Although GI symptoms and endoscopic findings of ulceration correlate poorly, I invariably continue to ask patients about upset stomach symptoms, and I always ask whether they have a history of ulcer disease. Once a patient gives a history of ulcers, I try to get an idea of the severity of the problem, and I ask follow-up questions regarding hospitalization, blood transfusion, or surgery. Nowadays, only the sickest patients with active GI bleeding require hospitalization, but things were different in the distant days before our high-priced drugs. One man told me that he had an ulcer in 1965. Treatment options were very limited. Ulcer patients from that era frequently tell me their treatment included dietary remedies such as eating baby food for 6 weeks.
My patient was hospitalized in the era before proton pump inhibitors. He told me he had been having a lot of upper abdominal pain, and the doctor ordered an injection of pain medication. The evening nurse administered this but forgot to chart it. The old saying goes, "if you didn’t chart it, you didn’t do it." That was exactly the conclusion of the night nurse. Seeing that the injection had not been charted, she also gave my patient a shot.
Perhaps my patient was exaggerating, or perhaps the passage of about 46 years altered his memory of the event, but he told me that after receiving two injections fairly close together, he slept for 3 days. He probably benefited from the sleep, and when he finally woke up from his iatrogenic hibernation, his hospital roommate told him that he had become a semi-celebrity. Lots of important people from the hospital administration had been holding candlelight vigils at his bedside and were hoping that he would recover and not sue the hospital.
Hospital administrators were only too happy to make amends, and they reassured my patient that the nurse who had failed to document his first dose of pain medication had been summarily fired. Although some people might have been appeased by this bit of obsequious viciousness, for my patient it had the opposite than intended effect. He told them they had to rehire the nurse immediately, or he would sue the hospital. He had the hospital over a barrel, the hospital knew it, and they promptly rehired the nurse.
Anyone could make a mistake, he told me, and besides that, the nurse was a widow with two children to raise. I was overwhelmed by this man’s magnanimous spirit, but I was bothered by a nagging question. He had been sick and heavily sedated for 3 days, so how did he know that the nurse was a widow with two children? I asked him this question, since digressions like this are the best part of my job. When I spoke with him, he was a tremulous old man with many chronic problems, but at the time of his hospitalization he had been a police officer. He had investigated the accidental death of the nurse’s husband! I was awed by this amazing coincidence, and I couldn’t help but think that perhaps the greatest form of quality improvement is forgiving an occasional mistake, something that has become increasingly rare in health care. It seems as if everyone is touting the greatness of evidence-based medicine, but there’s a lot of homespun wisdom in this anecdote. Perhaps a little more wisdom, plus some low-cost generics, might be just the thing health care reform is lacking.
Dr. Greenbaum is a rheumatologist who practices in Greenwood, Ind. E-mail him at rhnews@elsevier.com.