the-device-hospital-surgery

Patient Safety Awareness Week – A Book Review of “Your Patient Safety Survival Guide: How to Protect Yourself and Others From Medical Errors”

Seeing as though today is the final day of Patient Safety Awareness Week, I thought this would be the perfect time to present my review of a highly acclaimed book on patient safety and healthcare. Anyone who knows me will tell you that I am a pretty avid reader. I will read just about anything and everything, just as long as it appeals to my emotions and/or experiences at any given time. Given that my life currently consists of ongoing medical appointments and other healthcare management tasks, most of the supplemental reading I’ve been doing over the last few years (outside of assigned reading for school and keeping up with pertinent medical journals) has primarily consisted of self-help books relating to chronic illness, psychology, and navigating the medical system. So, when I was given the opportunity to review Your Patient Safety Survival Guide: How to Protect Yourself and Others from Medical Errors by Gretchen LeFever Watson, I was extremely elated. Although I had originally planned to take advantage of this opportunity during winter break from school since I knew that I would be recovering from a total hysterectomy and would be looking for things to do while stuck in bed, I am honestly kicking myself for not clearing some time in my schedule prior to surgery because I could have really used this information before my own patient safety was put at risk.

For those of you who are unaware, I was scheduled to have a total hysterectomy on December 8, 2017, using the da Vinci Robotic method in order to rectify the excessive and erratic bleeding that started as a result of complications from late-onset endometrial ablation failure following my NovaSure procedure in 2015. Unfortunately, what was supposed to be a “minimally invasive” procedure with “minimal scarring” and a “quick recovery period” turned into this mess…

Hysterectomy Scar Resulting in Injuries Caused by the da Vinci Surgical System

Photo by Undiagnosed Warrior (2017). Hysterectomy Scar Resulting in Injuries Caused by the da Vinci Surgical System [Image].

… but I will go into more details of this tragic event at a later time. Needless to say, it would have been far more helpful to have read this book before I actually needed the helpful tips supplied in the pages of Your Patient Safety Survival Guide.

The first thing I want to mention before reviewing the content of this novel is that I found myself drawn to this book simply because the author’s personal and professional background intrigued me. From a professional standpoint, Dr. Gretchen LeFever Watson holds a Ph.D. in Clinical Psychology and has held a variety of training and leadership positions in hospitals and community-based healthcare programs. Not only has she received numerous awards and grants for her research, but her work has also generated a great deal of media attention and recognition from other subject matter experts in the fields of psychology and healthcare as well (Watson, 2017). This is in addition to publishing two other patient safety books along with Your Patient Safety Guide and several peer-reviewed research papers. Considering that the author is clearly well-versed and has a long-standing history of working within both the past and current structure of the American medical system, I knew she would offer a great deal of insight from the professional side of health care. The fact that Dr. Watson has also been an advocate for patient safety and wellness from personal experiences as both a caregiver for her mother and as a parent when a medical error almost took her daughter’s life at the young age of only four-years-old made me think that her opinions would likely represent a more balanced perspective overall (Watson, 2017). As someone with multiple chronic and rare conditions, and a student studying for a degree in clinical psychology that has also spent many years working in veterinary medicine prior to disability myself, I was definitely interested in reading her perspective on some of the issues currently plaguing the safety and care of patients. Thankfully, this book did not disappoint.

Aside from the fact that each chapter of Your Patient Safety Survival Guide covered a wide breadth of obstacles in receiving adequate medical care (e.g., safety habits and best practices, avoidance of medication errors and overprescription of dangerous medications, and the prevention of infections and common medical injuries that can occur as a result of human error, negligence, malpractice, and purely bad luck), the thing that I liked most about this book is that every topic discussed in the text provides readers with an eclectic explanation illustrated through research statistics and patient examples. Chapter 1, for instance, notes some shocking statistics that suggest “at least 440,000 patients die needless deaths in US hospitals each year” and the “initial estimate of the financial impact of the patient safety crisis indicated it totaled around $5 billion annually, about one-quarter of which involves out-of-pocket expenses” (Watson, 2017, p. 7-8). While these numbers are obviously alarming, the author prevents hysteria or anxiety over such occurrences by putting the situation into a more realistic perspective by detailing the potentials causes of medical error and offering ways to combat it as either a patient receiving care or professional providing care.  In this way, the author is avoiding labeling the problem according to a single source but rather a complex, systematic problem that can result in an infinite number of breakdowns within the medical system itself. Personally, I find this account refreshing because it first acknowledges the problem, without placing blame on either the patient or medical professionals specifically, and then it explains the how and why medical errors happen. It also makes it easier for the reader to accept the information before the author moves on to discuss her own recommendations and potential solutions for resolving the problem at hand. Nevertheless, one factor that distinguishes this book from many other patients and/or chronic illness texts is that Dr. Watson wrote the content of this book to equally address a combined audience of both patients (or their family members) and medical professionals alike.

