Medical error. The personal cost.

On a beautiful summer day the July after I finished my fellowship, I prepared for an inaugural ride on a new bike. The bike was a gift to myself to celebrate the end of my formal training in pulmonary and critical care medicine. The sky was clear, a deep “Carolina” blue. There was no wind to warn of a change in weather, no premonition of just how ugly this beautiful day might become. Then, a seemingly insignificant event: a slight irritation on my left toe and a tiny honeybee stuck to my sock. I had no allergy to bees. My breathing was fine. But as the erythema crept up my foot and past my ankle, I grudgingly drove to the emergency department. I parked my car in the deck across the street and started to walk. The entrance to the emergency department felt like it was miles away. I vomited profusely, and sweat dripped down my brow. Despite my “training,” I had underestimated the situation. At triage, I was tachycardic and febrile. I was ushered to a hallway bed (whichmeant I was too sick for the waiting room, but not sick enough for a resuscitation bay). A corticosteroid and an antihistamine were administered intravenously. A repeat pulse oximetry measurement demonstrated that my oxygen saturation had dropped. As I was moved to the resuscitation bay, I remembered the patients I had met there: patients on ventilators, patients with tubes in their noses, their throats, their bladders, and/or their chest. The seriousness of the situation settled into me. In a trauma room, in the ED, at a teaching hospital, in July. My very busy nurse registered me to the new room, moved me to a new bed, hooked me up to telemetry, called for a respiratory therapist, and left to get epinephrine for subcutaneous injection. When she returned with the drug, I noticed that the syringe contained a very small volume. It looked like concentrated epinephrine for an intramuscular injection, but she hooked up the syringe to my IV. I considered asking her about the route of administration, but I said nothing. I had not made good decisions or good assessments aboutmy condition so far that day. A sense of impending doom overwhelmed me. I attributed this to a “fight or flight” response from the epinephrine. I looked for reassurance to the heart monitor, expecting sinus tachycardia. I saw a wide complex tachycardia. I called out for help. The attending physician arrived quickly, shouting to the nurse to administer epinephrine subcutaneously, as he had already ordered. “I received the epinephrine intravenously,” I shouted. “Intravenously”? he questioned. The nurse turned quickly. She glared at me intently, and stated, “I gave it intramuscularly.” Before we resolved that issue, I was intubated. During rounds two days later, the attending physician shared her plan to liberate me from mechanical ventilation. The ache in my chest suggested that extubation would fail. I have a chronic neuromuscular disease that predisposes me to respiratory failure. From previous experience, I had learned to be aware of the pain that was building in my chest. I communicated my concern using the writing tablet provided by the nurse, but was overruled by the team. I was extubated. Within a few hours, I struggled again to breathe. I sat upright and leaned forward into a tripod position in an attempt to catch my breath. The nurse replaced the sweatdrenched bed sheets. The emergency airway team was summoned to reintubate me. When they arrived, the medicine team communicated that I should not receive succinylcholine because of my underlying condition. Rocuronium and etomidate were ordered. Unfortunately, it seemed that the anesthesiologist did not remind the medicine house staff about the different half-lives of these two drugs, drugs that these physicians had probably never ordered or used. I awakened some time later, paralyzed. The endotracheal tube scraped the back of my throat, but I could not cough. I felt restraints around my wrists. Cognitively, I knew why I could not move. As if fierce motivation could overcome neuromuscular blockade, I tried to move anyway. First, my toes and then my eyebrows. To no avail. Next, I tried to communicate distress by thinking of something scary to raise my heart beat (which usually runs in the 50s). When I was finally able to open my eyes, I saw that my curtain was pulled closed. My nurse was gone, probably to lunch after a long morning. My bed was flat—leftover from reintubation. I was