COMPLICATIONS OR HARM AND THEIR
IMPACTS
M
HEMADRI
'Complication' is
such a sanitised word. When doctors and nurses speak about complications the
language is purely technical, distant and mostly third party. When the
complication comes true, it is of course none of those, it is very personal;
physically and emotionally hurtful with huge trauma to to the sufferers and
their families, in so many ways that we can never understand or even describe.
The following is
about a series of extraordinary real life happenings that relates to a normal
British person from Portsmouth and his family. The words are a cut and paste
from the court judgement with a few minor changes to help normal reading.
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paste----------------------------
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The patient was aged 39. His father had for several years
been undergoing kidney dialysis treatment and was suffering from renal failure.
The patient was anxious to give his father the opportunity of a better quality
of life in his well earned retirement by donating his own right kidney, thus
sparing his father further dialysis treatment. The operation was performed on
26th February 2008. The hospital admits that the operation was
performed negligently, and to a degree recklessly. There are proceedings before
the General Medical Council against the surgeon in question.
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The consequences of the hospital's negligence have been
catastrophic for the patient and his family: physically, psychologically,
emotionally and financially. Although the patient's right kidney was
successfully removed and transplanted, the patient suffered irreversible failure
of the left kidney. In fact he should never have been advised to undergo the
operation at all given the grave dangers involved. That negligent advice was
compounded by serial mistakes during the operation itself. The patient's life
was saved only after many hours on the operating table during which he received
over 100 units of blood and fluid transfusions.
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During the course of the operation the patient suffered
further complications which have had far reaching consequences: a minor
myocardial infarction; ischaemic damage to the bundle of nerves known as the
lumbo-sacral plexus, which supply the right leg and foot; a thrombosis of the
inferior vena cava.
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The patient was left in total renal failure. He was in
hospital for nearly two months, during which he started to receive
haemodialysis. He developed a serious drug induced confusional disorder. There
were further re-admissions to hospital in March and April 2008, following which
he received dialysis treatment three times a week as an outpatient for a year.
This treatment affected him profoundly. He became severely depressed, frequently
contemplating suicide. He contracted serious infections, one of which
necessitated a further admission to hospital for four days in October 2008.
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The patient's own act of altruism and family devotion in
donating a kidney to his father, which cost him so dear, was reciprocated by the
patient's sister. With the same outstanding altruism and family devotion she in
turn donated a kidney to the patient, at very considerable psychological and
emotional cost. That operation, performed on 27th March 2009, was
successful. It released the patient from an indefinite regime of dialysis.
However, he lives with the constant fear that his body will reject the kidney
and it is common ground that when he reaches his early sixties that kidney will
require replacement. This uncertainty, and his experiences generally, have left
him with an understandable obsession about his health.
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Unfortunately a recurrent infection was imported with his
sister's kidney, cytomegalovirus viraemia (CMV). This is a constant source of
worry. So is his blood creatinine level which, if raised, can be a sign of
kidney rejection.
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The renal failure the patient suffered increases
significantly the risk that he will suffer from ischaemic heart disease and a
stroke. Consequently he adopts a very careful lifestyle and diet. He has had
high blood pressure and high cholesterol levels which cause him constant worry.
The immuno-suppressant drugs he takes, in particular to control the CMV, greatly
increase the risk of his developing other debilitating and life threatening
conditions. The consequence is that he has become fastidious to the point of
obsessional about personal and general hygiene, which impacts upon the whole
family. He can be irritable and overbearing. He is prone to bouts of weeping.
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There are further serious physical consequences. The
nerve damage suffered during the negligent operation has resulted in altered
sensation below the right knee. There is hyper-sensitivity, pain and loss of
sensation in various parts of the right foot, and clawing of the first and
second toes. He has had surgery on the first toe. Further surgery had been
planned to straighten and fuse the toes but this drastic measure may be avoided
by regular injection of botulinum toxin for life. The issue surrounding this
problem with his foot has a bearing on his residual earning capacity. Currently
he is unable to run, and walking on uneven ground and stairs presents some
difficulty.
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The patient has also been much distressed by urinary
difficulties. For a time self- catheterisation was attempted. He found it a
dreadful experience. Urinary frequency bedevils his daily life, and results in
broken nights for him and for his wife.