Another important element of Your Patient Safety Survival Guide that I found relatively helpful is that each chapter presents the reader with either a tool that can help them measure and target goals relating to different variables of patient safety or an action plan that can minimize the potential for common medical mistakes. Although most of the tools and guidelines presented in this book are based on logic and common sense, I can personally attest to how easy it is to forget even the simplest of things, especially when you’re anxious about an upcoming surgery or procedure, concerned as to whether the physician will take your medical complaints seriously or not, or you’re just simply distracted by pain or other symptoms. In these cases, simpler is almost always going to be better in the long run anyways, although some of the planning tools and safety tips were also new to me as well. Still, the biggest takeaway that I got from reading this book came from the seventh and final chapter entitled Acceptance, Apology, and Forgiveness: Safeguard the Lives of Patients and Healthcare Providers. One of the reasons that this specific chapter stood out to me the most is that the end of this book overly emphasizes the fact the doctors and other healthcare providers are only human and, therefore, they’re liable to make mistakes just like anyone else. As Watson (2017) points out, “we all make errors. Our errors rarely result from the willful disregard for others. Factors beyond the control of providers often influence the emergence of error, and, when errors occur, providers are often in need of compassion – just like event’s primary victims” (p. 140-141).

With my own significant complications resulting from a major medical error fresh on my mind, the stories and information shared within these final pages clearly hit too close for comfort on a number of occasions. In many ways, it would have been easier to blame the surgeon and his support staff who performed my hysterectomy for everything. Lord knows that I had plenty of good reasons to rightly justify my anger and hatred over the situation, but what good would that have done in the end? Being angry about it wouldn’t make me feel better or allow me to heal any faster; yelling at the doctors and the hospital staff also wouldn’t prevent similar mistakes from happening to other patients in the future. Though it’s far more comfortable to blame the doctor when things don’t go as planned, it’s equally as hard to accept that it’s rare for patients to consider the harm we inflict on medical providers by establishing unrealistic expectations regarding our health care wants or needs. This is another reason why I really enjoyed reading this chapter because I liked that Watson (2017) discusses both the physiological and psychological impact that medical errors have on both the patient and their families, as well as the significant damage and stress that these faults can have on healthcare providers and facilities. Once again, it’s easy to forget that doctors and their support staff already feel the train and the pressure simply from completing the tasks they were trained to do in the first place. On the other hand, there will always be those few providers who tend to forget that patients are also human and just as fallible as they are themselves. Watson (2017) describes the apparent divide amongst patients and professionals best by suggesting that the biggest flaw in the wake of a major medical error or mistake occurs when the lines of communications are closed off, such as when full disclosure about the nature of the error is avoided in order to favor one’s pride instead.

In the end, there really isn’t too much more one could ask for in a single book regarding patient safety and healthcare, but if I had to choose one thing to criticize about any part of this book it would have to do with the fact that some of the chapters offer a rather viewpoint on the use and/or abuse of stimulants and opioids for managing chronic symptoms or pain. However, this is just my personal perspective based on taking these (or similar) drugs in order to manage my own symptoms either in the past or present, in addition to considering alternative opinions from other chronic illness patients who have also dealt with the medical system for an expansive period of time as well. Even if I don’t necessarily agree with all of the author’s personal and professional opinions as deliberated throughout Your Patient Safety Survival Guide, I still respect and appreciate the author’s judgments on these topics as she does support her logic using mainstream facts and theories regarding these types of medications. I am also very much appreciative of Dr. Watson’s willingness to devise solutions to the problems in healthcare and patient safety rather than focusing on the inadequacies of the system alone. I really do believe that this book – and Dr. Watson’s research and safety initiatives for patient care – will prove beneficial for anyone engaging in any part of the medical system to some degree. More importantly, I would highly recommend this book to anyone managing a chronic or rare disease since we are among the most vulnerable population of victims exposed to potential medical mishaps as we are routinely asked to put our faith, trust, and livelihood in the hands of practitioners of medicine.

