Errors

Yesterday there were mistakes. These are very tricky things. I saw a patient from Vocational Rehab. She was young, in the early twenties. She was injured when a heavy box of CDs fell onto her head in March. That's six months ago. Ever since then, she has pretty severe pain in the neck on the right side. She was treated with physical therapy, pain medications, and muscle relaxants. She isn't getting any better. I reviewed what the physical therapy people did with her. She is not on any at-home exercise program. She wasn't sent to me for her neck pain. She was sent over by Dr. L, a semi-retired excellent Neurosurgeon, who wanted nerve testing done to make sure there wasn't any nerve injury. She doesn't have normal neck range of motion. She can't bend or twist the neck properly. It isn't the same on the two sides. The left side moves normal, but the right side has limited motion. This indicates that the muslces don't stretch out normally, they're too tight. That problem has a very simple solution: stretch the muscles. Muscle stretching takes a long time with very consistent effort. The yoga people are very limber, and their range of motion increases with constant stretching. But that hasn't been tried yet. So I told her to do it. If she does it every day, twice a day, then she's going to be better in about three months. It's ridiculous that she hasn't had that done. It's upsetting, but that happens. I'm glad I got to see her, though. It's not because I like to see people make mistakes; not because I want to think I'm smarter than that other person: because now she'll probably (finally) get better.
I saw an eighteen year old who gets shakey. She feels just not right, and at various times in school she starts to shake. She shakes inside which is the most disturbing. It is variable in intensity. Now this girl is quite strikingly thin. Her bones aren't showing. She's just REALLY thin. I think most people would think that she's too thin, although I didn't figure out her BMI (Body Mass Index), the real way to tell if she's truly "underweight". So I asked her about her exercise habits, but she laughed at me (She doesn't like exercise). So I asked her about her eating. She doesn't really eat. She has a piece of toast for breakfast, and then she has a tuna sandwich after school. She has some candy. She says she only drinks water in the day time, but her mother thinks she takes a lot of coke and tea. She only takes those with dinner. I don't know, really. I want to believe that she's only taking the caffeine with dinner. You never can really tell. Anyway, not eating any food makes you shake. Eating nothing and then having candy makes you shake more. But no one told her to eat. Instead they checked her blood. She faints when her blood is taken. She told the people who drew her blood. People who faint with blood draws need to be lying down so they don't faint. But they didn't lay her down. So she fainted, and then had a seizure. Seizures that occur from fainting are called "syncopal seizures". They are a well known thing. They are one of the "provoked seizures". That is, seizures that are a normal reaction of the brain to a certain stress (like fainting). The reason she had that is that when she fainted, the chair that she was in held her up. If she had fallen down, then she wouldn't have had a seizure (she probably wouldn't have even fainted if she was laying down.) The proper treatment for THAT is to not draw her blood sitting up, making her not faint, and eliminating the seizures. Instead, she was given an MRI of the brain and an EEG which were both interpreted as abnormal and indicating seizures from epilepsy. Epilepsy is two or more UNPROVOKED seizures. That's the definition. So she can't have that diagnosis, no matter what the tests say. I had a great professor who told me "If there's any way possible you should always ignore test results from tests that shouldn't have been ordered. Never order a test that isn't crucial." Well, I should ignore the tests (MRI and EEG), especially if they have some subjective component to them (which these do). So she was placed on Depakote which is a fairly dangerous anti-epilepsy (and definitely NOT anti-syncopal seizure) medication. Luckily, that hasn't made her sick yet. I told her to stop that. The girl just needs to eat some food. Actually, she is a little high strung and she needs to relax a little bit too.
We all make mistakes, so it's going to happen. I have a fabulous patient who had surgery with an excellent neurosurgeon in town. He forgot to put the patient back on his coumadin right after surgery, so he had a stroke. That was a mistake. Our mistakes cause physical harm to people. I've made them. There are different causes. Some people just aren't very good at what they do. There's so many reasons for that. Some of them don't have the aptitude, and some of them have become totally "burned out". Some of them don't care enough, or don't try hard enough. Some are depressed, or they're ill and they don't know it.
Some people are good at what they do, but sometimes they make mistakes. Some of those are going to harm the patients. We miss simple things. We miss details. We go too fast and don't see things. We get tired. We do really stupid things because we refuse to go home with a migraine, or we took a medicine that made us goofy. We get emotional and believe patients when we shouldn't or don't when we should, or don't listen. I think it's us and how we are. We aren't really here a lot. We aren't focused on this very moment with this very person and this very person. We're distracted with all the things that are "stressing us out". We're thinking of another thing when we're with someone. We're carrying too many plates. Life isn't simple. So we should slow down. We should just take a breath. Maybe we should blog. Most importantly, we have to always try to find a way to let go of the past and forgive our mistakes. If it's possible, we should try to forgive the mistakes of the other people too.