Aside from the fact that as I grow older, I become more empathetic to the emotions of my patients and their families, two things have occurred over the past few months that have had a profound effect on the way I approach patients and families. Last month, at one of the quarterly VCSQI (Virginia Cardiac Services Quality Initiative) meetings that I attend, we were introduced to a husband and wife who lost their adult daughter after a series of preventable medical errors. Then, more recently, a friend underwent a heart transplant, only to come out on ECMO with primary graft dysfunction. At this point, we are not sure she is going to survive this. Both of these incidents have really made me think about the fear and emotions that our patients and their families are experiencing after cardiac surgery, and how we can better help them through difficult times.
To summarize their story, their daughter, who had two children of her own, underwent what should have been a straight forward (non-cardiac) surgery. She did well, initially, but had to return for a reoperation. During this procedure, she was incorrectly monitored while under anesthesia, experienced cardiac arrest, and eventually died after being diagnosed with an anoxic brain injury. The hospital staff was not immediately forthcoming with the details of what went on in the operating room but, eventually, an anesthesiologist told them the truth. He also stayed in their lives in the coming years to provide them with whatever support they needed. Fast forward several years. They now travel the country telling their story to medical personnel. They have also sat on several patient safety advisory boards. Their message was simple. Slow down. Don’t take short cuts. Remember that the person on the table is someone’s daughter, mother, father or son. Know that if you make mistakes, families deserve to know the truth. Transparency with patients and family members has been getting more attention lately, mostly because it has been shown to decrease lawsuits. It is also important, however, because we owe this to our patients and their families. They are grieving in ways that we may not be able to imagine. This is the least we can do for them.
When I started my current job, 13 years ago, I became close to one of my preceptors. She was like my second mother. Unfortunately, she had hypertrophic obstructive cardiomyopathy (HOCM) and had to retire on disability about 7 years ago. About 5 and a half years ago, she died from complications of the disease. She has a daughter who is also a physician assistant, and who was also born with HOCM. After her mother died, she and I became friends. She has been deteriorating over the past year and was admitted in early December to wait for a heart. As I mentioned, she has not done well post- transplant. A few of my colleagues and I were close to her, and all we do is worry and cry. I keep thinking, if I feel this badly, what must her husband, father and brothers be feeling? It also made me feel like I need to try to be even more patient with families, especially when their loved ones are critically ill. If I am knowledgeable in this field, and I am terrified, what does it feel like to be a family member who doesn’t even know anything about cardiac surgery?
I think these two situations are a good reality check, sad as they may be. When you are involved in a busy service, it becomes like a machine. You are faced with so much work to get done every day that sometimes you forget to slow down and think of what the people around you are going through. Often, taking a few minutes to offer a smile, an explanation, or just an inquiry as to how someone is doing, can have enormous impact on that person. Looking at things from the other side, I know I would want the same.