If you’d like to purchase a copy of Your Patient Safety Survival Guide: How to Protect Yourself and Others from Medical Errors, please visit one of the following online retailers:

https://www.amazon.com/Your-Patient-Safety-Survival-Guide/dp/1538102099

https://rowman.com/ISBN/9781538102091/Your-Patient-Safety-Survival-Guide-How-to-Protect-Yourself-and-Others-From-Medical-Errors

https://www.barnesandnoble.com/w/your-patient-safety-survival-guide-gretchen-lefever-watson/1126025512

https://play.google.com/store/books/details/Gretchen_LeFever_Watson_Your_Patient_Safety_Surviv?id=XQglDwAAQBAJ

References:

Brown, A., Demyan, A., & Agha, S. (2014). Research on Victimization Among People with Disabilities. Retrieved from https://www.nij.gov/topics/victims-victimization/Documents/violent-victimization-twg-2015-browne-demyan-agha.pdf.

Cleveland Clinic (2018). Hysterectomy: What You Need to Know. Retrieved from https://my.clevelandclinic.org/health/treatments/4852-hysterectomy-what-you-need-to-know.

Drugwatch (2018). Da Vinci Surgical System. Retrieved from https://www.drugwatch.com/davinci-surgery/

Good Reads (2016). Gretchen LeFever Watson. Retrieved from https://www.goodreads.com/author/show/15244917.Gretchen_Lefever_Watson.

Watson, G. L. (2017). Your Patient Safety Survival Guide: How to Protect Yourself and Others from Medical Errors (1st ed.). Lanham, MD: Rowman & Littlefield Publishers.

Wortman, M. (2017). Late-onset endometrial ablation failure. Case Reports in Women’s Health, 15, 11-28. https://doi.org/10.1016/j.crwh.2017.07.001.

Why I Hate Thanksgiving

I know,  I know… it’s un-American.

But I really do hate Thanksgiving.

I probably sound ungrateful, right?

But I promise you all that’s not my intent at all.

So why is Thanksgiving my least favorite holiday, you ask?

It’s better to start at the beginning.

I didn’t always despise this holiday. In fact, I use to love the excitement of waking up to the smell of a giant turkey roasting in the oven. My mom would start cooking sometime in the middle of the night while the rest of our family was still sound asleep.  She’d slave the night away just to make sure that she would have everything ready for a late lunch. I’d sit down in front of the TV in the living room to watch the Macy’s Day Parade, sneaking into the kitchen every so often to “taste-test” the food to make sure it still tasted good. It always did. Despite the stomach aches that came and went over the years, I still enjoyed gorging myself on a Thanksgiving Day feast like any other normal American.

That was until I turned 14.

The beginning of that holiday season still stands out in my mind to this day.

Although I had suffered a variety of symptoms before then, it wasn’t until Thanksgiving of 1997 that I truly learned what it means to be REALLY sick.

That morning started out like any other. The aroma of our soon-to-be Thanksgiving feast filled the house and in line with tradition, I stumbled down the stairs, half asleep, and plopped myself down in front of the television. Only this morning, something seemed different – something was off and I couldn’t put my finger on it. I just didn’t feel right at all. Not sick, per say, but not well either. I assumed that I was either experiencing another bout of nausea (which I seemed to grow accustomed to in the months proceeding) or I was simply coming down with the flu. It was flu season, after all. Despite these feelings, I felt it was best to leave well-enough alone and decided not mention it to anyone. I was sure it would pass. I thought maybe I was just hungry. And besides – it was Thanksgiving.

Not too much later, our meal was finally ready. I turned off the TV (the parade was over anyways) and made my way into the kitchen. We each made our plates, gathered around the kitchen table, and everyone waited for me to say the traditional Thanksgiving Grace. It was a prayer that I learned in pre-school and I remember being so excited, even that young, to be a part of the process of Thanksgiving. I felt like I was helping. Little did I know that many years later my simple but short prayer would become yet another one of the numerous family traditions. With a full plate of food in front of me, I grab my mother and my grandmother’s hands and began:

“Thank you, God, for happy hearts,

and rain, and sunny weather.

Thank you, God, for this our food,

and that we are together.

Amen.”

AMEN in our family is the code-word for GOand everyone dives into their plates. I started off by taking a bite of turkey, but my stomach turns. I wait a second before sampling my mashed potatoes – my stomach starts gurgling. Okay, that’s not good. I secretly wonder if anyone can hear me.

Now what?

I try the creamed corn. One bite makes me twinge.

What about stuffing?

Nope, can’t do it. My stomach is twisting.

The green beans?

