Unit 8Section 5 Exercise 20Medical Uncertainty & ErrorApologizing
Frank Huyler is an emergency room physician who has written several books of short stories. This one is from his collection The Blood of Strangers. Read these sections borrowed from “The Bee Sting” and the article that follows on the next page about the practical uses of apology.
"The Bee Sting" from The Blood of Strangers, Frank Huyler, Henry Holt, 2000
The nurse came up to me. “The guy in four wants antibiotics for his sore throat. Can I give him something?”
I glanced at his chart. He had a cold, that was all, and it was busy. “I haven’t even seen him yet,” I said.
The nurse rolled her eyes. “He’s just going to keep bugging me.”
The ER was full, it was the middle of the night, and I was feeling sorry for myself. Yesterday they had slept.
The waiting room was full of children. Coughs,runny noses, fevers, keeping their parents up until they’s had enough. I’d seen the llok so many times—the worried mother, the whimpering child whom I would simply send home agai. See your perdiatrician in the morning. Give him some Tylenol and lots of juice….
“I’ll be there in a minute. Tell him to wait.”
The man lying on the bed looked perfectly healthy. He was in his early thirties, fat, with curly black hair, a runny nose, and small rectangular eyeglasses. On the off-chance that he had strep throat, I knew that I would give him an antibiotic. But it was a virus.
“You have a sore throat?”
“Yes, it’s terrible. I can’t sleep. I’m congested. I’ve had it for a week.” His throat was red, his tonils angry and swollen, lit up by my penlight.
“Are you allergic to any mediciations?”
“I think I’m allergic to penicillin and erythromycin?"
“Are you allergic to Keflex?”
“I don’t think so. Ask my mom. She’s outside somewhere.”
“I’m asking you.”
“Whatever,” he said. “Just give me something for my throat.”
“OK,” said to the nurse as I left the room. Give him some Keflex now, and get him out of here.” He could fill the rest of the prescription in the morning. Even id he were allergic to penicillin, the risk of a reaction to Keflex was slight—less than 10 percent. The charts were piling up in the rack.
Thirty minute s later, as I bent over another child with an earache, holding her head with ne hand and the otoscope with the other, as she struggled and cried, they came and got me.
“The patient in four is in respiratory distress.”
He sat bolt upright on the bed, wheezing, fighting for air, his fingers and toes darkening with that look on his face, and I knew right away I was in for it. There was no one to call, no one to turn to. I was the only doctor in the hospital. “Page X-ray and respiratory therapy stat. Give him a milligram of epinephrine sub-Q now. Susan, start a line. He was blue, his eyes wide open and reaching.
“We can’t get a line, he’s a hard stick.”
Commands started flowing out of my mouth,without conscious thought. You and you, work on IV’s. You, give him another milligram of epinephrine sub-Q….
[The story goes on to describe the struggle to restore the patient to normal, requiring a paralytic agent, and intubation.] When people die of bee stings, this is what kills them. Anaphylaxis, the immune system set off like a bomb, and no one knows exactly why. It’s rare, I have never seen a case The whole body swells into hives, the throat constricts, the lungs spasm and close, the blood pressure falls, and it’s over in a few minutes….. His mother waited in the consultation room. I walked in and sat down, and for the first time there I was the one shaking, I was the one sick and damp with sweat.
“Mrs. Lopez, I’m very sorry. Your son had a reaction to one of the medicine we gave him. He stopped breathing for a while. He’s in critical condition, and I’m sending him by ambulance to the big hospital downtown where they can deal with problems like this.” I said it in a rush, barely looking at her.
“This is because of a medicine you gavve him?”
I nodded. “He’s had a terrible reaction. I was able to bring him back, but I don’t know what’s going to happen. He might still die.”
She looked across the room. “My only son,” she said, her lips tightening. “What have you done to my son?”
I sent him, blood pressure next to nothing, by ambulance to the ICU downtown, where the pulmonologists and the intensivists waited, and I stared at the empty cubicle, the trash on the floor from the frenzy of the part minutes, a smear of blood, a piece of IV tubing, alcohol pads, and there in the corner, his glasses, their tiny square lendses shining under the fluorescent lights.
The waiting room was still full of children. I had to see them. I had to go in, to look in their ears and listen, but he filled me completely. I was gone, I was somewhere else.
“Say that again?”
“He started coughing yesterday and then the fever started. You know, I’ve been waiting a really long time.”
I kept running to the phone.
That mording, at home in my bed, I could not sleep, and I was exhausted. His still figure on the gurney, blue , his open eyes—back and forth an back again. Less than 10 percent. By early afternoon I could stand it no longer, and I called again.
“This is Dr. Huyler, I’m calling about Mr. Lopez. He was admitted early this morning, and I’d like to find out how he’s doing.”
“I’m sorry sir, we no longer have a patient here by that name.”
“Can you tell me what happened to him?”
“Hold on, I’ll get the nurse.”
Then the silence of waiting, the seconds streaming past, and at last the nurse’s voice. “Yes, Doctor. He was transferred to the subacute unit an hour ago. They’re going to take him off the ventilator this evening.” I had never wanted anything so much.
The days passed, a first, second, and by the third day I knew it would be all right. But I had to do one more thing.
His room was on the fifth floor overlooking the city, and the sun lit up the mountains in the distance. It was early in the morning when I entered the room, and I heard his voice. He was standing up, talking on the telephone, the wells of his pale white back falling out of the open hospital gown. He heard me enter, and turned.
It took him a little while. At first, I saw the question on his face, and as it slowly gave way to recognition I realized that he was afraid of me.
“Mom, I have to go,” he said hurriedly on the phone. “That doctor’s here.”
“You,” he said, then paused. A long silence, and I stood there until he broke it.
“This should never have happened,” he said, gathering himself, pointing at me with a thick finger. I heard the anger in his voice, and as I looked at him, nodding as he accused me, humbling myself with an act of will, I felt suddenly large and powerful, somehow proprietaty. I had nearly killed him, and then I had brought him back from the edge, I had caught his hand just as he feel into the empty spaces and held him there. His anger sustained me: it meant he was undamaged, it meant that he was safe, nearly home again.
“I’m sorry this happened, Mr. Lopez.”
“easy for you to say,” he said, his eyes glittering,
He was so alive.
1. What is the cause of medical error in this story? What contributed to his failure to talk to the patient’s mother in the waiting room about his drug allergies?
2. Did this physician confront his mistake responsibly? What is his attitude towards the patient and does it matter?
3. What does this story suggest are the reasons why health care providers are often afraid to admit to error and apologize? Who pays for this patient’s hospitalization?
4. What is the significance of the story’s title?