Category Archives: Medical mistakes

THE WOMAN WHO HAD TO VIDEO HER STROKE

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So a woman having a stroke walks into an ER. And you’ll never guess the punchline. Yeah, they said it was stress.

In April 2014 a woman, Stacy Yepes, had one of a series of small strokes called a TIA (more on those below) and she went to the ER, described her classic textbook stroke symptoms. And was told it was stress by what are supposed to be competent doctors. Apparently she was also told that she needed to deal with her stress better (Now “all in your head” isn’t just a dismissal, it’s a guilt trip too!) And given instruction on how to manage her stress. With slow deep breaths. So, real jet age stuff. 40+-year-old woman in our society, yeah, she’s probably never heard that before. Interesting to me is that it’s a relaxation technique. Like for when you’re freaking out. Say at the dentist. So, the Bad Hospital people told her she had stress but clearly were thinking panic attack (stress, ripe piece of false knowledge, is normally portrayed as a pervasive force not a specific super noticeable event. This makes it less than useful when you want to use it to excuse inaction in the middle of a crisis! So now we have the panic attack.) Now, panic attacks may or may not exist. Certainly panic, the feeling, exists. Which begs the question what’s different about a panic attack versus a moment of panic? We’ll take that up another time. (Brief preview: it’s a mess.) Subsequent events will show Stacy’s not a panicky gal. So, if the doctors asked her about panic and she said no, what did they think? That she was a lying? “No, I feel perfectly calm. Get me the fuck away from these imbeciles!” So “stress” is now a panic attack and panic attacks have developed a deceit characteristic? “Oh, these panic attack people, always lying about the panic they feel.” Yeah. Right. Another problem: she’s having a fucking stroke! She knows it! That could make anyone panic, plus her doctor is AN IMBECILE!!!!!! Who doesn’t know the signs of a stroke from a flippin public-service commercial on TV! What kind of shithole hospital is this? she must of been thinking.

A word to medical people: if you bully, act crazy or really, really dumb – all common occurrences in hospitals – you will scare the living shit out of your patients, and yes that could make them appear panicky. So let’s not dismiss patient’s physical symptoms just because they are having an emotion (everyone always is) and especially one that you and your creepy, awfulness have induced. On top of which Ms. Yepes may have been perfectly calm. All we know is the doctor decided to say it was stress.

So the Bad Hospital sent her on her way. I cannot even imagine what that night was like. Ms. Yepes isn’t a stupid woman. (And no, in a situation like this, in a hospital you cannot just throw a tantrum and insist on seeing someone better. They just call security and might even have you arrested. Hospitals are well practiced and getting rid of their mistakes.) So Yepes is at home, goes to bed. Next morning another TIA. (No she doesn’t die in this story.)

This is what she experienced: the left side of her face drooped. And felt numb and tingly. Her talking movements were wonky. She still could but clearly not normal. And her left arm and leg got heavy and hard to move.

This is what happened inside her: a blood clot, which are not the little red spheres I used to picture but rather a long squishy piece of liver like thing, formed. So it’s in a vessel (blood pipe) in her brain. She had several of these TIAs (Transient = intermittent versus one big stroke where you go unconscious and you live or don’t. Ischemic, just means no blood so no oxygen to the tissues. Same thing as in a heart attack where heart muscle tissue is destroyed. Strokes are when that happens in the brain. The brain tissue is dying a.k.a. brain damage at all the thrilling problems that causes. And Attack is just redundant. Transient tells us it’s an event in time and can repeat. Oh wait, attack tells us it’s noticeable including by the person it’s happening too. Versus a transient event you don’t notice like some heart arrhythmias. So yeah Attack tells us it’s important!) Okay so a clot is in Ms Yepes’s brain, it could be short and stubby or really super long. And pieces of it are breaking off and stopping her blood supply, like someone standing on a garden hose, from getting to bits of her brain. This is a massive medical emergency. 1) because even a couple small clots that stop the blood supply briefly then dislodge (foot off garden hose) can cause life-changing and unpleasant brain damage. 2) but if the”mother clot” keeps shedding baby clots or breaks up completely, leaving the hunk of blood vessel lining it’s stuck to, it could kill her. Quick. That Yepes’s whole left side was affected, not just her head or vision or a weird skin sensation in a single big hunk of skin, means the middle cerebral artery was involved. (No, as I write this I haven’t seen Yepes’s medical records. Literally hundreds of thousands of people know those of the signs of a middle cerebral artery a stroke. This is not the hard stuff in medicine. And yet the Bad Hospital…) So Yepes is having little strokes that could build up to a big stroke that kills her. She goes to work. Yes, after a second TIA that morning. Why? Because the doctor at a hospital told her it was stress! This is why we can’t have nincompoops or any moronic blunders in hospitals.