Nope, not even close.

Not even the bread? Simple, measly bread?

No, no, no, NO!

I run to the bathroom. Okay, maybe it was more like a sprint but still… Oh God, I’m dying. I had never felt pain like this before. It felt as if someone was twisting and pulling at my intestines. I was literally in tears, shaking. When I finally compose myself, I head over to the sink to wash my hands and my face. I look up at the mirror and I can see sweat beads pouring down my face. My hair is soaked. I look sick at this moment. I take a deep breath and give myself a few more minutes to gain composure. I check myself in the mirror one more time and notice that I looklike my usual self once again. Odd, I thought, but I try not to think about it as I return to the table as if the episode never happened.

My entire family stares at me as I sit back down in my chair and pick up my fork as if I am going to try to eat again. What’s wrong with you?  Are you okay? What happened? I feel slightly embarrassed by the scene I made, but blow it off. I’m sure whatever just happened was probably a fluke. It’s surely out of me now and I was feeling much better – or so I thought. My family goes back to their conversations, ignoring the fact that I am stirring my food around the plate more than I am actually eating any of it. I take a few more bites of my mashed potatoes and one bite of stuffing before a familiar feeling comes on. Oh God, not again. This time, I actually do have to run.

By the time I finished in the bathroom, everyone had finished both their first and second helpings, the rest of the food had been packaged and placed in the fridge, and my mother was finishing up the dishes. My plate, however, sat lonely on the table – almost as full as when I had put it there in the first place. I couldn’t stomach looking at it. My mother turned around from the sink and told me to go lay down. I obliged. She must have seen the nice shade of pale yellow/green I had turned during my last adventure in the bathroom. I spent the rest of the day crawling (almost literally) from my bed back to the bathroom. I wanted to die. In fact, I thought I WAS dying.

When I woke up the next morning, I did actually feel a little better. I avoided breakfast, though, (just in case) and helped my family decorate the house for Christmas. Again, tradition. When dinner rolled around, I heated up some leftovers from the delicious meal I missed out on the day before. It had been over 24 hours since I had last eaten and I was starving. My strong desire for food quickly diminished minutes later, however, after only two measly bites of food. Again, my body was revolting. This pattern went on long into the month of December until I finally just reached a point where I completely avoided food altogether. It was the only way to keep the symptoms away.

In the few weeks following Thanksgiving, I lost somewhere between 15 and 20 pounds.

I felt hungry but knew the consequences of eating all too well. A couple days before Christmas, after not consuming anything for over a week, I had no choice but to force myself to eat. Moments later, I was plagued by the same symptoms I had experienced over and over again. Only this time – my symptoms came on tenfold and I began bleeding rectally. My mother found me on the floor after I had passed out from the pain and yelled for my father to come carry me to the car. I’m not even sure my father stopped for red lights on the way to the hospital. I remember that it was cold and flurrying that night, and I was shaking uncontrollably – unsure whether the tremors were the result of the cold winter’s air or the fear I felt inside. Somehow, I found the strength to walk myself into the ER and it was extremely crowded. Luckily, my mother’s worry often exhibited itself as anger and we were promptly seen within minutes.

This was not my first official trip to the ER by any means, having broken a few bones my younger years, but it was the first time I had gone in there really sick. It was like a whirlwind. One nurse after another. One doctor, then a specialist, and yet another doctor. When the last doctor decided to do a rectal exam to evaluate the bleeding, my father cringed and my mother’s eyes opened real wide. Meanwhile, I just cried out of both pain and embarrassment. Afterward, they doctors decided they needed more tests and multiple vials of blood were drawn. Only hours later, we had our answer…

Everything was normal.

How could that be? I am dying, can’t you see that?

I guess they saw something because they decided to keep me overnight for observation. The next morning, I wasn’t any better. More labs were taken, but again, I was fine. The doctors started to question whether I was even sick at all. “It’s all in her head,” they’d say or that it was “just anxiety”. But they kept me at the hospital because I was still bleeding. So I guess the rectal bleeding was caused by anxiety? I’m no doctor but that didn’t seem right. Even then, being young and medically naive, I knew the doctors were dead wrong.

The morning of Christmas Eve in 1997 change my life forever, though.

 It was on this exact day that paved the way for my up-and-down journey as a chronic illness patient – making me the Undiagnosed Warrior. I was still in the hospital when the main doctor handling my care visited me during his morning rounds, while I just stared blankly out the window. It was almost Christmas and I wanted to go home, but I still didn’t feel any better. The doctor began by reviewing his findings during my time in the hospital – which was nothing – and proceeded to tell my mother that in his professional opinion I must be suffering from anorexia. Yup, you read that right.

