December 9,2008

I know it has been a while since I blogged, but as you might imagine it has been hard to put into words the emotions you go through watching a disease like this effect your wife. Today however I am not low on words. I am PISSED. This I am afraid is a very counter-productive emotion that probably won't benefit anyone, but I can't help it.

As most of you know my wife was in the hospital for the better part of two weeks. Most of you are aware of what happened based on the e-mail I sent. I wanted to try and be a little clearer about what happened so that maybe everyone understands what we are going through.


I took Tiffany to the hospital on Nov 20th @ about 9pm with a slight fever and shortness of breath(SOB). We immediately were admitted to the ER and she was given 2 liters of O2 and pain meds and IV anti-biotics. They ordered chest XRAY and CT SCAN and @ approx 0415 they admitted her to the oncology floor based on her progressive disease and because she had a small right side pleural effusion(fluid on the lower right side of her lung). this fluid was believed the be a side effect from the clinical trial she participated in at DUKE, but the concern was that now that she had a fever that she may have an infection of sorts(pneumonia) and her oncologists should resolve this.


At approx 1000 the next morning her Oncologists and a team of residents and interns came into the room to tell her that they think her small right side pleural effusion was probably not from the clinical trial, because it never decreased in size with the lasix and steroids they gave her but that it was most likely a cancerous malignancy. no big deal so to speak to quote the DR we will just go ahead and start the Chemo(Navelbine) today vice next week, monitor you for a couple of days and then do outpatient infusions on a weekly basis until it is resolved.


I want to emphasize a couple of things here. The Chemo of Navelbine with Avastin was always the plan and just one week earlier he gave her an exam and said there was no immediate urgency to get the chemo on board and we could start on the 26th. Avastin is key in deciding on Navelbine as this is a biological agent that increases the chances of a positive response with Navelbine by 5 to 8%. Avastin has also been studied to increase the life of Metastatic Breast Cancer patients by 6 to 8months.


Moving on.


Her Dr at this point says he first wants to go ahead and do a Fine Needle Aspiration(FNA) also called a Thorocynthesis of the SMALL RIGHT SIDE PLEURAL effusion to confirm the malignancy, and then do the Chemo immediately afterwards. All part of his crossing the T's and dotting the I's so to speak. Her attending is DR Hopkins, and the resident performing the procedure was DR McDevitt. At around 1230 Dr McDevitt came in to brief the procedure. He said they were going to do a right side Thorocynthesis. He said they were going to use an ultrasound to find the spot, mark the spot, and then aspirate the spot. I even asked him why he would not use the ultrasound to guide the needle(known as an ultrasound guided FNA) and his response was that it was not required and that he has done this dozens of times and did not anticipate any issues. Our best friends Lora and Jeff were in the room for the brief and were then asked to step out. They did the procedure bed side and when I came back into the room my wife was already in serious pain. I asked Dr Hopkins what was going on and he said they bent two needles trying to get the fluid and were unable and that my wife just had thick skin. He said that they were going to get a pulmonologists up here to try and then walked out of the room. I sat on the bed next to my wife and it was evident to me that she was in much worse pain and holding her left side under her breast and said it hurt in her lungs. I then immediately went out to find DR McDevitt to ask what was going on, but apparently he had already been sent home. I asked Dr Hopkins what was going on and he said that what she was feeling was RADIATING NERVE pain. My wife would later tell me how she complained about the pain on the left side of her neck during the procedure but all Dr Hopkins said to Dr McDevitt was “Do you have the needle pointing down?”.


