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An open letter to the doctor who could have killed me

Dear Doctor,

Do you remember the numerous visits I’ve had with you during the last eight months? Just about every visit was related to my back injury (bulging and degeneration of L5-S1, overall degenerative disc disease, and arthritis) and the subsequent shoulder injury (left shoulder muscle tear/edema build-up) I incurred while shoveling with an untreated back injury. In addition to seeing you in your office, I was also seen four times in your network’s hospital ER, and at least half of a dozen times in your network’s orthopedic group.

At every visit, after describing the origin of the injuries (back – unknown; shoulder – shoveling) and the origin, type, and severity of pain, I then reminded you — and explained to the other doctors and nurses — that I had gastric bypass surgery five and a half years ago, followed by several intestinal surgeries, a perforated duodenal ulcer in February of 2013, and active ulcers since then. I also reminded you of my twice-yearly endoscopies to check on the status of those ulcers, and continued daily ulcer-preventative and ulcer-healing medications (Protonix, fish oil, and Carafate). I emphasized the importance of not exposing my stomach pouch or upper portion of my small intestine to any type of NSAIDs, steroids, or any other type of medication that causes stomach irritation because of my history of repeated duodenal ulcers and an actual perforated duodenal ulcer. I didn’t tell you all of this because I wanted attention, or sympathy, or enough narcotics to fell an elephant. I told you all of this — and made sure you had copies of all of my medical records — so that you could properly and safely take care of me.

And at just about every visit, you dismissed both my pain and my continued concern for protecting myself from aggravating or inducing another intestinal ulcer, and sent me on my way with a dismissive suggestion of taking aspirin, ibuprofen, Aleve, or Motrin for the pain – all medications that both cause and aggravate ulcers. On two occasions you relented and offered prescription pain relief in the form of a Tramadol prescription, but there was always an underlying admonishment and condescending suggestion to simply take an NSAID.

During one of the early spring visits, you relented and offered — instead of, not in conjunction with — Toradol injections. You swore up and down that Toradol was great for managing pain, and that its pain-relieving abilities would not cause me any harm, as injections would simply bypass my digestive system entirely. And in early May, you also prescribed a week’s worth of Prednisone, and again promised that “such a short dose” would do no harm.

All along this timeline, because the orthopedic specialists I saw for my back and shoulder were in the same network as you, they followed suit: my pain was minimized or dismissed altogether, and the most that would be offered for pain relief was a Toradol injection, and instructions to take so many milligrams of a pain-relieving NSAID per day. Mind you, I didn’t have my hand out for strong narcotics for pain relief. I told you repeatedly that the Tramadol you did grudgingly prescribe was helping to manage my pain. I wasn’t asking for Percocet, Vicodin, or anything along those lines. I even said at one point, “I would appreciate pain-relieving medication that is safe for me to take and you are comfortable to prescribe”. I asked. I pleaded. I cried. I explained six ways from Sunday how the pain in my back and especially the pain in my shoulder were affecting every day life – trouble falling asleep, trouble staying asleep, trouble focusing on work, kids, life in general. I promised I wouldn’t drive or operate machinery or cook – and I didn’t when I did have the small amounts of Tramadol you conceded to. I had no desire to harm myself by exposing myself to heavy equipment or sharp tools while under the influence of medication that alters one’s state of alertness and consciousness. I said all these things to you, and yet you dismissed and condescended to me – and worst of all, you offered pain relief that was dangerous at best, and lethal at most. You, and the doctors who followed suit and continually referred me back to you, my PCP, for pain relief, could have killed me.

So because I was in pain, because I thought you had all the information you needed from me — medical history, actual medical records from my bariatric surgeon and her co-surgeons and the other specialists on her team, and repeated reminders both in writing and communicated orally about my ulcers and previous perforated ulcer and continued need to be very, very careful with anything that is directly ingested or otherwise potentially coming into contact with my digestive tract — I trusted you when you said Toradol would be safe. And so I allowed you to administer several of these injections – no less than six in a 6-month period. I also dutifully took the Prednisone prescription, though I made sure to eat or drink a dairy product before and after taking each pill, in order to erect a protective barrier and create a sandwich effect around it. And, I allowed the orthopedic specialists to administer Toradol injections – I also allowed a pain management specialist to inject a mixture of Toradol and steroids directly into my spinal epidural space.

