Authors: 

 

Lawrence I. Kaplan, MD, and Rosalind Kaplan, MD

Citation: 

Consultant. 2016;56(6):550,552.

This is the true story, told alternately in both our voices, of Larry’s recent misadventure and how it affected us as a medical couple. We are both internists in practice for more than 25 years each. We see patients and teach trainees every day, but nothing prepared us for this. They say doctors are the worst patients; I guess we proved it’s true. 

—Rosalind Kaplan, MD

Larry: I woke up on a Monday morning feeling like I’d been hit by a truck. I had a fever and body aches, but nothing really specific otherwise. I got up and tried to get ready for work, but it just wasn’t going to happen.

 

Roz: The first couple of days, I figured it was just a virus, too. It’s unheard of for him not to go to work, but anyone can get the flu.

 

Larry: On the third day, I just pushed through it and went to work. I still felt awful. The giveaway should have been the rigors, although I didn’t know that’s what they were. I was shaking while I was talking to my boss, and I couldn’t stop. It was involuntary, and nothing like that had ever happened before. All the other docs said I looked bad and needed medical attention, but I just wanted to go home and sleep. Then I kept getting what I thought was heartburn, since I had taken Aleve for some muscle aches, but the boring sensation in my stomach wouldn’t go away, even with Prilosec.

 

Roz: After the rigor, I knew there was something really wrong. But he’s so stubborn, and when I told him he needed to see his doctor, he actually got nasty and snapped at me. When I came home and found him popping Pepcid, I told him it didn’t add up. I was angry that he wouldn’t listen, but he insisted he would be “better tomorrow,” and I wanted to believe it. That night he soaked the bed with sweat, and I had to get up in the middle of the night and change the sheets. I was alarmed. He thought it was his fever breaking.

 

Larry: The next day was Thanksgiving. I didn’t want to alarm my parents or make a scene, so I tried to pretend I was okay, but I ended up sleeping all afternoon at my sister’s. I couldn’t really find a comfortable position to get into. Every movement was painful. Thanksgiving dinner was actually annoying. I had to be there but really did not want to be. I just wanted to be left alone.

 

Roz: By the end of Thanksgiving dinner, I’d had it with the charade, and told him to get in the car to go to the ER. I’d told his family that I was concerned that he might have appendicitis. I’d been watching him walk as though it hurt, even though he never said he was in any pain, and he didn’t eat any dinner at all. He still had a fever. I really didn’t know what was wrong, but peritonitis seemed like a good bet.

He must have felt too bad by then to argue any more, because he did what I said, but he did get in a last dig: “This is a very poor use of medical resources.” I just ignored him.

Larry: The trip to the ER was painful. Every bump hurt. So was the trip to computed tomography scan. When the ER doctor came in and said, “It’s not appendicitis, it’s diverticulitis,” I was thinking, “Great, then no surgery.” But then he continued, “And you perforated and have free air under your diaphragm.” That’s when it finally sunk in that I was really sick.

Roz: At that point I was really scared, and I felt totally alone. Larry finally seemed to get that he was sick, but he was way too far gone to advocate for himself, and he was delirious with fever and pain and narcotic medication. The moonlighting surgeon came in and asked him if he wanted emergency surgery, which would have meant a temporary colostomy, or if he wanted to “wait and see if he got sicker.” I couldn’t believe he was asking Larry to make a decision like that when he was in that condition, and that he explained it so poorly. I dragged that surgeon out of the room and told him I was on staff and that I wanted the attending surgeon on the phone immediately. He looked shocked. I felt shocked. I am usually very polite and patient, but it was like someone else had taken over my body. Thank God he did what I said, and the attending surgeon—someone I knew and trusted—made the decision to hold off and try antibiotics and bowel rest.

 

Larry: I don’t remember much of that week. I didn’t feel like I was getting any better for a long time. I know the care was good, because the nurses seemed to be there every other minute, but I didn’t really care what was going on. I was just driven crazy by the heart monitor that kept going off for low heart rate.

 

Roz: He did get better, but he was really out of it for days. He avoided the immediate surgery, but we knew he’d have to have an elective sigmoidectomy in a few weeks. Larry wasn’t really sick during those weeks, but he wasn’t well either. It was all part of this prolonged time of things not being right.

We chose a surgeon at another hospital, one of the big teaching hospitals, unfortunately not ours. I hate to say it, but when you’re at your own institution, you at least feel like you’ve got your colleagues looking out for you. When you go somewhere else, you’re just another patient. And in all honesty, being a patient should be a safe experience. You should feel safe and cared for. But that’s not the way it really works. Sad but true. You think going to your own hospital might be weird, and that you won’t have any privacy, but in this case, I think we would have been better off.

 

Larry: In retrospect, our choice of hospital might have been a mistake. We chose it for the surgeon, and the surgery itself went fine, but the aftercare was a mess. I had uncontrolled pain and a wound infection, and I got overdosed with sedatives because of poor communication with nurses and residents, and poor communication between those 2 groups. The residents never really examined me; they just made doorway rounds. As a teacher of medical trainees, I was livid, but I was in a position of no power.

 

Roz: I felt like I had to watch everything that was done like a hawk. After the first couple of big errors, I would go in each day and ask the nurse what meds he’d be given. Sometimes I’d fight with the house staff about the medications, and once I pulled rank and called the attending surgeon myself. I hated being in that position, but I could see all the errors: doses that were wrong, failure to give him back routine medications once he could take pills, inadequate pain medicine orders. It was really frustrating. By the time he went home, after a week, I’m sure they were hoping they’d never see us again. I was in such a no-win situation. I wanted so badly to just sit back and let someone else do the work, but I couldn’t. And then I looked like this crazy control freak, I’m sure, but I couldn’t let them hurt him.

 

Larry: Doctors who take care of other doctors joke that it’s always going to be the doctor-patient who has the complications. Seems like it was true here, but some of those complications could have been avoided. Then I think about how the whole thing could have been avoided if I hadn’t been so stubborn in the first place.

Roz: You said it this time, not me. I just want to see you respond differently next time you’re sick. I don’t want to hear about the “poor use of medical resources.” Or better yet, let’s not have a next time.

© 2017 Rosalind Kaplan