Chapter 93

As a non-MD, I don't often get to attend M&M (mortality and morbidity) conferences of our various departments. These are usually highly technical sessions where doctors discuss cases that have gone awry or otherwise have educational value for the residents and attendings.

I was invited to attend one today, though, where a special guest was present, the patient who arrived in the Emergency Department and went through an incredible medical process, leading very close to death. He and his mother were at the M&M to offer the capstone comments after the medical discussion. Back to that in a minute.

This was a very challenging case. A patient with many medical problems. A difficult diagnosis. A delay in the diagnosis that probably led to "coding" and a need to resuscitate the patient. For those of you who have not been through an M&M, you would be impressed by the candor of the discussion and the lack of blame and recrimination -- so that lessons from the case can be clearly identified and applied in the future.

The diagnosis was delayed because of "diagnostic anchoring," a topic discussed in Jerry Groopman's recent book, How Doctors Think. If you put blinders on the diagnostic path based on early indicators or predispositions, you will miss things that are important. That happened here. Luckily, though, the ultimate diagnosis was obtained in this case because the doctor in charge refused to close off other avenues of inquiry when the facts did not seem to support the initial presumption.

The successful resolution for this patient required incredible amounts of teamwork among emergency department doctors, internists, radiologists, pulmonologists, anaesthesiologists, respiratory therapists, transporters, and nurses. Here is a summary of the people and resources applied to this case.

•> 100 lab tests
•10 Electrocardiograms
•Continuous telemetry monitoring
•3 Chest X-Rays
•1 Echocardiogram
•2 Line placement procedures
•Seen by 9 physicians, 4 nurses
•Administered 12 medications

Back to the patient, a devout Muslim, who finished the case discussion by saying that he had woken up the next morning after dreaming about the number 93. He looked out the window to see the bright sun and blue sky and realized he was dreaming about Chapter 93 of the Holy Qur'an. I quote an excerpt:

The Brightness

In the name of Allah, the Beneficent, the Merciful.

I swear by the early hours of the day,
And the night when it covers with darkness.
Your Lord has not forsaken you, nor has He become displeased,
And surely what comes after is better for you than that which has gone before.