source story.

He stopped strangers in the mall: Overdose lawsuits from misdiagnosis

Steven Ridley, a 45-year old husband and father of three in Napavine, Ohio, was suffering from back pain, so he saw his doctor. The doctor said his pain was due to a complication of rheumatic fever, and prescribed methadone, in a dose more than five times higher than recommended. Steven took the medicine, and died three days later.

His doctor believed there was an “epidemic” of undiagnosed patients in the county. Other doctors and state officials discounted this controversial theory. But the doctor persisted in believing it, and he even sometimes stopped strangers in the mall who had the red face he included in his diagnosis. His treatment was to prescribe strong narcotics, often methadone.

The state suspended his license to practice medicine. This was his sixteenth and final lawsuit, for up to 16 deaths of patients in his care.

Advice: If diagnosed with a rare disease, learn all you can about it, so you can ask intelligent skeptical questions.

Read another misdiagnosis story, or read Barbara LeBoe’s source story.

But the magazine said he was a Super Doctor: An overdose lawsuit

The cancer doctor’s web site touts the fact that he was named in Texas Monthly as a so-called “Super Doctor" in December, 2005. But earlier that year he had lost the biggest malpractice suit in the county’s history--$600 million!--and a month later, another patient died from a chemo overdose under his care.

How does a physician become a Texas Monthly “Super Doctor?” Or for that matter, a Best Doctor for D Magazine?

“Super Doctors” is actually the trademark of Minneapolis-based Key Professional Media, which has made a business of publishing “Super” lists. Key Media is secretive about how its “Super Doctors” are chosen, and would not disclose how many doctors vote, saying that number is “proprietary.” Every voter can vote as many as ten times. Lorelei Calvert of Texas Monthly says Key basically buys a section of the magazine, labels it a “special advertising section” and sells the advertising space to doctors.

D Magazine asks “Which Dallas Doctors would you trust to send your loved ones to for medical care?” Rogers says the D survey is announced to hospital PR staffs before it is mailed to doctors. This allows them to stump for votes among their own staffs. Each surveyed doctor could cast as many as 117 votes over 39 different specialties. D says it got about 25,000 responses from 1,014 doctors, and selected 640 people as “Best Doctors.” Doctors are offered the chance to buy an ad in D Magazine to “maximize their exposure” when they’re notified they’ve been chosen as a “Best Doctor.” It is the best selling issue of the year.

Advice on finding a super doctor: Start by checking the profile yourself, if you can. In Massachusetts, you should first look them up in the Board of Registration in Medicine’s web site.

Read the article by Byron Harris.

It turned out to be a few dozen: A misdiagnosis

Dr. H was working in the emergency room of a hospital on a Navajo reservation. Dozens of people had recently come to the hospital suffering from viral pneumonia. Blanche Begaye (a pseudonym), a Navajo woman in her sixties, came to the emergency room because she was having trouble breathing. She is a compact woman with long gray hair, worn in a bun. She told the doctor that she had begun to feel unwell a few days earlier. Thinking she had a bad cold, she had drunk orange juice and tea, and taken a few aspirin. Now her symptoms had worsened. She now had a slight fever, and was breathing at almost twice the normal rate. Her lungs sounded clear. A chest X-ray and a lab test of her white blood cell count made the flu or pneumonia unlikely.

However, her blood had become slightly acidic, which can occur in the case of a major infection. The doctor told Blanche that he thought she had “subclinical pneumonia”—an early stage of the infection, as the virus had not yet affected her lungs in a way that would show up on the chest X-ray. He ordered her to be admitted to the hospital.

A few minutes later, another doctor discovered that Blanche actually had aspirin poisoning. She was an absolutely classic case—the rapid breathing, the shift in her blood electrolytes.

Dr. H. had misdiagnosed her because the widespread viral pneumonia he had been seeing was uppermost in his mind. Rather than try to integrate all the information he had about her illness, he had focused on the symptoms that she shared with other patients he had seen: her fever, her rapid breathing, and the acidity of her blood. He dismissed the data that contradicted his diagnosis.

