One Bad Apple

“In here, Kirkpatrick.” he snarled. My urologist pronounced my name in such a way it sounded like he was trying not to vomit. His distaste for me was palpable and he was making sure I knew he’d rather be chewing ground glass than treating me. Of course, I wasn’t all that thrilled to be back in the urology department; the last time I was there was so traumatic that I literally have nightmares about it. But at least I was being pleasant and friendly, which is a lot more than I can say for him. After a few minutes of his attitude though, I got up to leave.  He caught himself, I think, because he got to the business of why I was there. While it was still plain he was uncomfortable, he at least addressed my reason for being seen. In 2008 I had been scheduled for a urodynamics test. It sounds innocuous, but it’s a test to determine urine flow and the amount of blockage a man is subjected to, and it’s anything but innocuous. I was having serious issues emptying my bladder and was set up to take the exam in anticipation of a new laser procedure that would open the urethra and allow easier emptying.

I had been subjected to a catheterization by a ham fisted physician a number of years earlier, and he tore my urethra inserting a catheter and I developed a painful infection. The scarring from that ended up adding to the difficulties that an enlarged prostate causes men, and thus here I was looking for relief. The urodynamics test involved inserting a catheter and  inserting electrodes in the anus. Using electric stimulation, the doctor causes the bladder to empty and the flow of fluid is then measured. If it sounds like the horrific tortures you hear about in the urban myths of wartime, try hearing about this as the patient. Anyway, I explained that I was particularly sensitive to catheters because of the previous experience, and cautioned the doctor to be careful. He said that he was using the very smallest catheter available and that there was no chance for problems.

The catheter was only inserted a couple of inches when the blood began to flow and I felt a burning sensation that grew. The farther he inserted the catheter, the more blood coming out and the greater the pain. Each millimeter seemed to amplify the pain. By the time he had inserted it the appropriate distance, I was in agony and blood was literally squirting past the catheter where it entered the body. I told the doctor to stop and take it out. He questioned removing it, saying that it was in, why not continue?  It hurt like hell but I asked him how long it would have to stay there. His reply was that the test would take about forty minutes. I told him to get it out of me, that it hurt too badly. He hesitated, but then acquiesced to my demand and removed it. When it came out, I spurted blood all over and was literally writhing in pain. I ducked into an adjacent bathroom and sat on the john for ten full minutes, trying to wait out the pain and the bleeding to stop. When I finally reappeared and asked him what went so wrong, he said he didn’t know, he’d never had anything like that happen.

I was sent home with the instruction that should either the bleeding continue or feel an increase in pain, to call the department so that the issue could be addressed. Although I called the department nearly twenty times over the next four days as the pain grew worse and worse, I could neither make an appointment nor leave a message for the doctor. All requests went unanswered or refused. That’s not the policy and procedure, I was told. In desperation, I finally went to the ER, passing out in the parking lot from the intense pain. I was found to have a torn urethra and an infection in my prostate. It took four weeks of antibiotics and pain medications to finally heal, and ever since then urination has been tremendously difficult. Angry with the system, I filed a complaint against the VA. I sued them for having a system that could damage me by misadventure and not support me properly in the aftermath. As my case came for adjudication, it was explained to me that my case would make no difference to the VA system, that it would be paid from a general fund and the personnel involved would be re3primanded and possibly terminated. Not wishing to affect the careers of the doctor and his staff, I withdrew my complaint. I could have continued, the legal representative from the Portland VA legal affairs office said that I had made my case. But I chose not to profit on the detriment of people who were simply cogs in a flawed system.

So here I am again, back in the same urology department and being snarled at by the empathy challenged doctor who had inserted the catheter and caused the damage I was seeing him about. The man whose career I chose not to damage. Instead of appreciating the opportunity to make it right and accept my gesture of confidence, he was instead acting like a first grader unhappy it was nap time and speaking to me as though I was something to be scraped from his shoe after a walk in a dog park. I spoke to him kindly, choosing to be polite and friendly instead of angry and begrudging his earlier mistake. He wrote me a prescription for a medication which had been tried on me previously and abandoned because it was ineffective and the side effects of hypotension. He obviously didn’t even bother to look at my record, which states clearly that the medication had been tried and discarded as an option. He just shrugged and wrote a prescription for a drug I wasn’t already currently taking and sent me home. Then, without notice, he discharged me as a patient from the clinic. He did not have the grit to tell me that he’d prefer not to treat me to my face. I see him as a coward treating heroes.

The VA has some excellent people who work there because they are caring and dedicated people. The attitude and intolerance I experienced from this man, a Physician’s Assistant, shows me he is not among them and makes me wish that I had persevered my tort claim. He didn’t care that I’d suffered so at his mistake, nor that I waived my claim to protect him.  I chose to forgive that and blame a system that failed to permit immediate care when a procedure went awry. As they say, let no good deed go unpunished, and this particular man proves the adage. I guess the good part is that he’s tossed me out of his clinic, and so I may now choose a different facility to get my urological care and the VA will pick up the travel tab for me to go there. The idea that I needn’t worry about having to deal with a petulant and grudging jackass is calming and reassuring to me. But I pity the other veterans who need to use his services, especially those whose problems are specialized and beyond the textbook. If the simple issues of scarring that I came to him with were too much for his level of competence, I feel sorry for those men who have more complex issues with their urinary system. Thankfully, it’s no longer my problem.

I guess my point today is aimed at those who suffer at the hands of the health care system. While I think many of the tort claims filed each year often tend to be ridiculous and not worth the tremendous judgements awarded, the filing of complaints is a good idea. The mistakes made should be recorded so those who make them in large numbers or demonstrate a reasonable questioning of their abilities can be identified. People in need of care have to be able to be confident of their care providers and those providers need to be up to the responsibilities they take with our lives. Good physicians will accept critique from their patients and learn from their mistakes. Those with an ego outmatching their skills don’t learn, and should be culled from the medical market. We only have one life, and doctors are supposed to cherish it as much as we do.