by Barbara Ebel
“Yes, I’m coming.” She looked at Bob and their eyes held.
“Good luck,” he said. “Only focus on the lecture material. You can do this.”
She grimaced and, on the top step, she glanced back at him and gave him a faint nod.
Bob took a seat next to his student colleague in the front row and Annabel pulled out the flash drive from her white jacket. The technician plugged it in as Dr. Harvey came strutting down the aisle and joined her on the stage.
“Good morning, Annabel,” he said.
“Dr. Harvey, an unfortunate event occurred at my apartment last night during the storm. So not only am I scared to be up here and talk, but I basically didn’t sleep all night. I apologize beforehand because, in all honesty, I’m going to blow this talk.”
She watched his hands and expected Roosevelt to tuck in his shirt, but he didn’t. He sighed and scratched his neck.
“I wish I could recite some significant quote to help you get over your sleepiness, but you have an inner strength that you can pull from, despite your tiredness, and your fear, and your nervousness to present this talk. As a matter of fact, for the next hour, your fight and flight hormones will kick in, and if you know your subject matter, which I know you do, they will pump you with enthusiasm and wakefulness and you will do better than you think.
“Another thing … a lecture is not about the lecturer, it’s about the content. Take yourself out of the picture. It’s not about you. Deliver the important subject matter so that each individual sitting here goes away with something they learned. They don’t care if you mess up a little bit; they want to know the bulk of what you’re enlightening them with.”
Although Annabel’s heart rate had inched up, her attending’s words were like manna from heaven. She gave Bob a second glance.
“I’ve pulled up your lecture,” the technician said and showed her how to use the laser pointer. He pointed out the forward and back buttons for her slides and clipped the wire for the microphone on her lapel. “You’re ready to go.”
The auditorium had filled up with long-coated attending doctors and residents, short-coated medical students, and some folks without white jackets at all. Situating themselves on the end of an aisle, Kristin Fleming and Caleb took a seat. Annabel glanced up at the three screens … one behind her and two to the side … confirming the title slide to her lecture:
“Medical Errors, Physician Burnout, and Drug Shortages.”
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Her heart raced like a runaway thoroughbred as she cleared her throat. To stand behind the podium felt too formal, so she stepped to the side, looked at her audience, and then the center screen.
“Most of you know me. I’m Annabel Tilson, an almost-fourth-year-medical student, and I’m about to cover three subjects of importance to physicians in any field of medicine and students on all rotations. Although each subject is important, I’m starting backwards, first with drug shortages. I’ll end with medical errors.”
With each sentence, Annabel’s pulse slowed down and a bit more composure took root. She went to the first slide.
“The FDA, or the Food and Drug Administration, has a strict definition for drug shortages,” she said, pointing the laser at the slide. “A period of time when the demand or projected demand for a medically necessary drug in the U.S. exceeds its supply.
“What this means to us is that doctors cannot give the right drugs to patients when needed. I had a first-hand glimpse of this recently when one of our obstetric patients was not able to receive the epidural drug that our astute anesthesiologist wanted to inject.
“This is a problem some of us in training are not aware of, but need to be by the time we’re loaded up with more responsibility. At present, our country is short on 182 drugs and medical supplies and the list is insane.”
Her arrow scrolled down the list on the slide and she read some of them aloud: “IV bags, injectable morphine, other painkillers, anesthetics, antibiotics, electrolytes, cancer drugs, and much more.”
She glanced at her audience; almost all of them were paying strict attention.
“So why is this so important?
“Drug shortages have serious consequences. When a health care provider cannot administer needed drugs, then they are not providing the proper treatment. Shortages endanger patients’ lives.”
Annabel went on to explain the reasons for shortages, much of what was explained to her by Dr. Fleming, and then discussed the effects the problem had on health care costs.
