Lewis Blackman: a Victime of Failed Doctor-Patient Communication

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Helen Haskell starts off her tragic story by describing her son. The reason she recounts all aspects of her son is because he is why we are in nursing. For all of the world war two veteran grandparents with an ejection fraction of ten percent. For all of the five year old ballerinas with terminal brain cancer. For all of the first time mother’s miscarrying in their third trimester right in front of our very eyes. For Lewis Blackman. We are here to care for them. We are not here to have an easy Sunday of work. We are not here to fault equipment failure for our oversights. We are not here to condemn our colleagues for their negligence. Above all else, we are here to care. Lewis Blackman suffered because some of us overlooked this delicate component to our work. Helen Haskell is reminding us to look at the patient as a whole and to always put them first.

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Ketorolac is a non-steroid anti-inflammatory drug used to treat moderate to severe short-term pain. Ketorolac works by reversely inhibiting cyclooxygenase-1 and 2 (COX-1 and 2) enzymes, which results in decreased formation of prostaglandin precursors (quote). Alike all of the medications used in the medical field, there are side effects especially when used at high dosages for long periods of time. “Analgesic nephropathy is a condition of slowly progressive renal failure, decreased concentrating capacity of the renal tubule, and sterile pyuria.” Kidney function should be monitored meticulously: urine output, fluid intake, serum bun, and creatinine. Lewis Blackman had not urinated in twenty-four hours. This clinical fact and his overdosing of ketorolac combined

I believe that Lewis Blackman’s lack of urine output can be contributed to the prescribed overdosing of ketorolac, Lewis’ underlying problem, and his increased need for fluids. However, I believe that the definitive factor was his increased need for fluids and decreased urine intake due to improper dosing. When a patient has gone through surgery, their fluid requirement increases due to fluid lost in third space losses. There is a twenty eight percent fluid loss during a two-hour operation (quote ncbhi). If this had been recognized, I believe Lewis’ outcome would have been better.

Medical professionals rely on advanced diagnostic equipment to provide pressing information promptly and efficiently one hundred percent of the time. Inadequate medical equipment can cause preventable delays in critical patient care situations. However, Helen Haskell said that the medical staff spent two and a quarter hours and measured Lewis’ blood pressure twelve times using seven different machines. The only thing this extreme and unnecessary attempt fighting with medical equipment rewarded was further delay in Lewis’ care. Yes, medical equipment can fail but in this particular circumstance the reason they could not ascertain Lewis’ blood pressure was because it was most likely at a critical and unreadable value. It was just too late.

I believe the fact that it was a weekend during Lewis’ Blackman’s case is a significant finding. According to an article done by PulmCCM using fifty one million patients from around the world, patients hospitalized on a weekend have a nineteen percent increased risk of critical illness and or death; a phenomenon known as The Weekend Effect in hospitals. Could it be that patient’s are just sicker on the weekends for no perceptible reason? No, this horrifying statistic can be attributed to lower staffing ratios. In the study, hospitals that did not experience fewer staff ratios on the weekend, the patients’ fate did not foresee an increased risk of mortality. Helen Haskell stated that the nurse and resident taking care of her son was the only nurse and resident there. Perhaps the medical staff taking care of Lewis’ was experiencing an increase in patient volume due to staff ratios leading to Lewis’ final fate. I believe that the hospital’s prime responsibility to properly staff nurses and physicians should be analyzed in this case as well.

Early diagnosis and treatment of septic shock is imperative to positive patient outcome. Although the mortality rate of sepsis can variate irradicatly based off of the source of infection and the patient’s underlying conditions, the mortality rate can range between twenty and eighty percent. (quote).An early indicator of sepsis that was observed by Helen Haskell was Lewis Blackmans’ decreased urine output. Lewis Blackman had gone twenty-four hours without urinating; the first sign of organ dysfunction. Death risk in septic shock increases between fifteen and twenty percent per each organ dysfunction. Lewis Blackman is now faced with a thirty five percent chance of mortality—at the very least. Now for the past four hours his blood pressure has been unobtainable. Lewis Blackmans’ cardiovascular system has now been overcome by his infection, lack of treatment, and improper attention ultimately leading to his demise. Septic shock can be monitored and diagnosed objectively and subjectively. If I were the nurse responsible for his care, I would have been monitoring his white blood cell count. I would not just be looking at the result for that day but his count from the past four days and looking for an increased trend. I would have been monitoring his intravenous and by mouth intake and urine output in conjunction with his creatinine and serum bun to determine the trend of his kidney function since he arrived to the hospital. Most importantly, I would have been monitoring his vital signs: blood pressure, temperature, respiratory rate, and oxygen saturation. More specifically I would have been vigilant of an increase in temperature, an increase in respiratory rate, an increase in heart rate, a decrease in blood pressure, and a decrease in oxygen saturation.

A critical component Helen Haskell informed medical staff of Lewis Blackmans’ decreasing condition was that they thought, “something was just not right.” In my experience, the family knows the patient best. Although they cannot see the vital signs we are recording, the blood work that has resulted, or the x-ray results that were scanned, they know more than we do about the patient. They see them every day for years. It would be imposturous to not take Helen Haskell’s concern whole-heartedly. Even if this family member is non-medical, they know what their husband, son, or mother is like and that this…this is not them right now. I would have taken this to action and expedited Lewis Blackmans’ care.

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