From: sbharris@ix.netcom.com(Steven B. Harris)
Subject: Re: Far Side cartoon on frozen bodies
Date: 13 Apr 1997
Newsgroups: sci.cryonics

In <wowk.860822072@mira> wowk@cc.umanitoba.ca () writes:

>In <5imtid$nhe@sjx-ixn6.ix.netcom.com> sbharris@ix.netcom.com(Steven
>B. Harris) writes:
>
>>   By the way, the story of the ICU patient bed which always had a dead
>>patient in it every Satuday, because the Friday night cleaning person
>>was temporarily unplugging the ventilator in order to plug in a floor
>>polisher (or some variation of this story), is a classic urban myth.
>
>	I hadn't heard that one.  Rather, I'm recalling the wire services
>stories last year about the Unluckiest Patient in the World.  Some guy
>in Florida we first read about when they amputated his leg (the
>*wrong* leg) due to a chart mixup.  Then a few months later someone
>mistakenly disconnected his ventilator and killed him.  Really.
>At least, according to AP.
>
>**************************************************************************
>Brian Wowk          CryoCare Foundation               1-800-TOP-CARE
>President           Human Cryopreservation Services cryocare@cryocare.org
>wowk@cryocare.org   http://www.cryocare.org/cryocare/
>--------------------------------------------------------------------------



   That one I believe.  One of these cases where they don't even think
about going to trial.  HMO and hospital lawyers just ask the family
"Okay, how much do you want?" and then go back and have the check cut.
"10 million?  Sounds fair.  Wait right there..."

                                            Steve

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.health.alternative,sci.med,misc.kids.health
Subject: Re: ASTHMA & Antibiotics
Date: 10 Mar 1998 23:13:24 GMT

In <35055CC7.F2F40155@erols.com> Rex Harrill <brixman@erols.com>
writes:

>jrfox@no.spam.fastlane.net.no.spam wrote: [snip]
>
>> ANY medical therapy has potential side
>> effects.  Even a physical exam.
>
>This is a strange statement.  I had always thought of a routine exam as
>the safest time to be under medical care.  Are you talking about such as
>where male doctors molest female patients, or what?  Or are you talking
>about where a doctor might administer a potentially reactive vaccine and
>consider it incidental to the physical exam?  Please explain further if
>you have the time.



   Findings on physicals can lead to further tests which can lead to
interventions which can be dangerous.  It happens.  Which is not to say
you might not be better off having the physical than not, only that the
physical isn't risk free.  My favorite risky physical exam procedure is
listening to the carotids in people who don't have symptoms.
Occasionally that leads people into a surgery they shouldn't have had,
which strokes them out or kills them.

    No medical test is benign.  When I was an intern I had a patient in
the ICU who'd started by going to his doc for a routine physical.  This
turned up an asymptomatic irregular heart beat.  This lead to a
treadmill test which led to treatment with an antiarrhythmic drug,
which caused a rare heart problem of its own called torsade de points.
Attempt at cardioversion of this rhythm resulted in bradycardia, which
required an emergency pacemaker insertion.  Which caused a collapsed
lung.  Which resulted in a chest tube.   Which resulted in a nosocomial
infection and pneumonia. Which resulted in intubation and long term
ventilation.  When I saw the guy he was a pretty sick cookie in an ICU
bed, buried in technology.  He shoulda stayed home.

   In hindsight, naturally.  The problem, of course, is that only
hindsight is 20-20.  I can tell you about a lot of other people whose
lives were definitely saved by a physical exam (a stool guiaiac, etc).
And I had one guy happen to fall dead in the office of one of my
attendings the same year.  Because it was an office, he got
defibrillated right there, and he eventually went home to his family.
Had it happened on the street because he had decided not to see his
cardiologist that day, that would have been the end of him.

    Life's a gamble.  You can't *guarantee* you'll win by playing the
best odds, but you're still a fool not to do so.