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The medication he takes has had unpleasant side-effects
including the profuse growth of unwanted body hair, the development of skin
acneiform lesions and the deposit of facial and abdominal fat. His inability to
exercise has also led to undesirable weight gain. Prior to the operation, the
patient was a healthy, fit and active 35 year old man. He took great pride in
his health and fitness, running several kilometres each morning to set himself
up for the working day. He had enormous energy. He was cheerful, optimistic and
extrovert.
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Now the picture is very different. At the age of 39 his
daily life revolves around his health worries. He is constantly fearful of
infection or changes which may increase the risk of the kidney being rejected.
Any venturing from the strictly enforced hygiene of the home is fraught with
anxiety. He lives with the certain knowledge that the kidney will require
replacement by the time he reaches the age of 61 and that this will be preceded
by symptoms of progressive renal failure. It is agreed that his life expectancy
has been reduced by 10 years.
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The patient's wife
says that the patient is a shadow of his former self. He is lacking in energy.
He is exhausted by 9 pm and generally has to be in bed by 10 pm. He is moody and
irritable. Their marriage, though very strong, is constantly under strain. The
children have been affected and distressed by their father's condition and
behaviour and he has bridges to build there.
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paste------------------------------
The above example
was of course extraordinary, further the issue reached the court of law
otherwise we would not have heard it in such a profound and full sense. It might
have reached us through the press in which case we would have discounted it for
journalistic embellishment. In reality most if not every healthcare related
'complication' has impacts on patients' lives which are significant but we will
never hear about it.
Perhaps it is time
to start describing some of the possible known effects of complications on
patient's lives should be described in a way that it really affects patients
lives. Let me explain. Do you think the hospitals, doctors or nurses when
explaining or consenting patients for surgery ever tell them 'if you had one
of the severe complications your marriage could be constantly under strain; your
children could be affected and distressed by your condition and behaviour and
your may need bridges to be built with them as a
result''?
For instance When
we talk about surgery on blood vessels in the limb we mention 'amputation' as a
possibility. Does that really describe anything to a patient who has never
experienced or seen amputation before? Perhaps we ought to tell them how in the
initial days even to move from side to side in a bed they would need support,
their entire body will need to put in daily heroic effort to cope, they will not
be able to do any sort of work for many months, if everything goes well it will
hurt during wound healing, during dressing change, during physio, during limb
fitting, when using the limb. When goes wrong it will hurt more, more often and
for longer – if it goes wrong even more it will hurt every day of their lives
(phantom limb pain). They will need to know that the pain will need strong pain
killers, strong pain killers will cause constipation, constipation could cause
fissure which will hurt even more. They would need to know that if the wound
breaks down their raw cut bone could stick out. Well, even after these
descriptions we haven’t even made a start on the long list and impacts in a
proper way!! These are only physical.
Perhaps we need to
tell them that they may not be able to drive a normal car; the pain could drive
them to become an alcoholic if they are lucky and a drug addict if they are
unlucky. Perhaps they need to know that their family and friends will provide
sympathy which the patient could misinterpret and end up feeling patronised resulting in
phenomenally strained relationships all around.
God help us avoid
complications.
Complications are
true complications only when every effort at our command is made
to avoid them from happening and yet they happened, otherwise it cannot be
called a complication; it is called harm. As an illustration, if a patient
developed deep vein thrombosis due to omitted drug thromboprophylaxis, poor
mobilisation, poor hydration or pelvic injury at surgery that DVT is healthcare
caused harm; similarly if a spinal or epidural catheter was removed without
regard to when chemical thromboprophylaxis was given and the patient developed
spinal cord problems, that would be harm caused by heal. DVT prevention is an
easy example, there are thousands of other ways that healthcare's omissions,
commissions and disagreements hurt patients; they can no longer be
euphemistically called complications any longer.
Here is something
uncomfortable, a number of these problems happen because of us (organisation or individuals) though we are often unable to even recognise that.
Once again, the
impacts of complications on peoples lives is something that healthcare
professionals would not be able to even begin to understand, or describe. There
are specific tried and tested methods to avoid harm or to reduce them to their
minimum possible. Most healthcare providers do not have to do world beating
cutting edge stuff, they only have to put in some effort to just avoid harm in
healthcare. If it was done that would count as Success in Healthcare.
© HEMADRI
Ref: http://www.judiciary.gov.uk/Resources/JCO/Documents/Judgments/xyz-judgment-14022011.pdf