When he had asked whether she had taken any medication, including over-the-counter drugs, she had replied, “A few aspirin.” Dr. H. explained, “I didn’t define with her what ‘a few’ meant.” It turned out to be several dozen.

Advice for patients and advocates: Prepare a summary of your symptoms for the doctor, and be specific. If Blanche had specified the number of aspirin she had taken, she would have made it much easier for the doctor to diagnose. The doctor is on your team; treat him that way, and help him do right by you.

Read another story of a preventable adverse reaction, or read Dr. Groopman’s article in the New Yorker.

His Handwriting Could Be on our Wall: Overdose lawsuit

On Wednesday I described the chemo overdose that took the life of Armando Castellanos. Two features of his story are especially troubling: His family wasn’t told of the error. And his story is almost untold.

In the days following Castellanos’ death, the medical center was knocked not just for the medical error but also not alerting his next of kin about the Cisplatin overdose on Aug. 12 until just before he died. Medical personnel reportedly discovered the mistake — 500 mg instead of 50 mg — but stayed mum while Castellanos’ health declined. In the end, his family was informed of the dosage before they removed him from life support. The hospital did not inform the Coroner about the overdose, though the law requires the Coroner to investigate all questionable deaths in the county.

Second, Armando’s story has been reported only in his hometown newspaper. We need to tell his story more widely, to give each victim a name, to honor him, and learn from this error to protect ourselves. The Japanese quality improvement experts say, Every defect is a treasure. We say, Amen, and each person is a treasure. If we don’t learn from his story, we’ll be condemned to repeat his experience….

Advice: Get an advocate who can help you know if an error is occurring, and help you handle it.

Tell his story.

Read Michelle Durand’s newspaper story.

Handwriting: A chemo overdose lawsuit

The trouble began with a doctor’s illegible handwriting, continued with clarification of the order not being recorded and a pharmacist misreading the medicine dose on the prescription, according to the report by the expert investigators at the Institute for Safe Medication Practices. Armando Castellanos’ doctor had written a prescription for 50 milligrams of Cisplatin as part of Armando’s chemotherapy. But he received 10 times that dose, causing his death several days later. The family of the middle-aged Californian man received a settlement from the medical center.

Advice: Read the doctor’s handwriting on your prescription when you get it, and ask the doctor to rewrite clearly anything you can’t read.

Read another overdose story, or read more in Michelle Durand's newspaper article last month.

Warn your friends and family.

He Was Judge, Victim, and Addict: An adverse drug reaction

This story may seem too wild to be true, but was based on physicians’ testimony and records, as reported by NPR, Fox News, and others.

Unexpected harmful reactions to drugs (“adverse drug reactions”) can sometimes land a person in the hospital. Sometimes the damage is self-inflicted.

For 10 years or more, William Rehnquist, the former Chief Justice of the U.S. Supreme Court, had been taking Placidyl. Placidyl is usually prescribed for insomnia; others describe it as a prescription pain-killer. Known as a habit-forming drug, it is recommended for no more than nightly use, usually for no more than a week. Rehnquist had been taking two to three times the prescribed dose, for many years. Apparently this was deliberate; he may have consistently filled a three-month prescription each month. The prescribed dose itself was nearly toxic, so much so that an investigating physician considered the prescribing physician’s behavior to be “borderline malpractice.” One reason: overdoses of Placidyl can create severe drowsiness, continuing confusion, and slurred speech, among other symptoms. Rehnquist was admitted to a hospital, claiming stress and anxiety. The doctor’s diagnosis was delirium, brought on by the overdosing. Rehnquist hallucinated that he was hearing others plotting against him, including the CIA. A doctor reported that he tried to flee the hospital in his pajamas. During his week-long hospital stay, doctors gradually reduced his drug level, and substituted an anti-psychotic drug.

Tough advice for spouses: If you are worried that your spouse is abusing a medicine that may be addictive, look at the dates and the prescribing doctors on the drug labels. You may need to have a difficult conversation with the pharmacist, psychiatrist, doctor, or your spouse.