                                       Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Post-hysterectomy Sex Abstracts (Re: Doctor-bashing)
Date: 19 Mar 1999 11:05:23 GMT

In <370a5f82.455788748@news.erols.com> vl-hb001@erols.com (Terri)
writes:

>A nurse's duty is to protect her patient from anyone who wishes to do
>him or her injury knowingly or unknowingly, deliberately or
>accidentally. That includes doctors and even family on occasion.
>That's in fact what a nurse is doing when she looks at an order for
>100mg of morphine IM and calls and says "I don't think this is what
>you meant to write/say is it., Doctor?" In that case she's using her
>own knowledge of pharmacology to protect the patient from the error of
>a sleepy/tired/overworked physician. Good ones even say "Thanks."


   Oh, come now.  Most say thanks.  There's not a physician alive who
hasn't been saved from a zillion mistakes by pharmacists, housestaff,
nurses, patients, and families.

    That being said, I can't imagine how you'd even go about giving 100
mg of IM morphine.  3 cc's in one cheek and 4 in the other?  Some
mistakes just can't be made these days-- like giving somebody 100 mg of
Synthroid.  The nurse would have to be an even bigger idiot than the
doctor.


>Really bad ones will refuse to admit their error and then the whole
>chain of command in nursing gets into the act. No nurse will give the
>overdose though. And in the event (I've never seen this happen) I
>think the doctor would be bodily prevented from doing so
>himself/herself.
>
>Terri


    Which would be a mistake, since doctors do occasionally know what
they are doing.  I remember once a pharmacist telling me rather
supercilliously that Procanbid, since given twice a day, would require
at least two days to reach steady state procainamide levels, not one
day.  We argued for 15 minutes before I told him to just think of it as
an internal IV drip, and to do it my way, thanks.  And I once had to
give 10 amps of Narcan myself to somebody in septic shock, since the
nurses went ape.  Well, I've got news: you're not going to kill anyone
with an overdose of Narcan (no, it didn't work very well, but it did
occasionally bring pressures up significantly).

                                          Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med.nursing,sci.med.cardiology,alt.travel,alt.lawyers,
	sci.physics
Subject: Re: Heart machines at the airport
Date: 7 Jun 1999 06:51:46 GMT

In <928735221.787.94@news.remarQ.com> "Jim & Jean" <zlomke@oasisol.com>
writes:

>No kidding--a 911 call came in on the scanner in the ER...Pt pulseless, not
>breathing and very combative to CPR...(not having a seizure...)  LOL
>
>Jean


    Somebody's been watching "Return of the Living Dead" (a great
movie, BTW) too many times.

    In medicine we have something almost as funny.  Somebody regularly
reports pupils of different sizes in a conscious and oriented person
after an accident.  You can tell they're afraid they are seeing brain
stem compression right in front of their eyes.  It's Uncle Herniation!
Scarier than Uncle Fester!

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med.nursing,sci.med.cardiology,alt.travel,alt.lawyers,
	sci.physics
Subject: Re: Heart machines at the airport
Date: 8 Jun 1999 08:37:41 GMT

In <375C7215.87057DA8@alum.mit.edu> Neal Lippman <nl@alum.mit.edu>
writes:

>Famous hospital urban legend. Patient is in ICU/CCU. ECG monitor leads
>get disconnected, or one falls off, or the patient is brushing his teeth,
>or whatever; the upshot is a load of artifact which is misinterpreted by
>the overeager intern (why is it always an intern or medical student who
>is overeager). Said white knight rushes into the room and delivers the
>precordial thump to end all precordium thumps, whereupon the surprised
>but not in cardiac arrest patient thumps the surprised doctor in the
>mouth...story ends with a description of how the intern/medstud completes
>the rotation with his/her mouth wired shut due to the broken jaw....
>
>On a more sobering note, I did once see a patient who was shocked
>multiple times for artifact on the telemetry monitor, essentially
>shocking her FROM normal rhythm INTO VT with a resultant arrest from
>which she sadly recovered in body but not in mind. And 1) No, I wasn't
>present at the time; 2) Yes, it was a full-fledged cardiologist who did
>all the shocking, and 3) Yes, I am sure, because he dutifully pasted all
>of the ECG tracings into her chart, laying out for all to see his
>prolonged resuscitation attempt on a lady with artifact on the tracing.
>
>Neal



    My own intern story regarding the pacer from hell:  A telemetry
patient (not mine, but somebody I'm watching for another intern while
on night call) is "signed out" to me, who has intermittant slow V-tach
at something like 120 or 140, but also has a temporary line running
into a vein and into her heart while awaiting definitive
electrophysiologic studies.  With this line, she can be paced out of
this bad but not immediately fatal rhythm by turning on the external
pacer box hooked to the line, and which is hanging on a pole at the
foot of the bed.  Just turn it on a few seconds, I'm told-- it's
pre-set already for 160/min, or something.  It will capture the heart,
run the rate up to 160, and when you turn it off the patient will be in
sinus rhythm again.  It's worked several times.  Nothing to worry
about. Great.

