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Patient Safety
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Mobbing and
Trust Us
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Crime in
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Thomas Jefferson said that given the choice between government without newspapers and newspapers without government, he would choose to have newspapers.

In medicine we have government without newspapers. Patients cannot find out what they need to know to make informed choices. No one in medicine records or reports the information patients need to know the most. So patients will have to.

I'm Mrs. Roark

The bits and pieces of experience that slowly create a child's awareness of who Mom is trickle in infrequently. There was the time Aaron answered the phone and someone asked if they could speak to Mrs. Roark. The question was posed as though Mrs. Roark would be there. So he didn't question the adult caller. Instead he walked to the next room and told his Mom that someone on the phone was asking to talk to someone named Mrs. Roark. His Mom rose from her chair saying, "I'm Mrs. Roark."

That was another moment that would stand out in his mind for the rest of his life. Like the moment later that same year, in the springtime when he was a nursery school and his mother was dropping him off. She'd had occasion to enter the school and speak with one of the teachers. After she left, one of his classmates swept her hair up on top of her head and began walking in an exaggerated fashion saying, "I'm Mrs. Roark." A teacher was standing near and, to no one in particular, without really expecting a response, Aaron asked, "Why is she doing that?" The teacher smiled and said, "Your mother is very beautiful and very stylish and little girls and sometimes their mothers imitate your mother."

This was amazing news. He had thought the other mothers and children did not like her. One day when she was picking him up from nursery school, Julie's mom had walked down the line of cars hollering at his mom. For several minutes his mom kept trying to get in the car, but was prevented by the finger pointing at her as the woman shouted at her. When she finally got in the car, he asked her about it and she said that the other mother's were accusing her of making all of their children sick by not vaccinating Aaron. There had been an outbreak of something. The suspicion was that Aaron had brought it to the school. They wanted her to take Aaron to a doctor, but his Mom did not go to doctors. He had heard this explained before, but it seemed as though there was a story he'd never heard.

So when he was seven and leaving a grocery store with her and she fell and hurt herself, he knew she was not going to want to see a doctor about it. It was winter. Everything was wet from melted snow and ice around the paths that had been cleared and salted. They walked carefully on the linoleum floor in Krogers as they approached the automatic doors to leave the store. He walked ahead of her and jumped onto the mat the triggered the door to open. When she was pushing the grocery cart out the door, he was ahead of her and not looking when he heard her yelp, turned, and saw her on the ground. There was blood on her face. He stood motionless having no idea what to do. She rolled over to sit upright.

"Aaron? Could you move the cart?"

He grabbed the front of the cart and pulled it away from her. He saw people inside taking notice. She pushed her hair back from her face and then she saw the blood on her hand and said, "Oh, no." When she started to try to get up, she was having trouble partly because she didn't want to put her bloody hand on the railing. He saw blood on the railing where she hit her head. And people began to arrive. Someone else's mother came asking her if she was all right. Someone else shouted to get the manager. This other woman was helping his mom get up. The manager arrived saying he was calling to get an ambulance. She didn't want an ambulance. He said that Kroger's was going to pay for everything. She said there was nothing to pay for. She just wanted to go home. He said that he wanted her to see a doctor. That was the last thing she wanted. He wanted her taken straight to a hospital. She would rather take care of this herself. He was insistent about it, but she was not persuaded until he said that he could lose his job if he did not see to it that she was seen by a doctor to make sure she was all right.

The longest breath he ever had heard come from his mother preceded the word, "Okay." Everyone had waited silently until the end of the breath. When they heard the "Okay," they snapped into action. Everyone on the scene wanted her to go to a hospital. There was no sensitivity for her disinterest in it. There was no thought that she might have a reason for not wanting to go. There was no question in anyone's mind that the very best and, in fact, only smart thing to do was to turn this over to medical professionals.

She said that she would drive herself to the hospital. Aaron knew that if she got in their own car they were going straight home. Maybe the store manager knew that too because he did not let her. He waited with them until the ambulance arrived and they were put into it.

At the hospital they waited for hours. He had looked at all of the Highlight magazines they had and now was sitting with one on his lap as he watched other people. A nurse asked his mom if she was sure she didn't want to call his father. His mom didn't want to interrupt him at work. Finally they said they had gotten a surgeon to agree to come down to see her and they took her through a door where he couldn't follow. He was taken behind the nurse's station where they said they would watch him for her. They gave him a clip board and a pen and told him he could draw. The paper had printing on the other side of it. He sat on a stool with nurses coming and going, patients arriving and leaving, doctors appearing and disappearing, as he made disinterested attempts to make marks on the paper with the pen. He didn't understand what was going on. He didn't understand what they were talking about. But he did understand one moment when one nurse pointed to him to tell the other not to say any more.