“Drugs shortages also increase the country’s health care costs. Staff must take hours to manage the shortages by tracking inventory and figuring out alternative drugs. Decisions must be made about rationing the scarce resources that exist. And most despicable of all, certain drug vendors then price-gouge the drugs that are in short supply. All told, that alone costs the U.S. several hundred million dollars a year.
“Dr. Kristin Fleming, one of the anesthesiologists, and I would like to mention one more thing. It is important to inform policymakers what is going on in the clinical setting. Without real-time stories of the drug shortages and how they affect our patients, they cannot set policies in place.”
Annabel peered over at Dr. Harvey, who flashed her a smile and gave her a thumbs-up. Her composure ramped up. Perhaps her lack of sleep helped to settle her nerves, she thought.
“Dr. Harvey and I will take questions in the end. I’ll go on to my second topic of ‘Physician Burnout.’” She scrolled to the next heading.
“Presently, this is a huge topic for M.D.s,” she stressed. “My next three slides list the physical, emotional, and behavioral signs and symptoms of physician burnout. These are important because …” She focused on her audience and held her gaze. “We should learn to recognize these signs and symptoms in the doctors we’re working with and, hopefully, recognize them in ourselves.”
The first slide she highlighted by talking about providers feeling tired and drained, having poor appetites or sleeping habits, and other physical signs and symptoms similar to depression.
She thought about Ling Watson when she scrolled ahead. “Look for the emotional signs in your colleagues - things like no motivation, constantly being cynical, and voicing helplessness. Or what if they derive no more pleasure from activities that used to give them joy?”
Annabel pointed to the third slide on the topic. “Here’s the third list, which I hate. Behavioral signs can include the physician turning to drugs or alcohol to cope, or snapping at their colleagues, or being nasty to their patients.” There were more signs and symptoms and she gave the residents, students, and staff a few moments to process them.
“So, being in training or being an M.D. is stressful. Prevention is the first key to avoid burnout. If you haven’t learned tricks to lower your stress or create balance in your life, then it’s time to learn some. We need to stop being invincible and learn to admit that sometimes we’re just not tough enough to handle every responsibility dropped on our plates. We must learn to ask for help and to recommend help for other colleagues. This is where the Psychiatry department is skilled. They have a program for docs, which is stupendous, with different treatments, therapies, and discussion groups.
“Don’t forget,” she said, “the symptoms we talked about can threaten your career as well as your marriage or relationships. Even your life.”
Annabel took a deep breath and glanced down at Bob. He nodded his approval and she gave him a small smile.
“Last but not least, here’s a problem that severely affects patients. The next department’s M&M meeting, or Morbidity and Mortality lecture, will cover an OB/GYN patient that we just lost because of a medical error.” Her face saddened, she scanned the faces in the room, and pressed the forward button on the remote. In bold letters, everyone read “MEDICAL ERRORS.”
“Officially, what are the three top causes of death in the United States as reported by the CDC? Most of us know the answer to that and we see patients with these underlying issues d
aily in primary care, internal medicine, and the sub-specialties.” Her next slide listed:
Number 1. Heart disease
Number 2. Cancer
Number 3. Chronic respiratory disease
“But we have to wonder about this; perhaps this list will be amended. Over an eight-year period, researchers at Johns Hopkins calculated something else … that 250,000 deaths each year are due to medical errors. That would surpass the figure of 150,000 people who die each year from respiratory disease. In that case, medical errors would be the third leading cause of death in the United States!”
The expressions from the audience wore worried looks. Dr. Harvey stood at attention to the side of the stage. She took a step and demonstrated her next slide.
“Yes, appalling, isn’t it? Does this mean we are training bad doctors? Does this mean physicians in university teaching situations and those out in private practice are inherently bad?”
Some folks squirmed in their seats. “No,” she said, answering her own question. “The researchers say that most errors are represented by systemic problems. Health care workers may poorly coordinate the care of patients; hospitals, other health care facilities, and doctor’s offices may lack or underuse safety protocols; there may be physician practice patterns which lack accountability; and insurance networks may be broken down.