My official diagnoses was Anorexia Nervosa.

If I had more strength at the time, I would have thrown a bedpan at him. Now I REALLY wanted to go home and I made my request abundantly clear. He then offered me two options:

  1. I could force myself to eat two large pancakes from the hospital cafeteria and be discharged that afternoon – I’d be home in time to celebrate Christmas. -or-
  2.  I could stay in the hospital and be put on a feeding tube.

Those were the only two options – No exceptions. My choice, of course.

I had to decide quickly, as most of the staff was ready to go home and be with their own families for the holidays. The choice should have seemed obvious, but when you’re THAT sick, it’s not the easiest decision to make. Still, home did sound much better than a feeding tube for Christmas and I figured food consumed in any, way, shape, or form was going to cause pain no matter what. So pancakes it was.

Although they weren’t the worst pancakes I had ever eaten, they were far from a gourmet breakfast. Caked in layers of butter and maple syrup, I began choking the meal down – one bite at a time. And with every bite I gagged. The doctor informed me that if I vomited my meal up, I’d have to try again until it stayed down. With tears falling from my eyes, I kept chewing.

Don’t throw up. Don’t throw up. Don’t you dare throw up, goddamnit!

I simply refused to let this seemingly-giant plate of pancakes defeat me.

Since the food was taking me a lot longer to finish than the doctor expected, he explained that he had another patient to look in on before he left for the day, but he assured me that he’d be back to check on my progress momentarily. In his rush to leave, though, he made one crucial mistake: he left my mother in charge of monitoring my food-battle. Shortly after he walked out, as I cried into the one and half pancakes I still had left to go, my mother announced that she had enough. She was over it! Although she had always been the characteristically strong disciplinarian type of parent, my mother wasn’t cold either. She saw the level of my suffering and she knew in her heart that these doctors were wrong.

She swiftly walked over to my bedside table, grabbed the fork straight from hand, and then proceeded to make the remaining pancakes disappear as quickly as physically possible. In fact, I was surprised she didn’t vomit herself. God, I loved her so much. She was my hero. When the doctor came back, he was pleased with MY progress. He asked me if I had any pain. I, of course, said no as I swallowed back the pancake vomit lurking between my stomach and my throat. He was oblivious, but I was cleared to go home.

The rest of 2007 and most of 2008 were generally a blur.

I had constant stomach pain after eating, on top of dizziness and fainting spells. I felt terrible most of the time, but I refused to go back to the hospital. Never again – or any doctor for that matter. I survived on croutons, saltine crackers, and water for the majority of that year. My weight dropped down to somewhere between 85-90 pounds. My mother, understanding my fear, compensated for my pain by consistently buying me new clothes. I had to quit swimming, I didn’t do much with my friends anymore, and I barely made it to school. I resorted to spending much of my “free time” on the bathroom floor.

This was my life and I had to accept it.

On the rare times that I did feel well enough to leave the house, both my peers, as well as some adults, would comment about how wonderful I looked with my new “figure”. That made me even more sick – I was being praised for being ill and malnourished. And at the time I was only 15 years old.

The following Thanksgiving in 1998, I didn’t even try to eat.

 I just plopped myself down on the couch and watched the Macy’s Thanksgiving Day Parade – It was tradition, after all – and ignored the smell of food coming from the kitchen. It did smell delicious, though.

I still don’t look forward to the holiday season – even today.

Or any other formal meal for that matter. Mostly, it’s difficult for me to be “stuck” at a table for long periods of time while staring at large quantities of food. It gives me anxiety just thinking about it now as I write this.

Trust me – I wish I could eat.

 I wish it wouldn’t cause me severe pain,

but it does.

So it’s not that I am being ungrateful for the many blessings I have experienced this year (or even the blessings from the years past). I know I have a lot of great things to be thankful for in my life, especially with all of the people who always there for me, despite my illness.

I’m also not trying to be difficult or picky when it comes to food either. I know there are millions of people in the world who would gladly eat both my Thanksgivings meal and any of it’s leftovers. If I could, I would gladly give it to them.

I hope you can understand. I associate Thanksgiving to pain. And pain is caused by food, just like it is every other day – only there’s a lot less pressure to gorge oneself with Turkey and Pumpkin Pie on any other regular Thursday.

And please don’t ask me if I want pancakes.

 More than likely, the answer is going to be NO.