SO, this is the procedure and this is what happened. They DID THE WRONG SIDE. She never had a left side pleural effusion. EVER. Keep in mind nobody has told us this yet. As Tiffany’s conditioned continued to worsen I called DR Hopkins into the lounge to ask what the hell is going on. Cancer does not go this fast. Why has she gone further downhill since the procedure? He told me and I quote “Her cancer is progressing faster than I expected, and if I can’t get a response from the chemo she might not live much longer”. Keep that in mind as you hear the rest of the story, because the translation is that I think we may have just killed your wife, but luckily because of her cancer I don’t think anyone is going to figure it out. Dr Hopkins came into the room to tell Tiffany to hang in there and that she had a Nerve pain resulting from the procedure, but they were going to increase her meds. This was at around 1600(4PM). DR Hopkins then went home not to be seen until noon the next day. At 1730 they gave her the infusion of Chemo and by 1830 she was on her way to the ICU. She had spent all afternoon breathing like someone having a panic attack. O2 had been increased to 10 liters, pulse was getting higher etc. Even throwing up from all the pain meds they were giving her trying to resolve the pain. She was in so much pain that even as they were wheeling her off the floor they had to stop next to the nurses’ station and give her a shot of TORODOL in the ass to try and calm her down so she might breathe better. The whole trip to and time spent in the ICU was a nightmare. 3 times as soon as we were wheeled in with a half dozen people trying to hook up everything under the sun to her I had to stop someone from sticking her on her right side. She is not allowed to have any BP or needle sticks on her right side as a result of her prior surgery for risk of infection etc. This is very common and nurses are to always check this prior to performing these things. When I stopped this guy the last time some girl from across the room said SIR it’s not his fault he did not know. Of course my response was this is the third time and both of you need to PAY THE F**K ATTENTION> I was then asked to step out at which time I said I would gladly step out as soon as they found someone big and mean enough to make me. Moving on.

After a while I was approached by a DR PAK. He was the ICU duty DR and he explained to me that he would like to get a Chest tube in on that left side. Keep in mind that at this point she is on a Bypaps mask that was traumatically installed on a woman that was still conscious and fearful, tearful, and in serious pain, who did not understand what was going on either. How can cancer move this fast? How is it that last night we were in a little SOB, with a fever that had since come down, with a plan to start chemo today, and now somehow be talking about chest tubes and in the ICU. I asked Dr Pak why he wanted to put a chest tube in her and he explained that she was bleeding out on her left side into her chest cavity and that if he did not get a tube in there she would surely die. OMG. Are you F**KING KIDDING ME. This was not supposed to be like this. I asked why was she bleeding on her left side and he explained it was a complication from the LEFT SIDE THOROCYNTHESIS. I immediately said what LEFT SIDE THOROCYNTHESIS. He said the one they did up on the floor. I explained to him that there must be another reason because we did not do a left side, and he then said that’s what I am telling you now is that they did it on the left side. He assured me that he was not there for it, and that he had nothing to do with it, and just wanted to save her life right now. I then said ok lets get the chest tube in there and he said he was waiting for the coagulants to work because she had been given blood thinners. BLOOD THINNERS? Who in the hell gave her blood thinners and why was I not told. He told me that he did not know. So as you can imagine I am ready to do a Homicide at this point, but I am not even in a position to have her transferred. I later gave the authorization to do the Chest tube, which required a subsequent blood transfusion as she lost initially 850 m/l of blood which eventually amounted to approx 1350 m/l and they put a small one in, and then later had to take it back out and put a bigger one in, because it clogged. The is a result of the coagulant they gave her to counter act the blood thinners. The thing about a chest tube in case you don’t know is that it goes in your side to about the middle of your chest(almost) and then goes up towards your neck. A lot of tube, and it was done twice on her(of course), which does not make the whole thing less painful like getting immune to pain meds. One ICU NURSE even commented that she wanted to get a tattoo that said no chest tubes just to make sure she never had to suffer through that.