After work Yepes is driving home and it happens again. She clearly has decided “screw the stress hypothesis” because she pulls her car over, gets out her phone and videos her stroke! Holy fuck! 1) she’s a genius, 2) WTF is wrong with our society and with our medical profession that something this evil is necessary? That’s a question I really want answered. How did the Bad Hospital fuck up so badly?

Then Yepes drove to a different hospital. She lives in a bedroom community north of Toronto but she drove to Mount Sinai Hospital in Toronto. The Toronto Star story on this doesn’t say if she needed the video at the competent hospital, or if they just listened to her textbook description. But they transferred her at once to the special stroke unit at Toronto Western Hospital. (Remember this is Canada so everyone has all the insurance they need for any in-hospital thing. And every test. And the Bad Hospital still booted her with a BS excuse.) At Toronto Western they did look at the tape but just to see it happening. And they treated her. Either with a clot dissolving drug. Or manual removal of the clot. With a kind of blood vessel rotorooter thing. And Yepes’s life was saved! And she was doing rehab at time of the Star article in June 2014. Hooray!

Now, here’s the thing, the article tells her story but never even names the Bad Hospital. There are no questions about an investigation at that hospital. Let alone what government agency now swoops in like the Transportation Safety Board does after a transport truck loses a load of watermelons on the freeway, to investigate this phenomenal stroke diagnostic balls up. Nothing. Nor any discussion of the lack of an investigative agency. The whole second half of the article is the stroke doctor (named, unlike whoever Yepes saw at the Bad Hospital) basically repeating all the points of a how to spot a stroke pamphlet.

