This Medical Student Witnessed Doctors Neglecting A Dying Patient. This Is Horrible.

We put our faith in medical professionals, but at the end of the day they're human too. Doctors were asked on Reddit: "What is the most unethical thing you have done or you have heard of a fellow doctor doing involving a patient?" And one user, Doctor__Throwaway, had a heartbreaking story to tell.

This happened a few years ago and began when I was a 3rd year medical student during my general surgery clerkship.

Just to get my bias out of the way, I should say I really did not like the surgeons charged with running the clerkship, I thought they were incredibly unprofessional egocentric pricks who only cared about how much a student would kiss their ass. And this went far beyond the stereotype of the "typical surgeon", I shadowed surgeons in highschool and college, and always wanted to be one. But this department was dysfunctional on a level I had never encountered before or since. I could write a book of the insanity I witnessed there.

So anyway, this particular incident starts about a month into the clerkship. By now us med students had settled into our roles there, learned the daily ins and outs. Get there around 5:30 AM, have morning conference and rounds, spend the remainder of the day in the OR or in clinic hours, and get done anywhere between 4-6 PM on a good day. Once or twice a week we would also do call, where after the regular hours concluded we would report to the ER and work there till around 11-midnight.

So as per usual I get through the day and arrive at the ER around the usual time. When I get there the attending covering the ER greets me and gives me a run down of the patients currently there. Most of them are the usual bullshit type stuff we see at the ER - abscesses, a laceration that needs stitches, nothing serious. But he says they have an interesting patient that was just brought in, a woman in her early 70s was just brought in by an ambulance, or actually a second ambulance.

She had gone to her GP complaining of dizziness, and the GP sent her on to the hospital. The GP was concerned about her driving in her state, so they called an ambulance to drive her to the hospital. On the way to the hospital the ambulance got into a car accident and flipped on its side, so the woman was then picked up by a second ambulance and brought to the hospital. Now in addition to getting a workup for the dizziness, there was concern of internal injuries stemming from the car accident.

So she gets a CT, and afterwards gets parked in the "urgent" room of the ER. The ER is divided into surgical and internal sections, and on the surgical side there is a bay room where the more urgent cases get brought for triage care: stabbings, gun shots, serious car accidents. The room has a couple of dedicated nurses - whereas the other 3 surgical ER bays share a group of nurses. The patient is hooked up to every monitor and then some, but she is awake and seemingly in good spirits.

I apologize for the detail here but I want to paint a vivid picture of just how incredibly f*cked up what happened really was.

So at this point I go over and introduce myself, let her know I'm the student doctor on the floor for the evening, and if she needs anything my name is ____ and to just ask. I'll call her Mrs. X at this point for sake of ease.

A little bit later on we get the CT with the radiologists report, says there is no internal injuries noted and no bleeding. The attending reviews the CT and report, as does the resident, and things seem to be fine.

The night goes on, I follow around the resident doing the shit work for the night, mainly cleaning up after he drained a couple of anorectal abscesses (like clockwork every time it was my night in the ER it was as if the moon and stars aligned to obstruct the anal sinuses of many a citizen and send them to my doorstep, but that is not part of this story).

Ok, so I get through the night, periodically checking up on Mrs. X in between my other tasks, and at around 11 PM the attending says its pretty slow so I can call it a night. I say goodbye to the staff, say goodnight to Mrs. X and that I will see her in the morning.

So I go home, crash. Get up the next day and head in around 5:30 for the regular morning meeting that comes before rounds. When I arrive I could immediately sense that something was off in the room. Everyone was visibly on edge and quiet, not even whispering among themselves. They were waiting for the department head to arrive and kick off the meeting.

So the department head arrives and he looks very unhappy. You should note that this many always looks unhappy. He was a German Jewish fellow in his late 60s, and he was tough as nails. Always serious, never a smile, never a compliment. You know in those WWII movies where they portray the Nazi villain as just some caricature of stern seriousness that is incapable of emotion? That was this man. Some of the residents even had a couple of Nazi inspired nicknames for him - which me being Jewish I found incredibly funny. But again not the point, gotta focus and not go on anymore tangents...

He walked into the room without saying a word and sits at the head of the table. There are now 30+ people in the room, mostly attending physicians, residents and med students. About 30 seconds passes without him saying a word, and then he just lets loose. In the span of a few seconds it was just a torrent of hate and vitriol pouring out of his mouth. His face turned so bright red I thought it was going to ignite his hair. And he was talking really fast and was so angry it took a couple of moments to piece together exactly what happened.

At around 1-2 in the morning Mrs. X start having trouble staying conscious. She was rushed to the ICU, and at the time of the meeting she was in a coma with a very low likelihood of recovering.

Apparently the radiologist, attending and resident all missed what was (allegedly - at the time I was not particularly skilled at reading CTs) a very obvious lacerated spleen. And to make matters much, much worse the resident on call wrote in her chart ordering "24 hour observation".

