Monday, May 5, 2014

Deadly Patient-Care Errors Excerpt

Thriller Explores Biggest Medical Nightmare:
Deadly Patient-Care Errors


"A thriller that only a doctor could have written. Wyler's sense of the worlds of the hospital and operating room are unsurpassed. You'll feel as if you are right there."


--Michael Palmer, New York Times bestselling author of Miracle Cure and The Sisterhood

Deadly Errors is a wild and satisfying ride! This is an ‘up all night’ pass into troubled places that only hard-working doctors know about, a turbulent world of trusting patients and imperfect humans struggling with the required image of perfection.”

--John J. Nance, author of Pandora’s Clock and Fire Flight


A comatose man is given a fatal dose of insulin in the emergency room, even though he isn't diabetic.  An ulcer patient dies of shock after receiving a transfusion of the wrong blood type.  A recovering heart patient receives a double dose of medication and suffers a fatal heart attack.
Brain surgeon Dr. Tyler Matthews suspects that something is seriously wrong with the hospital’s new “Med-InDx” computerized medical record system. But he doesn't suspect that there’s something murderously wrong with it.

As Matthews begins to peel back the layers of deception that cover the deadly errors, he crosses powerful corporate interests who aren’t about to let their multi-billion dollar medical record profits evaporate. Now a target, Matthews finds himself trapped in a maze of deadly conspiracy, with his career, his marriage, and his very life on the line.

Once again, Wyler blends his unparalleled expertise as a world class surgeon with his uncanny knack for suspense to create a true “best-of-breed” medical thriller. Deadly Errors is a lightning-quick action procedural that is destined to win new fans to the medical thriller genre.

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ABOUT THE AUTHOR
Allen Wyler is a renowned neurosurgeon who earned an international reputation for pioneering surgical techniques to record brain activity.  He has served on the faculties of both the University of Washington and the University of Tennessee, and in 1992 was recruited by the prestigious Swedish Medical Center to develop a neuroscience institute.
In 2002, he left active practice to become Medical Director for a startup med-tech company (that went public in 2006) and he now chairs the Institutional Review Board of a major medical center in the Pacific Northwest.
Leveraging a love for thrillers since the early 70’s, Wyler devoted himself to fiction writing in earnest, eventually serving as Vice President of the International Thriller Writers organization for several years. After publishing his first two medical thrillers Deadly Errors (2005) and Dead Head (2007), he officially retired from medicine to devote himself to writing full time.
He and his wife, Lily, divide their time between Seattle and the San Juan Islands.


EXCERPT:
November, three months later, Seattle, Washington
Trauma Room Three, Maynard Medical Center Emergency Department