One or more person at the Bad Hospital fucked up, big time. And Yepes could have died. You can watch: https://m.youtube.com/watch?v=SUzqLeC6XTQ She’s in her car doing the deep breaths the imbeciles “taught” her. And she could’ve died right there. That TIA was a little one. But it could have been a big one. How bad a failure of competence did the Bad Hospital personnel commit? 1) they should have immediately recognized when Yepes said that one side of her face drooped that this was a stroke. Why? Because literally nothing else affects only one side of the body, and is sudden onset. (Versus all the head colds we ever had: gradual onset.) The only other thing I can think of that affects just one side of the body is shingles. Also neurological. That’s how both can. ‘One side’ is a diagnostic gimme. So did she see a doctor? Or was she turfed by the triage nurse. Nurses are highly skilled. A nurse who didn’t know one side meant stroke would be an idiot. But triage in lots of hospitals is bullshit. It’s supposed to be a fast but real medical assessment. Often it’s no better than a) a check if you are bleeding and b) a time for staff to decide they hate you because you supposedly don’t have any ER worthy medical thing. Did Yepes see just triage or a doctor? Did the triage nurse write down that Yepes’s was a bullshit patient? Even give a bogus made up psych “diagnosis”: panic? I met a woman once who had started having convulsive seizures. Went to the ER, told: it’s panic. (Panic = leave the ER.) It was a brain tumor. Her husband had to pitch a fit to get her seen by a neurologist. Another person I knew had a long history of atopy: allergic with anaphylactic shock (which is fatal) to everything. Horrible condition. And asthma! Having an attack, goes to ER and once again: panic. So who decided Yepes’s problem was panic and not medical? Triage nurse? Or a doctor? A doctor hearing the one side thing should’ve just sent her to Toronto Western at once. Remember: at that point doctor or nurse, they knew she’d had a TIA, they knew that’s a small clot, they know clots are are like a long piece of liver and that the TIA could have been it, or just the beginning. Of a lot of small clots, so five or seven TIA in two days? Bing! Crippled. Or the “babies” of a huge fatal clot. They knew that. Because everyone in medical school is taught that. The doctor did the bedside neuro exam. (It is a defective, no-tech Stone Age piece of crap test for brain damage, but I will talk about in detail in another post. It is rubbish.) This includes having the patient move their face in various ways, supposedly to show weakness of the muscles. You can see Yepes doing those movements in her TIA video. (It makes me so sad. To a competent doctor her description of the face droop and numb-tongue way she was talking on the video is enough. It doesn’t matter how weak the weakness is. She should never have needed to do that. She described it fine in the first place. And Americans reading this remember: insurance for all the procedures and in-hospital drugs was 100% not an issue. Her government insurance covered all of that.) And because this was a TIA = transient, the very low sensitivity – meaning weak and crappy – bedside neuro exam would have been negative. Showed nothing. At which point the doctor should have said “are you having any of the symptoms right now?” She says no and looks at him like he has five heads. And that’s it. It’s a TIA. She described a TIA, she knows she is not having the symptoms when she clearly isn’t, ergo her account of the symptoms can be taken at face value. The only reason to do a bedside neuro in that situation is in case her degree of impairment is way worse than she’s saying. Like she’s 80% paralyzed on one side. If she’s seated how do you tell? This doctor clearly (since we know he did the bedside neuro tests, she’s repeating them in the video the next day) took the negative bedside neuro results to mean she did not have a TIA. So sharp he cut himself. The very nature of the TIA is that between the attacks there are no signs or symptoms. So the Bad Hospital is employing someone that incompetent. How that happened, would be one of the questions the Medical Fuckup Investigators would try to answer. If there were any. Does the hospital check their ER doctor’s references? If so, do they have any means by which to find out if they are turning their ER over to a joker like this? Was the doctor that Yepes saw a family practitioner i.e. a GP. Not an ER doc? If so, probably the problem. Undereducated for the job. (For any medical job?) But also may not be up-to-date on what to do with patients needing specialized care. This is probably a community Hospital outside the University of Toronto medical school’s network. But the main conclusion the investigator would draw is that this doctor is incompetent. Or weird. The doctor may have, for his or her own bizarre emotionally disturbed reasons, decided that Yepes had a psychological condition and that the doctor knew that. How? He just did. And thus she got her creepy stress counseling with the breathing crap. We will probably never know how appalling this doctor is. Or if he/she was responding to pressure from the administration to not have ‘too many’ patients. Because there is no Transportation Safety Board-like thing for medicine. There can and should be. And because even when the newspapers (including the crack mayor exposing excellent one!) do a story on a life-threatening medical fuck up they don’t dig. They don’t ask how did this happen?

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Filed under Bad hospitals, Medical Horrors, Medical mistakes, Strokes

EBOLA In Dallas, SARS In Toronto

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First we hear there’s an Ebola case in Dallas. The man is in hospital, in isolation and everything is fine. Today, October 2 we hear when he first went to hospital he was turned away. And I thought oh my god it’s like Toronto.

In 2003 SARS hit Toronto. And everything fell apart. The first SARS case in hospital was the fortyish son of the elderly patient zero. She got it in China came back to Toronto, passed it to her son. And died. First screwup, she got a sign out autopsy. That’s where if you’re old and have multiple diseases when you die they don’t do an autopsy they just pick one of them and call that the cause of death. This is considered completely acceptable. So her son is in the emergency room coughing all over everybody the doctor he saw, an intensive care doctor, thought he had tuberculosis. Funny thing, tuberculosis is a reportable disease. To public health and you’re supposed to isolate the person. Like immediately. (Isolate means put the person in a room by themself where the air from that room can’t mingle with the air from the rest of the hospital. It’s very clever and it stops airborne diseases from spreading.) Did they isolate him? No, didn’t have the facilities to isolate people at that hospital. Because hey the age of epidemics is like over right? So he coughed on a guy named Pollock, Pollock then passes it to his wife and they both died.

Before people die from SARS they have trouble breathing so they get intubated, the people who do that are anesthesiologists. Anesthesiologists got sick with SARS and passed it to their family members and at least one anesthesiologist and his teenage daughter were both on respirators in the hospital. But did not die. An entire hospital Westpark IRCC was taken over for just nurses and doctors who were sick with SARS. A lot of people were on respirators all at once. This actually helped lots of places prepare for the and H1N1 outbreak in 09. They were ready with the respirators because they knew they might have to, and would be able to deal with, an epidemic of people needing help breathing. Please be aware, the hospital in your town does not have 30 respirators just sitting around in the basement. They may well have used them many during H1N1. They had to order them. That’s one good thing that came out of this and where people showed that they had their head screwed on right. During SARS, and planning for what came in 09.

