The Yale Journal for Humanities in Medicine

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The Error

Saturday morning smelled like autumn. A warm blanket of leaves covered the streets outside, and dusty yellow rays of sunlight were streaking across my bedroom. I dressed quickly, finding comfort in the embrace of my favorite wool sweater and a pair of cords. Standing in the hall, clutching my stethoscope with both hands, I stared at my white coat on it’s hook. Sensing a contradiction, I left for the hospital without it.

There would be no physical exams today, no prescriptions. No x-rays, and no blood draws. Today would be the hardest day of my internship. Only apologies, and only one patient.

* * * * *

Morgan Davis is forty years old, weighs three hundred and eighty pounds, has asthma, high blood pressure, coronary artery disease, gout, depression, sleep apnea, and dermatitis. He has seen a dozen random physicians over the past year. He has gone to the emergency room twice for chest pain. Mr. Davis is ‘a train wreck’ in the parlance of interns. No quick visit for a sore throat or ear infection. No tennis elbow needing a sling and some pain meds. As Mr. Davis strode into the exam room, the wheels of the clinic outside were grinding to a halt.

We started with his past medical history. We talked about his asthma and recurrent chest pain. We discussed his knees, but nothing can stop the knee pain of a three hundred eighty pound male. That day he had come in for an ear infection, recurrent dermatitis and a new problem – incontinence. He was urinating quite a bit at night, and had occasional accidents. An exasperating problem in a homeless shelter, where his bed was an island in a sea of other people.

Mr. Davis and I hit it off right away. You wouldn’t expect us, two obviously different individuals on the outside, to find common ground so quickly. He a giant of a man – gold hoop earrings and a trimmed goatee perched atop a mammoth black frame. Me a scrawny white doctor – bony, balding, more swallowed-up than cloaked by my drooping white coat. But in the privacy of the exam room, with the door shut and the two of us face to face, he was at ease and spoke candidly about his life. He told me about the shelter, how his bedroom was essentially a public place, and his fear that everything he owned might be stolen during each five minute trip to the bathroom. Mr. Davis’ life was unstable at best, and he spoke with pride of his attempts to turn things around. He was working a regular job again, receiving health benefits, and taking better care of himself medically. Something about his courage and determination was inspiring.

I listened to Mr. Davis’ story of the shelter, struggling to imagine a world I can’t imagine. I flushed his ears with saline and prescribed two medicated ear droppers. I made an appointment for him with a dermatologist, and another with a primary care doctor who would see him regularly. Finally, I gave him a plastic container to use in the shelter, for which he was extremely grateful.

After forty five minutes Mr. Davis headed for the door with his plastic container in hand and a smile across his face. I headed for the waiting room, praying that nothing but sore throats and tennis elbows lay ahead.

* * * * *

Morgan Davis was back for another urgent visit two weeks later. I was happy to see his one familiar face among the dozens of strangers. But it was my last day in the clinic. The end of the month had come. Another visit with me meant one less visit with the regular physician he still hadn’t met.

Morgan detailed for me the urine volumes he had collected, and we explored his incontinence in greater detail. He was drinking a lot of water each day, “to stay healthy” as he put it. But he also seemed to have trouble emptying his bladder completely.

“Sometimes I go, but then I have to go again five minutes later.”

We catheterized him after he went to the bathroom, but there was no sign of retained urine in the bladder. I performed a digital rectal examination (no small feat given his large size) and found a slightly swollen prostate. My attending and I recommended that Morgan drink less water in the evenings before bed, and agreed to prescribe Hytrin for ‘benign prostatic hypertrophy.’ Morgan got dressed and sat opposite me as I typed in the orders. His jean jacket was on, and after thirty minutes he was getting restless.

“Will this take much longer, doc?” he asked. “My aunt is waiting for me outside in the car,” and as he said so a cell phone began ringing in his pocket.

Our new computer system in the clinic is just terrific. It saves time while reminding physicians to do things they might otherwise forget, like asking about smoking cessation or chronic pain. Lots of little boxes to check off. Screen after screen of ‘clinic reminders’ to prove just how much I forgot to squeeze into a fifteen minute interview, as if a fifteen minute interview has any room left for ‘squeezing’. And electronic prescription forms – the holy grail in the battle against illegible scrawl. Even better, the computer automatically fills in the name of the medication after I type the first few letters.

I typed ‘hyt’ and ‘Hytrin 10milligrams’ came up immediately. I hit TAB and continued to enter instructions. ‘Take one pill at night,’ I wrote in the memo field. I warned Morgan that low blood pressure and fainting were the most common side effects, and told him only to take it before bed. Usually we start with a low dose, say 1.0 milligrams, and go up from there. Isn’t that what the order had said? Morgan was pacing back and forth now, placating his aunt over the phone. I hit ENTER, walked to the lone printer at the end of the hall, and signed the script which Morgan grabbed like a relay racer accepting the baton on his way out the door.

Continued
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