A sharp abdominal pain woke me up shortly after I went to sleep. Soon I was throwing up everything I had for dinner, Injera ( Ethiopian bread made from teff, an ancient cereal) with red lentil ( misir wat) sauce, and some. I thought it was gastritis and would leave me alone but the pain got worse even as the vomiting subsided. I pulled myself up, opened my studio apartment and headed to the parking garage holding my belly. The hospital wasn’t far from where I used to live, a high rise apartment in Motown, Detroit. I parked my old Honda Civic and checked in the emergency department. The medical residents whom I worked with that morning would pass me by without recognizing me. I was just another patient in a white and blue gown with no name or profession or history. After exams, labs and scans I knew that it was not a simple gastritis. My gall bladder was inflamed and I had stones. I needed surgery and it had to be done right away.
It was just another day until that night. I had a quick bowl of cereal with milk and a cup of instant coffee before I headed to the hospital. I was the resident in the team that consisted of two interns. The rounding physician was a much respected professor with mild demeanor and aware of the different cultures that we all hailed from, me from Africa and one each from China and Mexico. He would ask challenging questions and if I slowed down he would say,
“I see that you are not related to the great track and field runner, you are not nearly as fast!” teasing me because of our similar last names with Haile Gebreselassie, one of the greatest distance runners of all time.
The interns would get to the hospital much earlier to see their patients and write notes. As a senior resident I supervised the interns. Bed side rounds would often start around 9 am after morning report where internal medicine interns and residents gather with rounding physicians including the Chief of Medicine to discuss admissions or challenging cases. That was one of the important venues for teaching. Rounds often end few minutes before noon. After a noon conference we get back to work to carry out the plans for the day, discharge the patients who were ready to go home, transfer the ones who need rehabilitation or nursing homes. Although most admissions happened during the night, on occasions we admitted new patients during the day and that alone would keep us busy. If we happened to be the on-call team, often once every four days, we had the responsibility to run code blues that can create a great deal of anxiety.
A senior surgeon with his team of residents and interns came over to the bed side. I was in severe pain after the medication had worn off. He discussed the procedure in detail. I knew that the main complications were bile leakage, bleeding, and infections. He said he intends to do laparascopic surgery but if necessary he could convert it in to an open procedure. He said that was a routine surgery with 0.1% chance of dying from it. He said he would put me on antibiotics so not to worry about infections. Throughout my childhood I beat higher odds so I wasn’t worried about complications or death. I also felt that because I was a trainee in the same hospital, I would get extra attention. I ignored the idea of calling home in Addis. That would have panicked my parents, siblings and close friends. Any type of surgery is feared in Ethiopia. Some may not come out alive.
The operation was a relative success although it took longer than planned, but that was just the beginning. The second day I started to feel chills, developed high grade fevers, became uncomfortable.
The surgery resident stopped by and threw a tube in to my stomach through my nose to decompress my distended belly. I was worried.
The high grade fever continued in to the third day. I wasn’t getting any better. That was when I took it upon myself to check what was going on. Medical records were all electronic including medications and physician notes. I found a laptop computer in my room that was left by the nurse. I quickly logged in and opened my own chart. The first thing I did was to check my labs. My white cell count was elevated. I reviewed the medications I was supposed to get. I was shocked to see that I was not getting any antibiotics. I went through the operative note and the surgeon’s progress note. It was a complicated surgery. The surgeon had indicated in his notes that I needed antibiotics. I was puzzled. Before I logged off, the nurse walked back.
“What are you doing?’
“I am checking my labs.”
“You are not supposed to do that.” She was angry at me.
“I am a medical resident here; I am worried I am not getting better.”
“Still you are not supposed to look at your chart.”
“Do you know why I am not getting antibiotics?”
“I only carry out orders. Ask your doctor.” She slammed the door behind and left unable to hide her anger at me. I wasn’t trying to be a demanding patient.
She must have paged him. The surgeon came to see me immediately and apologized that he forgot to write the orders although he had it clearly written in his notes. My fear was another operation and who knows what could follow. Medical errors cost tens of thousands of lives in US hospitals each year. It can happen to any of us. It was not too late for me. I got better.
I left the hospital a week later with a lesson to pay attention to details and to be a better doctor.