In the same way that he could be day dreaming in class when the teacher called upon him and somehow know what the question was, he knew the last several things they had said. It would have slid past as more disconnected gibberish if not for his suddenly having become the center of attention. The nurses had been talking about a surgeon who had just used a kind of suture that only is supposed to be used internally. If it is used externally it leaves an ugly and unnecessary scar. The one nurse said that the surgeon had done it to send them a message. He had done it to show them he was mad. He didn't want to be called down to the emergency room. He hadn't responded to their initial calls because he wanted them to find someone else. When they couldn't and they came back to him again and again, he finally came down and did what he did to send a message to them not to disturb him again. The change tone in their voices when they pointed at him had gotten Aaron's attention. He was looking straight at them. One of them said to the other, "This is Aaron. His mother is here because she fell down and we're taking good care of her."

That evening he saw his mother in front of a mirror looking at the stitches in her forehead, crying. They were ugly. She said she would have been fine with a band aid. As the weeks progressed and the appearance did not improve, one time she mumbled something about why stitches had to look so bad. Aaron told her what the nurses had said. She became silent and motionless in the way people can become when what is going on inside is anything but.

Someone suggested plastic surgery. Aaron knew that was never going to happen. And not just because of Uncle Harry. He wasn't really their uncle, but was distantly related somehow and on occasion came to their house for dinner. He was a car salesman. He sold Oldsmobiles. And he had had plastic surgery. On his face, on his cheek, was a square hunk of flesh about an inch and a half by an inch and a half that was at least a quarter inch higher than the skin around it. It had been taken from some other part of his body and slapped on his face like a pad of butter on a pancake. It could not have helped his profession as a salesman.

Apparently there had been some problem on his face that some physician had persuaded him he could fix. Uncle Harry was never going back to a doctor for such help again either. One of Aaron's earliest lessons in social skills had been his mother saying to him, "Don't say anything about that" when he asked her, "What is that?" It was so ugly as to be disturbing to have to sit across from at a dinner table.

Aaron heard this mentioned by one of his mother's friends as she was saying that some other physician could do a better job for her than was done to Uncle Harry. His mom was not persuaded. It was not just a matter of skill. For the rest of her life she would have to wear her hair hiding her forehead, which wasn't the style at the time. Because a doctor wanted to send a message to some nurses.

No one ever would be able to persuade her to go to a doctor again. Not even twenty years later when she had caught a parasite that gave her diarrhea and she was starving and dehydrating. After six weeks she had no fat left. Her lips were peeled back to where she couldn't close her mouth. She could not even swallow water from a glass. She wasn't strong enough tilt her head to take it. Aaron had had to hold a wet wash cloth against her lips to moisten them and let whatever drops could be wrung from it drip into her mouth. He could not find even find a pulse anymore. When he touched her skin, it wasn't cold. It was room temperature like leather. There wasn't enough moisture in it to conduct heat in order to feel cold. And they knew she was dying.

His father cried for the first time in Aaron's presence. They begged her just to let them allow a nurse to visit to put a water IV in her. She could hardly breathe, but she managed to mouth, "No." There never again would be anyone in medicine put in a position to violate her trust again.

After what they thought surely would be her last night, she didn't die. She leveled off. They guessed that even the parasite could not survive in a body so dehydrated. Within a week, she could take small amounts of water. It took most of a year for her to resume her life again. She never fully recovered. She went from middle age to old age in the course of a single illness. It wouldn't have been necessary. They were sure that the parasite could have been killed with some drug and she wouldn't have had to go through any of this. But so many of her encounters with healthcare had been so bad, that she would rather die than interact with them again. And when she she did many years later, the police arrived asking questions. Why had she died? "Old age. She's 82." But no physicians? No medical records? They suspected foul play and turned her home inside out looking for an explanation.

The explanation was the scar on her forehead, and the dentist who had tried to remove all of her teeth fifty years earlier, some of which still were serving her well when she died, and the hospital that had insisted that she had not had a baby, and then when finally persuaded  them that she had, brought her the wrong one - something she knew only because she had argued with them when Aaron was born and demanded to see him before he was carried out of the room. She had gotten a look at him and so knew when the one they brought back was the wrong one. She had had to argue, even fight, with nurses at that tender time, nurses who insisted she was wrong, when all she wanted was to have her baby.

The explanation also involved some story that Aaron knew existed, but got to hear. There was a certain laugh that he learned to make while watching a horror movie one time, a dark, sinister, evil laugh that he was surprised he could make. It was useful at certain moments with his friends. One time he tried it out on his mother. Emotionally she withdrew to someplace he had seen her go only a couple of times before, times when "that story" came up, the one he would never hear. He asked if this had to do with that. She said, "Please. Don't laugh like that again."

So when the police asked why she had not been given medical care, he could say only that she didn't trust doctors.

With all this in his background, why were the lessons learned by his mother so far from his own consciousness when a doctor and nurse did to worse to him than had been done to his mother. Why didn't he understand better than  trustingly to return to medicine, and even to that same surgeon, for help with the injuries - a debacle that ended his career, ended friendships, lost him the respect of his parents, and shattered his marriage?

Next Chapter

Medical Novel Table of Contents

Persons, places, events, and situations in this story are purely fictional.
Any resemblance to actual persons, living or dead, is coincidental.

Rough Draft / Under Construction


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Silence versus Patient Safety
Loyalty versus Patient Safety
The White Wall of Silence versus Patient Safety
Blacklisting Patients
Freedom of Speech for Patients
Medical Complaints - How to

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It's a path

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