   In the middle of the night I'm called.  The patient is in V-tach
with a very low blood pressure, and unconscious.  Aha.  I reach up,
open the clear plastic cover of the thing, and move the slide switch to
turn on the pacemaker.  Bingo, patient goes to 160 and sinus rhythm.
Pressure comes up.  She opens her eyes.  It's a brilliant cure.  The
crowd cheers!   Except that now she's having chest pain from that heart
rate of 160.  Obviously, time to turn the pacer off.  Except it won't
turn off.  There is a safety interlock which prevents this once it's
turned on, which nobody has bothered to tell me how to disengage, and
it's NOT obvious.  Switch will NOT budge.  I have never seen this kind
of thing.  Worse, there is the same interlock on the rate dial, which
also will not budge.  Now my patient is groaning in extremis due to
this plastic box I'm electocuting her with, and I CANNOT get the damn
thing to stop.  I'm considering taking a pair of nurse's bandage shears
to the wire coming out of it, when a hand comes over my shoulder and
calmly turns the voltage dial down to zero, so the thing isn't putting
out enough zap to capture anything.  Why didn't I think of that?
Patient's rate goes back to her natural rate, her pain disappears, and
the day is saved.  That's what residents are for, and this night, mine
has saved me.  Then he shows me how to take off the interlock.  It's
childproof.  Alas, also intern-proof, at least for 10 seconds and the
intern is in panic.  Fine.  Grumble.  I go back to bed.  But cannot
sleep....

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.nursing,sci.med.cardiology,alt.travel,alt.lawyers,
	sci.physics
Subject: Re: Heart machines at the airport
Date: 9 Jun 1999 10:02:36 GMT

In <oH473.526$h5.16944@newse2.tampabay.rr.com> "Leo Sgouros"
<lsgouro1@tampabay.rr.com> writes:

>Steven B. Harris wrote in message
>>    My own intern story regarding the pacer from hell:  A telemetry
>>patient (not mine, but somebody I'm watching for another intern while
>>on night call) is "signed out" to me, who has intermittant slow V-tach
>>at something like 120 or 140, but also has a temporary line running
>>into a vein and into her heart while awaiting definitive
>>electrophysiologic studies.  With this line, she can be paced out of
>>this bad but not immediately fatal rhythm by turning on the external
>>pacer box hooked to the line, and which is hanging on a pole at the
>>foot of the bed.  Just turn it on a few seconds, I'm told-- it's
>>pre-set already for 160/min, or something.  It will capture the
>>heart, run the rate up to 160, and when you turn it off the patient
>>will be in sinus rhythm again.  It's worked several times.  Nothing
>>to worry about. Great.
>>
>>   In the middle of the night I'm called.  The patient is in V-tach
>>with a very low blood pressure, and unconscious.  Aha.  I reach up,
>>open the clear plastic cover of the thing, and move the slide switch
>>to turn on the pacemaker.  Bingo, patient goes to 160 and sinus
>>rhythm. Pressure comes up.  She opens her eyes.  It's a brilliant
>>cure.  The crowd cheers! Except that now she's having chest pain from
>>that heart rate of 160.  Obviously, time to turn the pacer off.
>>Except it won't
>>turn off.  There is a safety interlock which prevents this once it's
>>turned on, which nobody has bothered to tell me how to disengage, and
>>it's NOT obvious.  Switch will NOT budge.  I have never seen this
>>kind of thing.  Worse, there is the same interlock on the rate dial,
>>which also will not budge.  Now my patient is groaning in extremis
>>due to this plastic box I'm electocuting her with, and I CANNOT get
>>the damn thing to stop.  I'm considering taking a pair of nurse's
>>bandage shears to the wire coming out of it, when a hand comes over
>>my shoulder and calmly turns the voltage dial down to zero, so the
>>thing isn't putting
>>out enough zap to capture anything.  Why didn't I think of that?
>>Patient's rate goes back to her natural rate, her pain disappears,
>>and the day is saved.  That's what residents are for, and this night,
>>mine has saved me.  Then he shows me how to take off the interlock.
>>It's childproof.  Alas, also intern-proof, at least for 10 seconds
>>and the intern is in panic.  Fine.  Grumble.  I go back to bed.  But
>>cannot sleep....

