Doctors hurt doctors, too

July 4, 2008

The author's quest to find out what went wrong with a "routine' needle biopsy was met by a stony wall of silence.

As I write this, it's been almost three-and-a-half years since my medical procedure, and I'm still haunted by it.

Physically, I've recovered as completely as possible, thanks to the doctors who treated me afterward. But it's the lingering emotional injury that still wakes me up at night-and this I owe to my profession, as well. Indeed, doctors can be miraculous healers, but they can also cause needless, avoidable suffering.

One morning in February 2005, my husband, Bart, and I drove to the hospital where we'd been medical interns 20 years before. At age 52, I'd discovered a hard mass the size of a fist in my abdomen. As we drove, I imagined chemotherapy and premature death.

Every day, physicians perform thousands of diagnostic needle biopsies on patients suspected of having cancer. I assumed there was nothing to worry about. And because my platelet count was normal, any bleeding from the biopsy site was almost certain to stop on its own, according to an article by an interventional radiologist that I'd read recently.

In the minutes before he began, the radiologist who'd be performing the procedure explained what would happen. To reach what were suspected to be abnormal lymph nodes, he'd place a needle through the skin of my abdomen, while being directed by a CT scan. The small piece of tissue he'd remove would be analyzed, and that analysis would guide the course of my treatment. Complications-mostly bleeding-were rare, he said. Except for mild sedation, I'd be given no medications or blood products. In all likelihood, I'd be heading home in several hours.

I signed the consent, thinking that I'd be able to see my boys get off the school bus later that day.

I experience the worst pain of my life

After receiving mild sedation, I underwent the procedure. Minutes later, I awakened, while Bart sat in the waiting room.

The radiologist came to check on me. There had been bleeding from the biopsy needle deep in my abdomen, he informed me. To staunch it, he'd injected D-Stat. In his pre-surgical talk, he'd never mentioned D-Stat to me, nor did I know much about it.

Eventually, I learned that D-Stat is liquid thrombin, a protein extracted from pig's blood that serves as a powerful clotting agent. Typically, it's used to stop bleeding from open wounds of the kind seen during surgery. It's also used to stop any oozing blood that may occur in the arm or groin after cardiac catheterization. In my case, instead of waiting for the bleeding to stop on its own, as it might well have given my normal platelet count, the radiologist had immediately turned to D-Stat. In so doing, he'd turned my low-risk procedure into a high-risk one.

Soon, I began experiencing the worst pain of my life. In a panic, I remember trying to climb from the stretcher. In my chart for that day, the radiology nurse recorded this note, a half hour after the injection: "Patient writhing in 5/5 pain." I was also hypertensive and tachycardic, both consistent with severe pain.

It was only much later that I was able to deduce-through research and by examining my own records-what had happened. The radiologist had inadvertently injected the potent blood-clotting agent into an artery, thereby halting the blood flow to six feet of my small intestine and causing me sudden, excruciating pain. No one knew this at the time, including the radiologist, who failed to appreciate the causal link between his coagulant injection and my sudden severe pain. Instead, he attributed my postop problem to simple peritoneal irritation. I was given morphine and wheeled to the floor to recover. The expectation was that I'd be going home in several hours.