A reader sent me their horrible experience of being awake and paralyzed while getting intubated for respiratory support for a COPD exacerbation. And now, a bunch of lawyers are getting involved. It didn't have to come to that:
Hi Happy. I have a horrific story I wanted to tell you about. It was the worst day of my life. I am a long time smoker, who quit last year thanks to your daily harassment of smokers. I am one of your quit smoking success stories. But you and I both know that my lungs aren't normal. That's where the worst day of my life came into play. I'm 67 years old. Four months ago I was admitted to the hospital because I couldn't breath. They called it a COPD attack. I got put on one of those breathing machines and that's where my Hell started.
While they were putting the tube in, something must have gone terribly wrong. I'm just a lay man, but even I know you aren't supposed to be awake when they do it. I couldn't move. I couldn't talk. But I was completely awake and aware of everything going on around me, including when they jammed that damn tube in my bladder. I felt like I was drowning and being buried alive at the same time. But I was paralyzed and couldn't do anything about it.
They only realized something was wrong when my blood pressure shot up. I could hear the panic from everyone in the room. Finally, they realized that the medication that is supposed to make me go to sleep never made it into my vein in my foot. My vein had blown and I could tell no medicine had made it into my system because I could feel it.
This was the worst day of my life.
Have you ever heard of this happening? The hospital thinks I made the whole thing up. I know I didn't. It really happened. What do you think? Now it's all up to the lawyers to sort it out.
That sounds horrible. I can't say I've been involved in an episode of patient care where the patient was paralyzed from being given paralytic medications but still awake because the sedation medication didn't work. I can't even begin to imagine what that must feel like. I would suspect that all the nurses and doctors must feel awful about the possibility of having their patient paralyzed but not sedated.
I believe you. And in fact, it wouldn't surprise me that this series of events probably happened. Considering your IV was in your foot, you likely had very difficult IV access and the nurses and anesthesiologists did the best they could to stabilize you with the veins they had to work with, during your near death illness. They saved your life under the least optimum conditions. It sounds rude, but it's not your doctors' or nurses' faults that you had bad veins. Perhaps, if they had a vein light at the bedside, things would have been different. But that's not something every hospital has the money to fund.
Unfortunately, a foot IV is not the best of circumstances, but when you're in an urgent situation, you deal with what you have to the best of your abilities as a nurse or doctor. Because you were paralyzed, they really had no way of knowing you were awake. Their main focus, I'm sure was to get a breathing tube in you and secure your airway and maintain your hemodynamic status. Everything else was secondary. You couldn't thrash around. You couldn't reach up and pull the tube out, which would be the natural response to suffocating. You couldn't do anything. And it's unfortunate you had to go through this experience. But I'll say it again. They saved your life under the least optimum circumstances. That you are here today to discuss the whole thing says that things worked out.
The unfortunate part about this whole story is that the physicians and nurses and hospital administration should have simply acknowledged that your IV had likely blown and you were awake during the whole ordeal. They should have said:
I'm sorry. You had a complication of our life saving therapy. We meant you no harm. We wish it wouldn't have happened but it did. We are grateful you are here today to discuss it. We don't think there is anything we could have done to prevent it, but we will treat it as a sentinel event and we will investigate our systems processes to see if it can be prevented in the future. We are willing to discuss compensation for your pain and suffering if we can determine that what you experienced was preventable given the urgent condition of your near death experience.
I suspect if that's the course your hospital had chosen to take, that's the course you would accepted as well. The hospital culture is a major determinant of how they respond to adverse events. Now, instead, we have doctors and nurses and hospital administrators who provided the supplies to save your life lawyering up and hunkering down for a lawsuit. Nobody, except the lawyers, will come out ahead with this one.
As a physician, I view your experience with a different set of glasses. I know this could very well happen to me during a middle of the night intubation. The bottom line is these people saved your life. You experienced a horrible complication, but one that was not likely to be preventable, unless an honest review of the process determines it was.
As a physician, I view your experience with a different set of glasses. I know this could very well happen to me during a middle of the night intubation. The bottom line is these people saved your life. You experienced a horrible complication, but one that was not likely to be preventable, unless an honest review of the process determines it was.
You had unintentional suffering. Was it preventable? Was it somebody's fault? I don't know. Sometimes, medical care doesn't go as expected. If there is one thing I've learned in my last seven years as a hospitalist is that we, as doctors and nurses and all the other care providers, can only do so much to prevent bad outcomes. Sometimes bad stuff just happens, despite our best intentions and there isn't anything we can do to predict or prevent it. But if there is, we should do everything in our power to implement those changes.
As a patient, the last thing I would want is to sue a hospital, doctors and nurses who will likely be taking care of me for the rest of my life. You will always be known as that patient who sued. They will always treat you differently and probably not in a good way. They will be more aggressive and more likely to intubate you for fear of your legal trigger finger. You are more likely to get more of everything. Sometimes forgiveness is the best course of action. Your graciousness could perhaps place a seed in the hearts of other doctors, nurses and administrators to compel them to do the right thing the next time, for you and others. It's amazing what happens when you let down your guard and spread good will to others, even when they don't feel compelled to do the same for you. When you take the higher road, you take a win for everyone.
As a patient, the last thing I would want is to sue a hospital, doctors and nurses who will likely be taking care of me for the rest of my life. You will always be known as that patient who sued. They will always treat you differently and probably not in a good way. They will be more aggressive and more likely to intubate you for fear of your legal trigger finger. You are more likely to get more of everything. Sometimes forgiveness is the best course of action. Your graciousness could perhaps place a seed in the hearts of other doctors, nurses and administrators to compel them to do the right thing the next time, for you and others. It's amazing what happens when you let down your guard and spread good will to others, even when they don't feel compelled to do the same for you. When you take the higher road, you take a win for everyone.