>Good God.
>That has got to be one of the scariest things I have read in a long
>time.
>L



Comment:

   Hope not!  The really scary ones have no redeming element of humor
(though if you are in medicine long, your humor tends to be rather
dark). I once walked in on an ICU patient who had managed to turn so
that his wrist arterial line (one of the old short ones used in the
early 80's) had pulled out.  He was on a ventilator, and tied down in
wrist restraints, as people on ventilators often are (so they don't
extubate themselves). So, he can't move.  The arterial blood is pumping
out of his wrist-- spurt-- spurt-- spurt-- with each heart beat, in a
thin red jet about a foot long.  He's watching this.  Not only can't
move, but can't even whisper (he's intubated).  Can't reach call
button.  Eyes are VERY wide....

    Now, you have to admit there's at least a *little* humor there.
No?  The guy survived with no physical or psych damage, since he wasn't
at all the anxious type.  If he had been, well, it would have been a
different story.  This is just my illustration that even a naturally
calm guy can look quite concerned in the right circumstances.  I really
don't know what the risk management people eventually told him, but
knowing them, it was probably really good.

    We live in the world of our minds, and are completely at their
mercy-- or, alternately, bathed blissfully in it.  I had a guy once as
an ICU patient who'd gone to the doc for an executive physical and the
doc had heard an irregularity in heart beat. EKG had showed PVDs.
Stress test then done had caused more-- even runs of V-tach.  Chemical
antiarrythmic treatment (in those bad old days before we realized how
dangerous some of this was) had itself caused a rare and even worse
dysrhythmia (called "torsade de points").  Electrical defibrillation
from THIS had caused asystole, then bradycardia.  An emergency
pacemaker insertion for THIS had caused pneumothorax (collapsed lung).
Which had led to a chest tube, pneumonia, ventilator, sepsis, an ICU
bed.  Another day having failed to live up to expectation.  This guy
also survived and was not bitter, but suggested to me later that
perhaps one should stay away from doctors, unless feeling unwell.
Hmmm.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.nursing,sci.med.cardiology,alt.travel,alt.lawyers,
	sci.physics
Subject: Re: Heart machines at the airport
Date: 9 Jun 1999 17:14:26 GMT

In <7jloma$ba6$2@miranda.gmrc.gecm.com> rnh@gmrc.gecm.com (Richard
Herring) writes:

>In article <7jle3s$51@sjx-ixn9.ix.netcom.com>, Steven B. Harris
>(sbharris@ix.netcom.com) wrote:
>
>> I had a guy once as
>> an ICU patient who'd gone to the doc for an executive physical and the
>> doc had heard an irregularity in heart beat. EKG had showed PVDs.
>> Stress test then done had caused more-- even runs of V-tach. Chemical
>> antiarrythmic treatment (in those bad old days before we realized how
>> dangerous some of this was) had itself caused a rare and even worse
>> dysrhythmia (called "torsade de points"). Electrical defibrillation
>> from THIS had caused asystole, then bradycardia. An emergency pacemaker
>> insertion for THIS had caused pneumothorax (collapsed lung). Which had
>> led to a chest tube, pneumonia, ventilator, sepsis, an ICU bed.
>
>If anyone ever needs a definition of "iatrogenic", you now know
>where to look ;-)
>
>--
>Richard Herring      | <richard.herring@gecm.com>



  "Iatrogenicus fulminans" led the problem list in rounds, alright.
But they don't like you to write that kind of thing in the hospital
chart.

   It's sort of like when somebody dies from lack of a drug you know
has been developed, but which the FDA is holding up.  "Sclerosis of the
the government" is not a recognized entity that the public health
department likes to see on death certificates.  Even if it's perfectly
correct.