And, after multiple potent Toradol injections, my duodenum did what even a healthy, not-prone-to-ulcer-formation can often do after even a single Toradol injection: it perforated. Perforated sounds so minimal; what really happened is a large 3mm hole surrounded by 25mm of necrotic tissue blew open at 7:00am on the morning of Saturday, August 1st, 2015 – just 11 and a half weeks after I was scoped during an urgent intestinal hernia repair surgery and it was determined I had absolutely no ulcers. I went from zero to dying in 11 and a half weeks, with no dietary changes other than the week’s worth of Prednisone and multiple Toradol injections that were prescribed by you – someone whom I literally trusted (wrongly so) with my life. I did my best to be educated and informed but looked to you, the supposedly compassionate, educated and extensively knowledgeable professional, for anything I may have missed. And you failed me by almost killing me.

So here I am, still suffering from physical pain and emotional trauma four weeks after two ambulance rides and two ER admissions led to an emergency, life-saving three hour surgery that required four types of antibiotics to combat the sepsis that was settling into my chest and abdominal cavity, two units of donated blood to replace what I had lost from internal bleeding, nine incisions, and a significantly painful gastric feeding tube that was removed last week due to the constant pain it was causing (fortunately I have been able to tolerate liquids and soft foods by mouth, so I did not have to depend on that gastric feeding tube for nourishment and medication). I was sent home with two weeks of blood-thinner injections and a doubled Protonix prescription, and I have another EGD set up for November to make sure the damage you caused has fully healed up after my medical group’s other bariatric surgeon (mine wasn’t on call that day and couldn’t make it in “in time” – she told me she sent the other surgeon to operate because she didn’t think I had enough time left to wait for her) spent three hours removing dead tissue, stitching up living tissue, and grafting tissue from my old stomach (aka gastric remnant) to the perforated area. I’ll spare you my tale of post-op misery, but let’s sum it up with this: a 6-day hospital stay, a pain pump that remained in place for four days, multiple IVs, a catheter, a JP drain, the already-mentioned gastric feeding tube, oxygen, compression boots, and what probably amounted to at least $10k worth of life-saving and comfort-inducing medications.

And let’s not forget about the terrifying scare this caused my husband, children, mother, and brothers. My husband had to make the call to 911 because I could barely breathe from the pain, let alone speak. My nine year old son watched as I was loaded into an ambulance. He and my ten year old daughter were left alone for 15 panicked minutes until my mother arrived. My husband waited alone while my surgeon saved my life. He received the news about the extent of the surgery and the probable “weeks in the hospital” recovery I would have ahead of me (thankfully I was able to recover quickly enough that an estimated month-long hospital stay turned into just one week – but I still came home in severe pain, with a feeding tube, and received visits from a home care nurse). My children, my mother, and my brothers all came to see me a day after surgery and went through the shock and fear of how miserable and sick I was, and how close I came to dying. I went into surgery praying to be knocked out in order to be delivered from the pain, and simultaneously praying I would wake up again.

You know how it’s often said that animals know when they’re dying? People know it, too. I know what that sense feels like – when you feel your body rebelling against a horrible trauma, when you know your heart and lungs and brain and very nerves and sane mind are struggling against the knowledge of impending death, but all you can do is cling on and focus on taking in the next breath and beg and hope and wish and pray that you won’t die, even though the pain and the primal fear that goes along with impending death makes you want to move the death clock hand’s faster to get it all over with. Even though that very wish means leaving your husband a widower and your children without a mother, and so you fight against wanting to die faster, even though in the same shallow breath you want to die now.

* * *

Doctor, I once trusted you and even referred family and friends to you. Now I can’t even bear to make an appointment with you in order to personally confront you, though for my own peace of mind I need to do that. I need to move on from this, and to another doctor who is better educated, informed, and concerned about not killing his or her patients. I can only hope that this experience of mine, which came directly as a result of your actions, will give you pause in the future.

Sincerely not ever again your patient,


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