In 1998 I suffered a crushing injury to my left leg.
After more than two years the battle was lost and it was amputated above the knee.
My medical records from that time stand almost three feet high.
The things that were done to me, the mistakes that were made are staggering in proportion!
I’ll start with post-op of the first of three amputations.
I was back in my room from recovery and the nerve block was rapidly wearing off. Every one to two minutes my stump would spasm and my whole left side
would seize up solid.
After say an hour or so of this the nurse finally made her second visit, that I knew of anyway and agreed to call my pain management doctor.
This doctor was and is awesome, one of the very best doctors I’ve ever had!
She walked in just as my stump went full spasm, she still jokes to this day about watching my eyes pop right out of my head.
She said, I’ll be right back and spun on her heal. In what seemed like an hour but was really only a few minutes she returned holding two
hypodermic‘s.
The doctor just smiled as she stuck the first in my IV line and I felt a warmness begin to spread through me and I could feel my stump relaxing.
As she inserted the second needle her smile widened as she lowered face close to mine and said simply, ”Good Night”.
I watched her smiling face as it raced away from me as though I was looking backwards at her through binoculars and then, wink, there was darkness.
I wish the rest of my stay during those two weeks could have had happy endings like that day did.
I was on a morphine pump that I could give myself bolus’s with and I was burning through bags of the medication.
I clearly remember my doctor having a discussion to change the mix of the bags with the pharmacist near the end of my bed.
Being so long ago I don’t remember the amount of morphine to saline but I knew it then.
Later that night I remember the nurse on the 3-11 shift literally running up and down the corridor passing out the 11:00 meds to everyone. She was the
only RN on a floor that had 31 patients. It’s close to midnight and she, a very sweat woman came busting in and slapped the new bag in my morphine
pump. I was so happy, as I had called for meds over 30 minutes earlier.
As soon as she activated the machine I hit the bolus button.
Oh, I do remember the dose,10 mg but not the timing or the amount of the bolus. I don’t remember the mix either but I know I did then for sure. Time
went on and I began feeling strange.
At one point the aide came in for the normal temp and BP check and I told her something was wrong, that I didn’t feel right. She just ignored me and
tried to put the BP cuff on me anyway. I yanked my arm away and said again, somethings wrong.
Now, I am NEVER a combative patient, ever, unless of course meds have turned me into a demon. (don’t give me ketamine, that’s my cuckoo juice)
The aid threw the cuff in the cart and stormed out saying, “ if I have time I’ll come back”.
I got worse and worse.
I’m pretty sure I had given myself at least a couple of bolus’s after that and I remember the pump sending a timed dose.
Then next thing I remember there was vomit everywhere and I know I went out again. I think in my confusion I actually gave myself another bolus that
did it.
Again I woke up and grabbed the garbage can.
It was then the the image hit hit me.
The doctor and pharmacist talking about changing the mix.
I reached over and grabbed the morphine pump turned it around and yup the mix was different.
That poor nurse, in her frantic racing around to care for her THIRTY ONE patients she had missed the script change in the notes and on the bag. I was
getting TEN TIMES the amount of morphine I should be.
This one incident created shockwaves across the country. Standards of how meds are handled changed country wide. Now TWO people are required to
inspect and sign off on all meds before the meds can be given to patients.
Some of you doctors may remember this....
In one way it was a blessing.
If that had happened to ANY other patient on the floor the hospital would have had a corpse on their hands.
The aide quit the next morning and I confronted the chief administrator in my room the next day as well.
I told her that if that nurse had a single black mark put on her record or was punished in any way I’d sue the hospital and create a nationwide
scene. It was the hospitals fault for severely under staffing that floor. As I said, that poor nurse ran herself ragged that night trying to care for
her patients.
I can still hear her feet pounding up and down the corridor.
Got a story of a Hospital Horror?
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edit on 08-19-2021 by PiratesCut because: 41.422500, -70.911944