Empowered Patient, Myself.

I was watching a news report on CNN the day before, titled The Empowered Patient. There was a story about a lady who was misdiagnosed by a doctor which almost cost her life.  I occasionally come across these situations in my professional life. But the story I have for you is more personal and involves my then 3 year daughter.

We just moved to Tampa around that time. We were sitting on a new sofa which we recently bought, watching a late night TV show. My 3 year old daughter was doodling something on a paper at the same time chewing on a pencil. After a while she tried to climb the couch, as soon as she came up she fell down, face first with the pencil in her mouth. She started to cry and I saw a speckle of blood at the corner of her mouth. I immediately examined her mouth and I noticed a small amount of blood at the palate. My wife who is a physician too washed her face, gave her some cold water to drink and everything seems to be alright.

Around 11 pm my daughter started to fuss a little more and complained of mouth pain. I decided to take her to the ER after my wife insistence. In the ER she was examined by a familiar physician. He examined her ear, nose and throat along with a chest X-ray. He diagnosed her with middle ear infection and prescribed her codeine and antibiotics. I was perplexed; I could not fathom how she would develop an ear infection after this kind of injury. He assured me she must have an underlying problem which is manifesting now. He added “Irfan, you are analyzing things like a father rather than a physician”. I was confused, but there was nothing else to do. After his repeated reassurance I brought her home around 4 AM with instructions to restart feeding with milk and food.

Her condition at home started to deteriorate, around 5:30 AM she started to develop shortness of breath and became lethargic. My wife looked at me and said “We need to take her back to a different hospital; my motherly instincts are telling me that there is something terribly wrong here”.

As we were putting her back in the car I got a call from director of the ER. He said “ the other doctor missed a finding on the chest x-ray, you daughter has pneumomediastinum”. I felt like being kicked in the chest. Knowing pneumomediastinum is an air collection (mostly after a trauma) in the space between the lungs, this space is in the middle of the chest (the mediastinum). Basically the pencil penetrated her throat, made its way into the space in the middle of her chest. This created an opening between the throat and the chest. We had been feeding her milk, a perfect medium for bacteria. Infection with pneumomediastinum has a very high mortality rate.

We literally ran to a different hospital where she was seen by an excellent ENT and ER physician. She had few procedures, couple of tubes and she was admitted to the ICU for a week. She recovered without any residual problems and we brought her home. A happy ending.

There are certain concerns though. To err is human. But how do you deal with your mistakes. Full disclosure would help in most cases. I never got a call from the physician who was involved, he never explained what happened even after we met; considering this could have resulted in a disaster if we were even an hour late. A sincere explanation would have sufficed. That is where transparency comes in.

On the flip side systems puts in place for patient safety helped us save her life. Any X Rays read by ER physicians are read again by the radiologist, which decreases the chances of error. I am glad that this system of checks and balances exist, as this improves the safety of our patients.

About the Picture: At a lake nearby.