Something else to keep in mind is that it’s now well after midnight and her condition has done nothing but worsen. Pulse never below 120 at rest respiration never less than 35 to 50 breathes per minute(normal is 12 to 19). Her O2 saturation has went from 2 liters when she was admitted to 15 liters on a bypaps mask. I can’t even begin to explain the amount of IV pain meds, but the one interesting fact throughout all of this is that SHE HAD TO SUFFER. You see they did not want her to lose her PULMONARY DRIVE. Basically the only reason she continued to live was because she continued to fight for every breath and if they over medicated her she might not try so hard. Can you believe this SHIT? We eventually had to INTUBATE her and she was placed on a ventilator. That had some issues as well but I won’t go through that except to say that by 0800 on the 22nd her respirations were down, or should I say controlled by the ventilator, and by the next morning we were starting the process of taking her off the ventilator. By Wednesday we were back on the floor and by Friday we were shoved out of the hospital. She received another round of chemo and we were back in the hospital the next morning because her counts were low from the chemo. The story could obviously go on forever, or at least it seems that way, but here are some things that really BOTHER me, and I assure you I will get answers.

1.After finally getting her medical record there is no documentation of the thorocynthesis being done on the wrong side. NONE

2.Why would DR Hopkins tell me her condition was based on the cancer when he knew that it was done on the wrong side. Dr Hopkins came to the hospital the around noon the day she was intubated and admitted to me that Dr MCDevitt told him that he knew why they did not get any fluid, and that it was because they were on the wrong side. DR Hopkins knew this before we talked in the lounge but still did not tell me.

3.How did they end up on the wrong side? DR McDevitt told me that they were going to use an ultrasound to find the spot, mark the spot, and then aspirate the spot. How do you end up on the wrong side if you first have to find and mark the spot?

4.I saw Dr McDevitt in the passageway and he admitted to me that he was wrong and that he did the wrong side, and he was sorry etc, but when I asked him how did he end up on the wrong side if he in fact used an ultrasound and he said they had one in the room but did not use it. I later talked to an intern DR Habelow who was in the room for the procedure and she said they did use an ultra sound. So again how did they end up on the wrong side? This guy is suppose to be an attending in 6 months? Are you kidding me? He can’t read an ultrasound?

5.This is the thing that pisses me off the most. According to the record they say they did a left side thorocynthesis on a left side pleural effusion. That’s it, and then several hours later she is in the ICU. The whole thing is coming across as a cover up. How is this possible? Is my wife’s life less important because she has cancer?

6.Who gave her blood thinners and shouldn’t we have been told?

7.Who gave him permission to do the procedure twice when the first one did not work?

Tiffany suffered from a WRONG SIDE/SITE procedure in that the first needle punctured her lung causing her lung to partially deflate and air outside the lung, the second needle punctured a blood vessel and she eventually bled to the point of having to be intubated and fighting for her life. Nobody thought she was going to make it, and at the end of the day she saved her own life. We just got back from the hospital again yesterday because her arms swelled up bigger than mine, and after an ultrasound it was discovered that she has numerous clots on her left side. Of course the hospital is gonna say it is her cancer, but the truth is that this is a known side effect associated with central lines like the one she had installed in her when she was intubated.

After all is said and done, my wife had two chest tubes, a trip to the ICU(6 days), Intubation, extubation, blood transfusions, central line installation and removal. The fact that now she can never get Avastin because of the left side trauma and blood clots has limited the options available, ability to treat, and potentially shortened her life A fact admitted to her by her now new DR, Dr Reninger. She also suffered the pain associated with struggling to breathe and almost dying as a result of the wrong site procedure and they don’t acknowledge any of it, and lots that I am sure I don’t even know or just forgot to mention.

I have served this country since 1985 and for the first time ever I am ashamed of my uniform. Not because a mistake was made. Not because someone did not follow procedure, but because the integrity of which this whole thing has been handled goes against everything I thought the NAVY stood for. I know at the end of the day that the people that work at the hospital are not SAILORS. They are just people given a uniform because of their medical training and will probably never even tour a ship. Fact is though that they still wear the uniform. What happened to my wife will not go unacknowledged. Her days are too limited and too precious to me. We did not fight all this time to have someone treat her like a stray dog who does not matter. I apologize to everyone that cares for her. I was not able to or did not do a better job of protecting her. It was my only job and I failed. . I promise you I will get answers. I promise you that those responsible will be held accountable.

Stephen