“I wonder if medical errors are even underreported because there is always the fear that if a physician or other health care provider reports an error, they will be punished or they will be incriminated by the legal system. As you all are aware, in our training programs, those repercussions are dampened because of the systems we have in place. We should all report errors when we learn about them so that the problems involved can be addressed, allowing us to change some medical schematic that is in need of repair.”
Bob nodded in the front row and she glanced quickly at Roosevelt.
“Here are some tips about giving a medication to a patient. Some of us personally deliver drugs more than others, such as anesthesiologists; in other cases, the nursing staff is carrying out doctors’ orders.. Remember all the ‘R’ tips.” She turned to a slide with a list of eight bullet points:
“Right medicine
Right dose
Right patient
Right time
Right route
Right documentation
Right reason
Right response.”
She paused, giving everyone a chance to read. “Remembering and abiding by these may prevent a medical error. They are self-explanatory, such as … is the right medicine being given or is the medicine you’re about to give going to the right patient? What about the correct route? Are you sure whether or not the drug is to be given by mouth, through a vein, or an intramuscular shot? Is the patient exhibiting the correct response from the drug you just gave?
“This last week, a patient died on the obstetrics ward because the correct drug was given but in an accelerated intravenous time frame because of a mix-up when the medication label was incorrectly slapped on the wrong IV bag. In essence, the simple Lactated Ringer’s IV solution without the label was the bag that had the magnesium sulfate in it and ran into the patient’s vein at a higher rate meant for hydration … causing an overdose.”
There was so much more she could tell to all the concerned faces in front of her. “Another thing … we had a patient on the ward mistakenly receive morphine instead of Motrin. Sometimes caregivers have difficulty reading physician’s handwriting. If an order is handwritten, it must be legible!”
Next, Annabel highlighted drugs that sound alike when an order is verbally given, cautioning physicians to pronounce them clearly. When she looked over at Dr. Harvey, he pointed to his wrist watch. She looked at the wall clock.
“It’s time to wrap this up,” she said. “Although we’ve only touched on these three topics, I hope they leave you with a lasting impression and you will take care to practice the advice or look into these matters further. Dr. Harvey wants me to remind you to attend the next M&M conference.”
Roosevelt began clapping as he strolled over and the audience gave her a loud applause, which was more emphatic than most endings to grand rounds.
“Thank you, Dr. Tilson,” Roosevelt said. “We appreciated your fine presentation and important topics.”
Annabel nodded and put the remote on the podium.
“Are there any questions?” he asked.
No one raised their hand and yet no one seemed to be in a hurry to leave.
“Thanks, Annabel,” someone finally said.
“I second that,” Bob said from the front seat.
-----
The technician helping with grand rounds stepped over from the sidelines, pulled out Annabel’s flash drive, and packed up the wires. Many attendees came forward and complimented Annabel, and soon the majority of people thinned out of the auditorium.
“Nice work,” Dr. Harvey said. “You did an excellent job. The residents, students, and staff in this room will especially remember this talk because it was given by you … an example of a doctor-in-training who is and will be making a difference in health care.”
He nodded as she slipped the flash drive in her pocket. All of a sudden, every last morsel of nervousness from before the lecture lifted like a bird in flight and tiredness swept over her. She arched up her eyebrows, trying to fight the feeling.
“Thank you, Dr. Harvey.”
“I think you have some sleep to catch up on. You call me late in the afternoon if you don’t nap. If that is the case, I’ll arrange for you come in later, around 9 p.m., for overnight call.”
She took comfort in his words and thoughtfulness. “I don’t know what to say.”
“You’re welcome.” He left in a hurry, ready to face the responsibilities of the obstetric ward.
Annabel walked down the short staircase where Bob waited for her.
“You hit that lecture out of the ball field!”
She rolled her eyes. “You’re just saying that.”
“Really. You didn’t bore us with jammed up slides with too much to read like some lecturers do. You were succinct and interesting and educational. Shall I go on?”
