Simple Procedure

I'm seeing M in the hospital. I was called to evaluate him on Sunday due to problems with thinking. He was in a near coma. He went to the hospital for a simple procedure. He needed a very large kidney stone removed. He developed some bleeding. He got acute renal failure. He went into severe liver failure. Then, he developed problems with brain function. His blood ammonia level was too high. That's what happens with liver failure. The liver gets rid of the ammonia in your blood. So he couldn't think, which is what happens because the brain can't work with too much ammonia. His thinking has improved somewhat, but he's far from his old self. He can't walk more than 250 feet. He has trouble moving around in the bed, from pain which is all over. In order to get his ammonia levels down, we used lactulose. This produces VERY severe diarrhea. So he had a diaper. The nurses weren't on top of it (they're always very busy) and he was sitting in a dirty diaper a lot. His wife isn't doing well. She's very frustrated.
A few years ago, I had a patient who went for a rotator cuff surgery. That's another simple procedure. They called me because she was in a coma after the surgery. I never really understood what happened, but she ended up dying after about one week in the ICU. My guess is that this was from a bad reaction to the anesthesia. I'm not really sure, though.
If you're going to have a simple procedure, you need to understand that these things happen. I'm not fear-mongering. We have to do what we need to do. Obviously, these things are rare. But that doesn't matter when it's happening to you. Things can happen without simple procedures, of course. People slip and fall in the bathroom and die from hitting their head. I've seen that happen. I've seen someone fall off a bicycle and get brain damage. I had a patient who was hit in the head at work by a scissors lift that suddenly collapsed. So we don't need any procedure at all for things to suddenly turn into catastrophe. But we need to be aware of the possibility. I'm not putting in a plug for the insurance industry. It's about feelig lucky. We're lucky if we didn't have a simple procedure, or a fall, or a piece of large equipment falling on us. It's good to remember to feel lucky. I send money places. There are starving children and there's genocide. There are women in Iraq who have turned to prostitution to feed their children (husbands killed, no work). Sending money helps alleviate the suffering a little, but it also makes me feel lucky. That makes it a lot easier to be there for the people who want me to be there for them.