The power of knowing “what happened?”

 

The past few days, a ghost from the not-too-distant past has been visiting. Someone I didn’t know was still with me. Someone whose impact I didn’t fully appreciate at the time.

The patient was a man who seemed much younger than his 30-odd years, in part due to some mild cognitive impairment. He had a childlike vulnerability, a fragility that was accentuated by the fact that he was very ill and nobody could quite figure out why. I was the sub-intern on the medical service and he was not my patient, but I met him on rounds, heard the other team members talk in a worried manner about his hospital course, observed that his frightened and fiercely protective parents never left his bedside.

And then one morning I arrived at the hospital to find the third-year medical student ashen-faced and shaken and the rest of the team somber. The young man had suddenly died the previous evening during a procedure under anesthesia and nobody knew why. The student had watched the whole thing; the intern in charge of the man’s care had been called to the hospital immediately. Afterward the two of them together went to tell the parents, who were eagerly awaiting their son’s return to the medical floor, that he had not survived.

For the rest of that month, the medical team talked about the young man constantly. What exactly had gone wrong during the procedure? Should the procedure never have been ordered in the first place? What, if anything, could they had done differently? The attending suspected perhaps something had gone wrong with the anesthesia, though the anesthesiology team insisted that nothing was wrong on their end. Everyone felt guilty.  Everyone felt terrible for the family.

Eventually an autopsy was done showing that the young man had metastatic cancer and was undoubtedly far more fragile than even the team had suspected. As far as I know, that was the conclusion of the story: the patient was sicker than anyone knew and he died. The month ended, I moved onto my next rotation, and the residents and other student did the same. I never saw the family again. In fact, I mostly forgot about them.

The past few days, at Telluride East, I and the other students have heard powerful stories from patients about their experiences with medical errors. We’ve heard them talk about the shock and grief of dealing with a loved one’s unexpected injury or death, and about the pain of not having answers to the question “what happened?”

I don’t know if the patient I met on my sub-internship died because of a medical error or if his death was truly unavoidable. In fact, I’m not sure if anyone knows. I also don’t know if the family was aware of how many unanswered questions the medical team had about the conditions surrounding the young man’s death; I suspect nobody ever told them. In retrospect, I think that it would have been therapeutic for both the team and the family to open the doors of communication, and that it would have helped the family immensely to know of the team’s doubts and fears and concerns and guilt.

Nothing can undo a pain like the one the family experienced. But hearing others’ stories has given me a deeper appreciation now of the importance of openly, honestly, and thoroughly answering the questions “what happened?” and “why did this happen?” when such an event occurs. Not only can the answers to these questions help to prevent future deaths, they can also be healing for patients, families, and providers alike.

 

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