“Is this how you found him?” Robin Beck, the doctor on call, asked the paramedic as she quickly ran the back of her fingers over Tyrell Washington’s skin. Warm, dry. No fever, no clamminess. Black male. Age estimated in the mid-sixties. Half open eyes going no where. Findings that immediately funneled the diagnosis into the neurologic bin. 
“Exactly as is. Unresponsive, pupils mid position and roving, normal sinus rhythm. Vital signs within normal limits. They’re charted on the intake sheet.” Breathing hard, the paramedic pulled the white plastic fracture board from under the patient, unofficially consummating the transfer of medical responsibility from Medic One to Maynard Medical Center’s Emergency Department.
“History?” Beck glanced at the heart monitor as that the nurse pasted the last pad to the man’s chest. Heart rate a bit too fast. Was his coma cardiac in origin?
A respiratory therapist poked his head through the door. “You call for respiratory therapy?”
She held up a “hold-on” palm to the paramedic, told the RT, “We’re going to have to intubate this man. Hang in here with me ‘til anesthesia gets here.”
The tech nodded. “You called them yet?”
“Haven’t had time. It’s your job now.” Without waiting for an answer she rose up on tip toes and called over the paramedic’s head to a second nurse plugging a fresh line into a plastic IV bag, “Glenda, get on the horn to imaging and tell them we need a STAT CT scan.” Better order it now. The scan’s status would be the first question out of the neurologist’s mouth when asked to see the patient. Nervously fingering the bell of her stethoscope, she turned to the paramedic. “I need some history. What have you got?”
“Nada.” He shook his head. “Zilch. Wife’s hysterical, can’t give us much more than she found him like this.” He nodded at the patient. “And, yeah, he’s been a patient here before.”
A phlebotomist jogged into the room, gripping the handle of a square metal basket filled with glass tube Vacutainers with different colored rubber stopper, sheathed needles, and alcohol sponges. “You call for some labs?”
“Affirmative. I want a standard admission draw including a tox screen.” A screen blood test for coma producing drugs. Then to the paramedic, “Did the wife call 911 immediately?”
He shrugged, pushed their van stretcher over so his partner standing just outside the door could remove it from the cramped room. “Far as I know.” He paused a beat. “You need me for anything else?”
“That’s it? Can’t you give me something else to work with?” She figured that under these circumstances a hysterical wife was of little help in giving her the information needed to start formulating a list of possible diagnoses.
His eyes flashed irritation. “This was a scoop and scoot. Alright? Now, if you don’t need me for anything else…”
She waved him off. “Yeah, yeah, thanks.” She wasn’t going to get anything more from him now. At least knowing the patient had been treated here before was some help.
She turned to monitor. Blood pressure and pulse stable. For the moment.
She called over to the lead nurse. “We got to get some history on him. I’m going to take a look at his medical records.
At the work station, Beck typed Tyrell Washington’s social security number into the computerized electronic medical record. A moment later the “front page” appeared on the screen. Quickly, she scanned it for any illness he might have that could cause his present coma. And found it. Tyrell must be diabetic. His medication list showed daily injections of a combination of regular and long-lasting insulin. Odds were he was now suffering a ketogenic crisis caused by lack of insulin.
Armed with this information, Robin Beck hurried to the admitting desk where Mrs. Washington was updating insurance information with a clerk.
“Mrs. Washington, I’m doctor Beck… has your husband received any insulin today?”
Brow wrinkled, the wife’s questioning eyes met her. “No. Why?”
Suspicions confirmed, Beck said, “Thank you, Mrs. Washington. I’ll be right back to talk to you further.” Already calculating Tyrell’s insulin dose, Beck hurried back to Trauma Room 3.
“I want 15 units of NPH insulin and I want it now.” She figured, Let him start metabolizing glucose for an hour before titrating his blood sugar into an ideal level. For now she’d hold off calling for a neurology consult until assessing Washington’s response to treatment.

“Mama, what’s happened to Papa?”
Erma Washington stopped wringing her hands and rocking back and forth on the threadbare waiting room chair. Serena, her oldest daughter crouched directly in front of her. She’d called Serena – the most responsible of her three children – immediately after hanging up the phone with 911.
“I don’t know, baby... I just don’t know.” Her mind seemed blank, wiped out by the horror of what life would be like without Tyrell.
Her daughter reached out and took hold of both her hands.  “Have the doctors told you anything yet?”
“No baby, nothing.”
“Nothing?”
“No, wait…” Amazed that she’d completely forgotten. “A lady doctor came, asked had Papa been given insulin today.”
Insulin? Why’d she ask such a thing, Mama? Papa doesn’t take insulin!”


In November 1999, the Institute of Medicine concluded a study entitled, To Err Is Human: Building A Safer Health System. It focused attention on the issue of medical errors and patient safety by reporting that as many as 44,000 to 98,000 people die in hospitals each year from preventable medical errors. This makes medical errors this country’s eighth leading cause of death — higher than motor vehicle accidents, breast cancer, or AIDS. About 7,000 people per year were estimated (at that time) to die from medication errors alone. In spite of efforts by health care providers to decrease the rate of these preventable errors, they are still a cause of morbidity and mortality.

How can you, as a consumer, limit your risk of becoming the victim of an error? Numerous studies have shown errors to be lower when using computerized medical records. Does your doctor use a computerized system? Also, errors occur more commonly during “hand offs,” when care is passed between providers. Examples are: a change of shift for hospitalized patients, or when doctors refer a patient to a specialist. Always make sure your personal health information is passed accurately between providers. You might consider keeping a copy of vital information such as your prescription drugs and thier dosages. Always be sure to check prescriptions when accepting medications from pharmacies, especially if receiving generic drugs. If a pill doesn’t look familiar, verify with the pharmacist the does and drug. Although errors are unlikely to be reduced to zero, consumer vigilance by lower the rate to more acceptable levels. 

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