To the uninitiated that may seem normal, or at the very least not problematic. However in this setting when you want someone observed you need to give clear instructions on exactly what you want observed, and at one time intervals. Writing to have the urine output checked every 15 minutes, or blood pressure, or oxygen saturation, or any number of other parameters to assess the status of the patient. These things need to be very clearly enumerated to ensure the patient doesn't get overlooked.

And unfortunately that is what happened to Mrs. X in this case. Without instructions for what to do, the medical staff (attending, resident, nurses) all just sort of passed by her assuming that someone else was on it, or assuming that since there were not clear instructions everything was "alright".

So the verbal ass-reaming continued for what felt like hours. The resident that wrote "24 hour observation" got told several times by the department head that she would be thrown out of the program during his scream session, and this was in front of the entire department staff. The attending on call got it just as bad if not worse - unprofessional, lazy, not worthy of being a doctor. Pretty much anything you can imagine. During his tongue lashing it was implied he should start sending out resumes to other hospitals.

Finally, herr doctor decides to end his scream session by rhetorically asking the doctors involved what they plan to tell the family of Mrs. X, to which they all sat silently. After a moment of awkward silence everyone starts to shuffle out of the room and continue on with their day.

So now fast forward a couple of months. At this point I have finished my surgical clerkship, and a couple of clerkships that followed it. Now I'm rotating through a family medicine clinic in the suburbs about a half hour from the hospital. And on this particular day we get and elderly gentleman coming in complaining of a cough or a cold, I can't quite remember what his original complaint was.

Anyway the doctor I'm working under, lets call him Mike, says that this patient Mr. X is an interesting story. Dr. Mike says that a couple months earlier Mr. X's wife came in complaining of dizziness, and he sent her to the hospital to get a more thorough work-up. Mr. X then tells me what happened to his wife, as he was told by her doctors at the hospital (a surgeon from the department I clerked at).

That on her way to the hospital the first ambulance ran a red light, and in the ensuing accident she suffered an internal injury. After she passed they told him that there was nothing they did everything they could and that she ultimately succumbed to her injuries. When he was telling me this he was getting a bit irate, because he said when he was with her late that night in the ER (this would be prior to being rushed to the ICU) he had been trying to get the attention of a doctor or nurse to no avail for a couple hours because he thought she was worsening.

So with little recourse left and being told that it was the ambulance drivers at fault, he was currently pursuing legal action against them.

I remember him telling me his story so vividly, because I was so overcome with anger during the whole thing. First being reminded of such a stupid f*ck-up by so many people that ultimately led to Mrs. X's untimely death, and then infinitely more angry when it became clear how much he had been lied to or intentionally mislead concerning his wife.

And I vividly remember how not at all conflicted I felt when I told him everything I knew about the situation regarding his wife: that I was on call when she arrived to the ER, that I spoke with her throughout the early evening, that multiple doctors missed the lacerated spleen in her imaging, about the resident's f*ck-up in the chart that escaped notice of the attending and led to his wife being basically ignored until she was comatose, and about the conference the following morning where it was clear that everyone in the department knew what ultimately caused Mrs. X to die, and that he was clearly being lied to by whomever he spoke with.

I remember the look on Doctor Mike's face, almost a look of shock and happiness. Doctor Mike and I had really hit it off from the start of my Family Medicine rotation. Even though I didn't go into Family Med, I really loved the community work. Also Dr. Mike and I had very similar philosophies about medicine and life in general, so we got along really well. And I could see he was happy that I decided to speak up and tell the truth about what happened, instead of just keeping quiet to protect a fellow doctor.

It was at that point of course that I remembered, "shit, I'm still a 3rd year medical student. And I just outed what could be at the minimum a serious lawsuit and at worse a scandal at the primary hospital of the medical school I attend. And I could face very serious retaliation over this."

I don't want you to think I'm exaggerating, there was a fellow student (who admittedly was a real asshole that no one liked) that spoke up about some shady stuff the administration was doing a year earlier, and he got expelled from the program over it. Fortunately for me Mr. X was extremely mindful of my situation, and he and Doctor Mike told me that they would keep my name out of anything that happened going forward.

To this day I still keep in touch with Doctor Mike periodically to see how things are going. Last I had heard about Mr. X was a couple years ago. He had his lawyer go after the doctors responsible and the department of surgery. Knowing this was a case of egregious medical error the hospital offered to settle, and because they were now aware that the doctors actually lied to them and tried to cover up their error, Mr X got a settlement almost an order of magnitude larger then he would have had it been just an egregious error, minus the lying.

I know of course that this does not make up for Mrs. X, and frankly I wish he hadn't settled but taken them to court and try to have the medical licences of all those involved stripped, but Mr. X did what he needed to for him and his family to move on from their tragedy. I am only glad I could play a part in making sure those scumbags that give my profession a bad name paid for their callous disregard of their moral, ethical and legal obligations.

And that is my story of the most unethical thing I have ever seen another doctor do involving a patient.


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