Living with Cancer: Careless Care
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When I consider what happened to an esteemed friend and colleague, I fume at the mayhem that ovarian cancer wreaks and at the deficient care she received at a university hospital in another town. Do instances of medical negligence sometimes go unnoticed because patients are so debilitated that they cannot testify — especially if they are still in treatment?
After diagnosis, surgery and a round of chemotherapy, my friend had developed a habit of talking with me on the phone every Sunday night. Because of her bounteous insight and candor, it was a great pleasure for me, even though we often discussed her depression. As the months passed, she began suffering from abdominal pain, constipation and rectal bleeding, and her anxieties grew. A CT confirmed growing malignancies.
In “The Ultimate Guide to Ovarian Cancer,” Dr. Benedict B. Benigno explains that “when a patient develops a recurrence, she has an overwhelming chance of developing yet another recurrence.” It’s no wonder that with little hope of putting cancer in the past tense, my friend was dismayed.
The plight of this younger woman fills me with a loathing of cancer, which has blighted my life. “You think you were depressed before?” the disease sneers, like an abusive parent. “I’ll give you something more to get depressed about.”
Getting mad at cancer is pointless, but now I have another target for my anger: the negligent care my friend received.
Despite the abdominal pain, constipation and rectal bleeding, the gynecologic oncologist did not arrange a personal consultation until 13 days after the CT. When the meeting finally occurred, the oncologist sketched three miserable options: chemotherapy with only a 20 percent chance of arresting the tumors; a trial at a distant hospital for which, in any event, she might be ineligible; or no treatment except palliative care.
Back at home deliberating on these alternatives, my friend happened to have an attack of vertigo, unrelated to the cancer, which landed her in the emergency room. Only because of this coincidence did a doctor there decide that she had to be hospitalized. Twenty-four hours later, another doctor ordered an X-ray that showed she had a bowel obstruction. Without surgery, she would have died one or two days later from a perforated bowel.
Horror enough, surely, but other calamities followed. After she had an emergency colostomy, her husband was unable to find anyone in the hospital to help with the persistent problem of rectal bleeding. One doctor proposed taking her off heparin, an anti-coagulant routinely prescribed after surgery to stop clot formations. A nurse pointed out two problems: Through a dangerous oversight, heparin had not actually been administered after the emergency operation — and it could not have caused the bleeding, which had started before surgery.
Eventually, the same doctor who had diagnosed the bowel obstruction decided the best course was to control the bleeding with localized radiation. As my colleague’s husband, a medical researcher, put it in an email to me, “This is a good plan, but the process by which the gynecological oncology team made the decision resembles brain surgery performed by middle school children.”
If we cannot destroy cancer, at least we should be able to put a stop to this sort of negligence. The word “negligence” derives from the Old French word for sloth or the Latin word for carelessness. In tort law, it signifies a failure to exercise the care that a reasonably prudent person would exercise in like circumstances. Not intentional harm, “just” sloppy incompetence and inexcusable inattention.
I cannot help wondering if such carelessness is a particular problem for people with metastatic disease, and especially for women with gynecological cancers. These malignancies infest the abdomen and then the bowels, not easy matters to discuss publicly. There is no detection tool and no treatment that saves the majority of those with these cancers from death. Do some doctors disengage when a disease is assumed to be incurable — when people need more, not less, assistance?
Because I am all too aware of the diabolic tenacity of ovarian cancer, I realize that it remains the villain in my friend’s case. Yet all the careless care — the 13-day delay, the oncologist missing clear signs of a bowel obstruction, the mix-up on the heparin — jeopardized her life and undoubtedly contributed to her deepening depression. Negligence cannot be said to have caused the harm that cancer wrought, but it certainly compounded it.
I pray that my friend will find a treatment that will allow her to continue living a comfortable life as long as possible. Though I fear hospitalizations and medical interventions, as she does, this is the provisional decision I have made after three recurrences. But I am blessed with an oncologist who would never make me wait 13 days for an appointment.
After I went on the web to order flowers in celebration of my friend’s going home from the hospital, I was about to finalize the transaction when I noticed an error in the “Send to” box. The address I had typed was correct, but the name of the recipient was my own.
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