Medical Error

Medical Errors and Breast Cancer

A headline in today’s New York Times got my attention: Medical Errors May Cause Over 250,000 Deaths a Year. I didn’t die from my breast cancer surgeon’s medical error, but I did get a firsthand look at how these errors are glossed over by hospitals and insurance companies alike.

Short version: In March 2009, my breast cancer surgeon gave me a double mastectomy but missed the cancerous lump. I discovered the error a week after my surgery when the surgeon removed my drains and, reflexively, my fingers flew to the spot on my body where the lump had been and — gulp — it was still there. (Here is the blog post.)

My lump had been close to the skin, high on the breast. Six o’clock. The lump’s location meant I wasn’t a candidate for a lumpectomy. So, I chose a double mastectomy without reconstruction. Six weeks after my initial diagnosis, I had no breasts but the pea-sized lump of breast cancer still sat brazenly on my chest.

And so began my crash course in how to advocate for yourself in the surgeon’s office. In short, I refused to leave until the surgeon acknowledged his mistake, took accountability for it, apologized and scheduled a do-over mastectomy. (This is a big part of my memoir FLAT…and is way too long to detail here but suffice it to say it was a horrifying and traumatic experience.)

Two months later I got a lesson in how insurance companies deal with medical errors. Paperwork arrived in the mail showing my surgeon billed my health insurance company his full fee for the do-over mastectomy. I called the company to tell them they should deny the charge. After all, it was the surgeon’s mistake. Why should he profit from it? The insurance rep told me it wasn’t his job to parse what was or wasn’t a mistake. If the billing made sense, they paid it. And, just like that, my mistake was recast as a recision. In the records, my breast surgeon simply “went back for more tissue.” No one mentioned it again.

I was a health journalist. I interviewed three surgeons for the job. I chose the one with the most experience and the best credentials. I did everything I could possibly do, except control for human error. The NYT article reports that if medical errors were considered a disease it would be the third leading cause of death in the US behind heart disease and cancer. Whoa.

No one expects health care practitioners to be perfect but 250,000 deaths a year? We can do better.

Here We Go (Again)

Mary and I are up before the sun, preparing for another long drive to Indy. Pre-op arrival time is 10:30; surgery is at 12:30; they tell us we’ll be home in time for dinner. I am hopeful. For reasons too lengthy and complicated to explain at this early hour, I am headed back to the same surgeon. I’m giving him the chance to correct his error. I trust his technical ability 100 percent. I believe his error was one of oversight. With his reputation on the line,  I know he’ll bring his A-game (too bad he didn’t bring it the first time).

These past few days have been a blur. I found a new therapist; I call her my “cancer shrink.” She helped me to diffuse my emotions–a good thing. I visited family and friends in Louisville and gained much strength from their love. And I read, re-read, and deeply appreciated every email and blog post. Thank you all for feeling angry, sad, and frustrated for me. While, I am still all of those things, I did find a place of emotional equilibrium to usher me through today–or at least to the doors of the operating room.

Meanwhile, Mary’s got my back. For those of you who don’t know Mary, she is amazing. (So much so that she deserves her own post, which is on its way.) But, for now, just know that even with her crazy-making academic career, Mary has been by my side at every appointment, held my hand through every procedure, and asked the tough questions when I was overwhelmed.

Since today’s questions are tougher than ever, we’ve called in reinforcements. Our generous, smart, fearless  friend, Z, is coming along to support Mary in her quest for answers. The three of us motoring up to Indy to kick ass and take names is quite the picture.

Wish us luck!

Shock

He missed the tumor.

I’m headed back to surgery on Monday.

I can’t believe this is happening.

I was thrilled to get the drains out yesterday. Finally, I felt almost-human again. Reflexively, my hand went to where the tumor had been. Of my body’s typography, this is a location I know intimately. Which is why I was disturbed to feel a lump. Albeit, a smaller lump (more of a button than a broach) but still very much a lump. I pointed this out to the surgeon. He said it was probably “fatty tissue.” I made him feel it. “Nothing to worry about,” he assured me. I assured him–I’m a worrier. I need to know what this thing is. He tsk-tsk’ed and sent me downstairs for an ultrasound. His nurse smiled brightly.

Slowly, things began to unravel. The ultrasound confirmed the lump was solid–a huge calcification at its core. But was it a new lump or the same lump? A biopsy was ordered. But before they could plunge a needle into my aching chest, Mary remembered the lump was tagged. During my biopsy in January, the radiologist inserted a tiny metal tag next to the mass. She explained that it acts like a beacon shining brightly on future mammograms to help techs sort new lumps from old. At the time, I felt like an animal tagged and released back into the wild, but yesterday that tag made all the difference.

Alerted to the tag, the radiologist switched course and ordered a mammogram (yup, a mammogram. don’t ask). Afterward she and I stared at the display in disbelief. There was my tumor in black-and-white. Metal tag still firmly in place. Shining brightly. Illuminating the spot where–without a shadow of a doubt–the cancer still lies.  

So many questions.

So much sorrow.

So much disbelief.

So much anger. 

Forgive me if I don’t post for awhile, but I don’t have words to describe how I’m feeling.