Two family doctors died because patients were sick with a cough went to see the family doctor. The city didn’t have adequate protocols or places to put people with suspected SARS. No isolation rooms.

Except for Sunnybrook hospital, the major trauma center in Toronto. The guy in charge there as soon as he heard about the SARS thing rented compressor units that allowed him to turn regular rooms into isolation rooms. They’re called negative pressure rooms. They’re used in treating cancer too when the patients’ immune system is all buggered. In cancer they keep everybody else’s germs away from the cancer patient. They worked. None of the other hospitals did that. Not right away anyway. Two infectious disease doctors at another hospital both got SARS. They lived.

In an epidemic like this the public health department of the city government is one of the most important agencies in keeping it from being an even worse disaster. What a thrill. They are in charge of tracing contacts. Anybody who came into contact with the person who has in this case the respiratory-cough-the-germs-all-over the place disease. We’ve all heard about contact tracing when there’s an outbreak of foodborne illness. At a banquet or from a store. Whatever. This is a little more complicated. It’s some individual person’s trail through the city. Okay so public health departments did this all the time in the era of polio. They do it now for sexually transmitted diseases. The city of Toronto was completely unprepared. Their computer crashed. They were reduced to using tiny slips of paper with peoples names on being stuck into little charts on for floor. Well you might say nobody expected SARS. Everyone knew it was coming for a fact. They didn’t know what the disease would be but they knew that an epidemic like that and like Ebola now, was coming. They’ve had a name for it since at least the 90s and that name is jet spread. Okay you may say but if they didn’t know what disease was going to be spread by the jets then they couldn’t prepare for it. BULLSHIT. The way you fight epidemics of air- or sputum-borne diseases is with barriers. With the negative pressure room. With gowns and masks and gloves. It doesn’t matter what the microbe, the germ, is. What the microbe is matters for the drugs you give the person who is sick. But the keeping it from being spread is a whole other critter. They didn’t preplan they didn’t prepare they were fuck ups.

People were in quarantine, now it’s s called isolation in, their homes. They had suspected SARS and some of them did, some of them didn’t but nobody could tell until a certain period of time had passed. So they had to stay in their homes in a different room from the other people in it and wear masks. And they had to change the masks every so often and they had to take Their temperature. And they were checked on by an organization that was monitoring them, the Salvation Army? I think. Lots of quarantined people to monitor. They had to call in volunteers. Like during a hurricane or something. So that sounds pretty good right? And it would’ve been if they had been able to do it competently. They kept calling to check their temperatures of people who had already died of SARS. Competent planning, competent administrative stuff in a crisis would have completely prevented that. This stuff is doable. But you have to spend the time and money before the crisis to prepare for it. You do drills. They didn’t drill. Is that on the Salvation Army? It’s on the city of Toronto public health department. Let’s hope the Dallas one is more competent.

It gets better. The epidemic was slowing, maybe it had stopped. But with epidemics you have to wait until there have been no new cases for some period of time. Depending on the incubation period for the disease. Okay so one hospital in the north of Toronto said oh it’s over we’re going to stop doing our special procedures with the gowns and masks and gloves. We’re going to stop isolating people in the hospital who have pneumonia when we don’t yet know that it’s SARS. You know, the proper precautions. So they stop them. And there was a secondary outbreak of SARS in that hospital. Old people died who were in there to get joint replacements. Even though the outbreak was in a completely different ward. Why did it affect them. Weaker immune systems. That’s medicine 101. They had all the information they needed to do a good job. And this secondary outbreak was in the media for days before the goddamn hospital administration brought back the gowns and gloves and masks. Everyone knew what was going on and some idiot in charge managed to keep the right thing from being done for days or weeks. So elderly people in for joint replacements died. So did a young woman who was in having a fibroid removed from her uterus. Something you can wait six months or six years before you have done. Absolutely elective surgery. If the hospital had told her the truth about this possible SARS outbreak, that in fact was one, she was simply have had it done later and she would be alive today.

This is why the level of governmental that is in charge of fighting epidemics in our society can’t fuck up on every possible point.

Let’s just hope they don’t do this in Dallas.

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Filed under Bad hospitals, ebola, Epidemics, government, Medical Horrors, Medical mistakes, public health, SARS