The tragic consequence of a defensive appendectomy. “Neveen Morkos, of Tinley Park, was rushed to Oak Forest Hospital last May, where doctors performed an emergency appendectomy. According to the woman’s attorney, the anesthesiologist at the county-run hospital failed to insert a breathing tube properly, which then deprived Morkos of oxygen for at least 10 minutes.”

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  • Anonymous

    The direct cause of this woman’s injury was the failure of the anaesthesiologist failed to insert a breathing tube properly.

    The decision to do an appendectomy was not necessarily bad simply because the woman had gastroenteritis and not appendicitis – there may have been enough suggestion of appendicitis to warrant an emergency exploratory surgery.

    If the doc took a lousy history or ignored a good one, did a lousy exam or didn’t order the appropriate tests, that’s one thing. But the standard of care is to err on the side of “appendix out” rather than letting a probable appendicitis asplode.

    Perhaps a little defensive fricking IMAGING could have helped prevent the rush to surgery, if there was one.

    It’s still unfair with this limited info to say that this was an inappropriate surgery. The proximate cause of this woman’s grave injury was failure to put the breathing tube in properly.

  • Anonymous

    It appears that the age of the anesthesiologist and medical condition contributed a lot to his inability to properly place the breathing tube. Maybe the credentialing committees of each hospital and the chairman of each department should look into whether the doctor they are credentialling is mentally and physically capable of the job.
    This 78 y.o. Anesthesiologist may have had a perfect record and maybe he loved his job, but it’s time for him to retire, and somebody needs to tell him that.

  • Samson Isberg

    Can an MD continue practicing at that age in the US? In my country (Norway), after your 70th birthday you must apply to the medical board for re-licensing once a year, every year, and they’re mighty quick in yanking that license if they feel you fail in any way. (By the way, the same system goes for your driver’s licence).
    In which case, this ancient anesthesiologist would have been spared this final indignity in his golden years; the patient would have been spared being brain dead for the rest of her life, her children would’ve been spared a childhoos in misery.
    Of course, some doctors are demented at 30 years, some are crystal clear at 80, but as a general rule, your mental capacity has a tendency to diminish somewhat after 70. As far as I know, they ground airline pilots around 50 years, don’t they?

  • gasman

    This has quickly turned into an agism discussion. Why not have yearly licensing review at a point in a career that would have greater impact for decades to follow. Young doctors (granted, adults in their late 20s and 30s) , like young drivers (youthful arrogance and no appreciation for mortality) are unknown quantities and apt to poor judgement from less prior experience.

    Sometimes the tube goes in the wrong place. It happens for me too. As with any medical catastrophy, it usually takes several factors to align just right to allow an initial problem to snowball into a bad outcome for a patient.

    Urgent surgery requires precaution against aspiration of stomach contents into the windpipe. These precautions cause a poorer view of the windpipe, and depend upon speed of completion. The likelihood of placing a tube in the esophagus is higher in these emergenc situations. The next line of defense is the detection of the wrong hole so that the breathing tube can be repositioned before death or brain damage. Listening to breathing sounds can detect many esophageal intubations, but I have listened to several chests with breathing tubes in the esophagus, and was not able to conclude from that difinitively that the breathing tube was mal positioned. A dector of exhaled carbon dioxide is a next line of defense, but sometimes technology breaks or is unreliable; sometimes there is carbon dioxide in the stomach. The next line of defense is the measured oxygen level in the blood stream. This level might change within seconds, or might not change for several minutes with the breathing tube in the wrong place. Depending on what’s happening when the oxygen level begins to drop can influence the likelihood that the drop could be due to a malpositioned tube and the subsequent search for a cause. Once shit starts to hit the fan only a couple minutes are left to solve the problem that has eluded the usual detection maneuvres. Back to basics (ABC’s of airway breathing, circulation) is likely to reveal the same ‘breath sounds’ that were eroneous the first time. The carbon dioxide monitor may or may not reveal new information; if the carbon dioxide is now no longer present does it mean the breathing tube is in the wrong place or that that is is in the lungs but inadequate blood circulation is failing to deliver carbon dioxide to a properly place breathing tube. Does one spend time removing and replacing a breathing tube that might be, and in this instance probably had all clinical indication of, being in the right place. If the problem is inadequate circulation then prompt action is needed here (CPR, drugs, figuring out why there is inadequate circulation). Long before I can type this much the death spiral is nearly complete.

    Sometimes bad stuff happens when medical care is done poorly.
    Sometimes bad stuff happens even when medical care is exemplary.

    I don’t know if being 78 and practicing anesthesia jeopardizes patients. I do hope that I will have found a less stressful second career by then; I really like the idea of teaching high-school level physics or math (my premed days were engineering bachelors and masters degrees; far more interesting than the rote memorization of biology education)

  • Anonymous

    As an intensivist, I took care of a 20 year old who was brain dead after the anesthesiologist inserted a breathing tube wrong. Elective procedure. The anesthesiologist was 32 years old. Errors do and will happen. Even if 100% of the GDP is spent on Healthcare.

  • Anonymous

    “Perhaps a little defensive fricking IMAGING could have helped prevent the rush to surgery, if there was one. “

    You don’t understand imaging then. A negative scan does not rule out appendicitis.

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