Near Misses and Incidents

David M. Angaran, M.S., FCCP, FASHP

Disclosures

Am J Health Syst Pharm. 2012;69(3):256-258. 

In This Article

Abstract and Introduction

Introduction

Take a deep breath; try again. How did the oxygen content of the room drop? I am sweating and becoming really lightheaded—that 6 G-feeling. In a minute, the world view will narrow to a dark tunnel, then complete blackness, and I will keel over. I need to sit on the floor; it is hard to fall too far from that position.

Let's review my medical history. It has been three days since I had an emergency appendectomy, and I have been home from the hospital for one day. My clinical mind defaults to disaster—PE. This could just be anxiety, dehydration, and recovery from anesthesia. With my current run of luck, it is a PE. My wife and I just beat the "bad luck" lottery odds by having consecutive emergency appendectomies five weeks apart.

She said it was the ultimate of shared experiences and was telling all the neighbors how we share everything. I am glad she did not have an emergency hysterectomy; otherwise, they would have been digging around in my abdominal cavity looking for a uterus. Now that would be reportable.

We used the same hospital and surgeon. Of course, there were all the questions: "Weren't you just in here?" "No, I was not. Please, notice my name is Dave not Ruth."

The emergent part of the appendectomy experience is still fresh in my mind. The onset was a blow to my lower-right abdomen that drove me to the floor, on my knees, unable to emit a squeak loud enough to alert my wife, 10 ft away. "Mr. Angaran, on a scale of 1 to 10, just how painful are you?" How about 10 to 10th power! My mouth went Sahara Desert dry. No spit here.

Post-op was uneventful. My surgeon did share this tidbit: "Mr. Angaran, your appendix leaked a little." Hey doc, want to know how many cases of abdominal peritonitis I have seen in my career? There I go again, the worrywart. Knowing I have reached the age where it is a risk factor for PE, I am an early ambulator, no matter how unsteady or hurtful.

Even so, considering my current SOB and with the serial appendectomies looming in my mind, I call my surgeon, knowing exactly what will happen, with a report of SOB, by an SOB, in the immediate post-op period. Forget the low probabilities, the way my life is going at this moment I need confirmation from someone who has expertise and is not still exhaling anesthetic gases and taking Vicodin every six hours.

The surgeon's office responded in an efficient manner. Of course, it could have been because I started the conversation with the following: name, symptom (SOB), three days postappendectomy, and my presumptive diagnosis ("Could it be a PE?"). So it is off to the ER.

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