Read another story of a famous person’s medical error or hear Nina Totenberg’s report on National Public Radio.

Her Only Kidney: A drug error lawsuit

Tiffany Phillips had been born with only one kidney. She had a kidney transplant, and was discharged from the hospital to her home in South Carolina. The hospital’s doctors hoped the prescription they wrote for prednisone would keep her body from rejecting her new kidney. The medicine was not in stock at the Eckerd pharmacy, so the pharmacist there called a pharmacist at CVS. The pharmacist saw an alert on the CVS computer, but overrode the alert, and filled the prescription. Unfortunately, the pharmacist had dispensed the prednisone in 1,250 milligram doses rather than 250 mg doses, and the young woman took a five-fold overdose.

She was soon hospitalized and again is needing a new kidney, her lawyer said. Unfortunately, the mistake has left her with few alternatives. After taking too much of the steroid, she is unable to use dialysis. And she cannot have another kidney transplant. The error has reduced her life expectancy. The judge and jury considered that in awarding her an $8 million judgement against the pharmacy. The jury found the pharmacies 90% responsible. They found Tiffany 10% responsible because she had not noticed the correct dosage on her hospital discharge papers.

Advice to pharmacies: Require pharmacists to document their reason for an override of a computer alert, to discourage overrides. Require the approval of a second pharmacist to override computer alerts for medications for fragile patients, e.g., those who have just received organ transplants.

Advice to patients and advocates: Carefully verify the medicine label against the hospital discharge prescription.

Read another story of a drug error lawsuit, or read more about this one in Taylor Bright's newspaper story.

In Her Second Trimester: Medical device and overdose lawsuit

Sylvia Lane was 17 weeks pregnant. Diabetic, she lay in her bed in her Lynnwood, Washington apartment, comatose and alone, her blood and brain in desperate need of sugar. But the medical device she'd just received instead kept pumping insulin into her body, starving her brain. Her husband was on an aircraft carrier, halfway round the world. The small pump had a safety feature designed to stop the insulin flow in emergencies like this. But the feature had never been turned on. The pump had been shipped to her with the option turned off, and she hadn't known about the "auto-off" safety feature. She suffered severe and permanent brain damage. And her doctors determined that her growing fetus had suffered irreparable harm; she was not able to have the baby. Her family sued Medtronic Inc. — the parent company of the pump's manufacturer — claiming the pump was unsafe. Her family reached a settlement with Medtronic whose details have only now come to light. This riveting story is reported by Ken Armstrong and Justin Mayo.

Advice to patients: Before you use any pump, make sure you know what safeguards in the pump's design might prevent an overdose.

For another story of multiple errors caused by a machine, see The Machine Was the Perp.

Loving Intentions: A Medication Error

Saleem (not his real name) was a Syrian-born toddler, brought to the hospital with a viral infection, feverish, and bleeding from the nose on October 29. His mother, an X-ray technologist at the hospital, had given medicine to her two-year old son when he first became ill. Then, when Saleem started bleeding, she took him to the hospital.

The boy died soon afterward. Based on a liver biopsy, the physician in charge of the investigation into Saleem’s death found necrosis (tissue that had died from a lack of oxygen) and fatty tissue in his liver. He, the pathologist, and the government’s health department investigators are 98% sure the cause was a drug interaction or drug sensitivity.

Type of error:
This was a preventable adverse drug reaction, from the wrong drug, or perhaps from an overdose of the right drug.

Causes:
Apparently, Saleem’s mother had inadvertently caused her son’s death by giving him the wrong medication or dosage.

Ways to prevent similar tragedies:
Parents and grandparents should avoid giving one child’s prescribed medication to another young child; an infant’s organs may not be able to metabolize (break down and use) the medicine.

Readers: Is it ever acceptable for a parent or grandparent to give one child’s prescribed medication to a different child? When? Do you know of similar errors?

Read more in Nina Muslim's article, “Toddler’s death due to adverse drug reaction” GulfNews.com, Nov. 6, 2006.