why doctors retire…

Posted on Thursday 18 February 2010


Navy opens review of care Murtha received in surgery
CNN

By Barbara Starr
February 17, 2010

Washington (CNN) — The National Naval Medical Center has opened a review of the surgical care provided to the late Congressman John Murtha after the Pennsylvania Democrat died following surgery, a senior U.S. military official told CNN Wednesday. The official declined to speak on the record citing privacy concerns, but confirmed to CNN that the review includes an in-depth "quality assurance review of the outcomes" of the care Murtha received. The Navy is keeping the Murtha family apprised of its findings.

Murtha had his gallbladder removed by laparoscopic surgery January 28 at the National Naval Medical Center in Bethesda, Maryland. He later became ill and was admitted to Virginia Hospital Center’s intensive care unit January 31 in Arlington, Virginia. Murtha died there February 8 at the age of 77. Military sources say it’s believed Murtha’s intestine may have been nicked during the initial procedure, leading to massive infection. A source close to the congressman confirmed that theory to CNN’s senior medical correspondent Elizabeth Cohen earlier this month.

"He went in for a routine, minimally invasive surgery" but doctors "hit his intestines," the source close to Murtha told Cohen. The review is being conducted to determine if Murtha died due to a preventable surgical error and whether any action against those who performed the surgery is potentially warranted…

As many as 500,000 gallbladder removal operations are done each year in the United States, with relatively few complications. At most, only one out of every 1,000 patients dies during gallbladder removal, according to the American College of Surgeons. Factors that increase the risk of death include gangrene, a burst gallbladder or severe diseases. The laparoscopic surgery is a safe, minimally invasive procedure, said Dr. L.D. Britt, president-elect of the American College of Surgeons and professor at Eastern Virginia Medical School. Out of hundreds of thousands of cases, only a handful result in damage to the intestines, he said. Precise statistics are not available…
Sooner or later, every doctor is going to nick the intestine [or something very like that]. I remember considering that back in the sixties when I was in medical school and thinking about choosing a specialty. The way I said it back then was:
    Surgeons can’t ever be heros. The best they can be is  adequate [which means perfect]. If you do it completely right, the best you get is a patient who has a big bill to pay, a lot of post-operative pain, who has gone through something they would rather have never had to deal with in the first place. If you don’t do it completely right, you feel guilty and ashamed, get sued, and no matter how many excuses you or others make, the result is with you forever. Sometimes even if you do perfect surgery, the outcome is awful and you feel terrible anyway.
Then, you read this, "… died due to a preventable surgical error and whether any action against those who performed the surgery is potentially warranted." I liked doing it [surgery], but I was slow, and I don’t know if I could have ever developed the meticulous attention to detail that characterizes the surgical personality.

Yesterday, I was up at 4:00 AM. We got to the Atlanta Hospital at 6:00 AM. The Neurosurgeon who was to operate on my wife’s herniated disk had a hand injury, so the surgery was performed by one of his partners who we met for the first time in the pre-op room. Surgery [Middle English surgerie, from Old French, short for cirurgerie, from cirurgie, from Latin chÄ«rÅ«rgia, from Greek kheirourgiā, from kheirourgos, working by hand : kheir, hand; see ghes- in Indo-European roots + ergon, work.]. She went into the operating room at 8:00 AM and was in recovery by 9:30 AM. We left the hospital at 5:00 PM, fought the Atlanta traffic and were home by 7:00 PM [in time to watch the Olympics and eat KFC]. The Sciatica [leg pain] that has wrecked her life for a year is totally gone, but the operative incision is very painful today and barely made tolerable by the pain medication. Had things gone badly, I would kick myself for an eternity for agreeing to change Surgeons, but it went fine. After a week of misery, this will all be relegated to the mostly unremembered.

I expect John Murtha had a day like my wife’s yesterday back in January – Modern Miracle Laparoscopic Gall Bladder Surgery and home by the afternoon. A nicked intestine doesn’t cause symptoms until later when the infection sets in. Three days later, he was readmitted, presumably with sepsis and died in a few days. Did the surgeon screw up? Maybe. Maybe not. It doesn’t really matter because the outcome answers the question — "Yes!" The Surgeon[s] will have to live with that outcome sitting in front of the other thousand good outcomes. The ones that go badly are the ones you remember. They’re all are indelibly etched in my mind.

Watching the medical scene yesterday with the crowds of patients coming in for surgery – with the hospital staff juggling the need for speed and the need to do it right, I remembered why I was ready to retire at 62. I loved the work, the challenges, but the background weight of responsibility took an increasingly palpable toll. In my case, forty years was all I had in me. I still do some volunteer work and love doing it, but I don’t have an answering service, I don’t take "call," and my cell phone stays in the car. My friends say, "I never thought you’d ever retire." They all ask, "What do you do?"

And when I sat in a room with a patient on Tuesday who fell and had a concussion when I increased one of her medications in an attempt to help her with an intolerable symptom, I felt bad. It was a dose of the medication most people tolerate well, but not her. She was forgiving. And I’m glad her fall was just a concussion instead of something more ominous.   She  We were just lucky. That’s all. I thought about John Murtha and his Surgeons as the patient and I talked. They weren’t so lucky…

I’m ready to comment on most things government, but I have almost to say about the Health Care debate. As I sat around in the hospital yesterday, I was aware of how impossible the compromises are in Health Care. There are a jillion things that push up the cost of care that are cya [cover your ass] things. And there’s a push to move people through quickly to keep costs down. It’s like every medical act is like the surgeon’s knife. Get it done fast, perfectly, with no loophole for malpractice, but keep it inexpensive. The forces at work create an impossible dilemma for the people working in the system and it shows on their faces…
  1.  
    Jack
    February 18, 2010 | 10:22 AM
     

    Glad to hear Sharon’s surgery went well; best wishes for good recuperation. Having spent a career as a trial lawyer primarily defending civil suits I saw the phenomenon you describe quite often. Any trial occurs far removed from the exigencies of the circumstances of whatever event resulted in injury–years later, in a sterile courtroom environment. There is always an expert ready, willing and able to testify that no matter what happened, it was not an accident, but could only be someone’s fault. While there clearly are cases in which injury results from negligence, your point is well taken that all too often perfection is the expectation and demand. Several years ago the Georgia appellate courts eliminated the legal defense of accident in personal injury cases.

  2.  
    February 19, 2010 | 4:52 PM
     

    I’m also glad to hear that Sharon’s back pain will be gone now. Hope the recovery stage passes quickly.

    I was struck by the immediate news headlines about Murtha: “surgeon’s error” figured prominently, as though it was already a foregone conclusion that the surgeon had done something wrong.

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