Sunday, January 6, 2013

Day 204 - for me? an apology?

Like yesterday, today was relatively relaxing and devoted to social activities. Dan and I drank coffee, took the dog for a 3 mile hike, had lunch, watched some Downton Abbey and had Thai food. A good day. Sadly, he has to leave tomorrow morning. I won't even be able to see him off at the train station because I am going to Lebanon tomorrow morning to see the pulmonologists.
Why am I seeing a lung doctor? Back when I had my first neutropenic fever, when it wouldn't go away after several days of the right antibiotics, they sent me down for a CT of my chest, abdomen and pelvis. The chest CT showed a lung nodule so we repeated it a month later. The repeat showed two nodules so we repeated it a month later. The re-repeat showed the nodules had gone away, but the CT scan looked like I had a pretty good pneumonia. I had no symptoms of any sort. Dr. Hill says all of this stuff can be consistent with chemotherapy effects to the lung so rather than CT'ing me enough times to really give me lung cancer, I'm going to see a pulmonologist. I suspect she is going to want a re-re-reCT in three months which will be fine because everything should be all settled out by then. I sort of want to go to the lab and ask them to hand my slides and blocks to me so at least I know where they are.
An interesting thing about this is that they taught us in medical school that once a mistake is made with a patient, doctors/nurses feel badly about it and tend to avoid the patient. This compounds the problem because now you have a patient who may or may not know something has gone awry (obviously, in this case, I know) and who is feeling relatively neglected compared to previous treatment. I must admit to being very disappointed that John has not called me to say, "Gosh, I'm sorry; I forgot to order your lab. You know, I was on service over the holidays and it's no excuse, but I have a little kid and was being pulled in way too many directions. I had asked the pathologist to run the lab, but it's a bit off the usual stuff he does and he didn't understand. Anyway, I didn't follow up on it because I was distracted by the holidays. Thank you for tracking it down." That I could totally forgive because I really want to be happy with John; I am so appreciative of the care he provided for me at the beginning in particular of my treatment which I think was way less traumatic than it could have been for me because he did communicate well with me. But I know some one has made a mistake and I know the buck stops with the attending doctor because he did not track down why he didn't get a result from a lab that he ordered--or--he forgot to order the lab. Now I'm left wondering why I'm not getting an apology call. My most likely explanation is that he feels badly and thinks that ignoring me will make the bad feeling go away sooner. Other possibilities include that he thinks I didn't notice a mistake was made (some insult to go with your mistake, Mary?), that he doesn't realize I deserve an apology for the mistake (doubtful as he knew when to apologize before), that he figures he'll just apologize when he sees me in two weeks at my appointment.
Perhaps in some cases, it is good to let the other person calm down for a while after you make a mistake, but medical mistakes are not an example of such a case. I think the apology should be given as soon as the mistake is discovered. Even though it's tough to say, "I was wrong. I'm sorry. I made a mistake. I'm not quite sure what I was thinking." or whatever you have to say, it just gets tougher for patients to hear it as time goes by. So, now you're in a situation where first you have to apologize for your mistake and second you have to apologize for not apologizing sooner. The relationship can be salvaged through even big mistakes (what has happened to me I would classify as little to medium mistakes) as long as it is clear that the provider wants to salvage the relationship. An apology is probably the clearest way to say that the patient is important to the provider despite the fact that the provider has made a mistake. I'm hopeful that the apology is forthcoming.
For me, for tomorrow, I am hoping that my pulmonology vsit will be a painless as I am imagining. For you, for tomorrow, I hope all your best case assumptions are true.

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