“No, but Dr. Fleming and Dr. Harvey did render their help.”
“Yes, I’m sure. But you pulled it together and stood on that stage like a champ.”
“All right already. That’s enough.”
“I’m finished, but I’m so sorry again about Oliver. We have to do something about his behavior. You can’t not sleep like that.”
“Neither can you. Your time will come. I’ll ask the vet and search online about dogs with storm phobias. Poor Oliver. He doesn’t intend to be so frightened. It must be in his genes.”
“Speaking of genes, Oliver’s DNA results arrived in an email. But, come on, I need to hustle back to the internal medicine ward. The student who was with me already left. And you … you must go home and get some sleep and be sure not to tank down coffee from the Keurig machine I gave you.”
“His DNA results are back?”
Bob nodded with a mischievous smile.
“Bob Palmer, do I have to squeeze the report out of you? Let’s hear it.”
They both walked out the back door with their shoulders close together, talking about Oliver the whole way.
End
FROM THE AUTHOR
If you’d like a release alert for when Barbara Ebel has new books available, sign up here. This is intended only to let you know about new releases as soon as they are out.
Barbara Ebel is a physician and an author. Since she practiced anesthesia, she brings credibility to the medical background of her plots. She lives with her husband and pets in a wildlife corridor in Tennessee but has lived up and down the East Coast.
Visit or contact her at her website: http://barbaraebel.weebly.com
The following (two medical suspense series and other books) are also written by Dr. Barbara and are available as paperbacks and eBooks:
The Dr. Danny Tilson Series: (Box Set or individual books)
The Dr. Danny Tilson Novels Box Set: Books 1-4
Amazon US: http://amzn.to/2nDTy3J
Amazon UK: http://amzn.to/2DYNwW9
Amazon CA: http://amzn.to/2nyPLFA
Operation Neurosurgeon: You never know… who’s in the OR (A Dr. Danny Tilson Novel: Book 1).
Amazon US: http://amzn.to/1fYfPh7
Amazon UK: http://amzn.to/k4xol9
Silent Fear: a Medical Mystery (A Dr. Danny Tilson Novel: Book 2). Also an Audiobook.
Amazon US: http://amzn.to/1fTlicS
Amazon UK: http://amzn.to/1lA2DSE
Collateral Circulation: a Medical Mystery (A Dr. Danny Tilson Novel: Book 3). Also an Audiobook.
Amazon US: http://amzn.to/1BrINiE
Amazon UK: http://amzn.to/1CNTgta
Secondary Impact (A Dr. Danny Tilson Novel: Book 4).
Amazon US: http://amzn.to/1N7iyI2
Amazon UK: http://amzn.to/1P1AnKL
The Dr. Annabel Tilson Series:
The Dr. Annabel Tilson Novels Box Set: Books 1-3:
Amazon US: https://amzn.to/2MZgJ3q
Amazon UK: https://amzn.to/2m0zlV4
Amazon CA: https://amzn.to/2zl8sVD
DEAD STILL: A Medical Thriller (Dr. Annabel Tilson Novels Book 1)
Amazon US: http://amzn.to/2ai7H1T
Amazon UK: http://amzn.to/2a37GL3
DEADLY DELUSIONS: A Medical Thriller (Dr. Annabel Tilson Novels Book 2)
Amazon US: http://amzn.to/2gE7R3D
Amazon UK: http://amzn.to/2gXlsGb
DESPERATE TO DIE (Dr. Annabel Tilson Novels Book 3)
Amazon US: http://amzn.to/2ta1GeH
Amazon UK: http://amzn.to/2tyZEHV
DEATH GRIP (Dr. Annabel Tilson Novels Book 4)
Amazon US: http://amzn.to/2mDfoUu
Amazon UK: http://amzn.to/2EQqFIz
DOWNRIGHT DEAD (Dr. Annabel Tilson Novels Book 5)
Dr. Annabel Tilson Novels Book 6 coming in 2019