Ms. Romero is an otherwise healthy medical student who was transferred to the MICU with acute liver failure; isoniazid toxicity. Crystal had a positive PPD screening, negative chest x-ray and started therapy for potential LTBI. After seven weeks the patient felt fatigued, anorexic, jaundiced, RUQ abdominal pain, and was found to have elevated LFT’s & INR. She was originally admitted to INOVA for observation, but was transferred to Medstar Georgetown University Hospital MICU and worked up for a possible liver transplant.
My medical adventure was one of triumphs and failures on behalf of the medical profession. I would like to introduce three points I learned from this experience as both a patient and as a medical student. One of my first words of advice is: don’t assume that every patient fits the criteria for a medical condition, even if you “think” it is unlikely. Four weeks into treatment I sought medical care for abdominal pain and was sent away without blood work, even when I questioned if I was having a reaction to the INH. Two weeks later my symptoms intensified and had been turned away again. A few days passed after that, I sought medical care from the ER and was sent home twice; my INR was not assessed. The ER doctor even had the gall to quiz me on Prometheus, a tale of a man whose liver is eaten by a crow, and dismissed my pain because as I should have learned, the liver regenerates.
Then the battle truly began. Two days after my ER visit I was in the ICU preparing my family and myself for many possibilities, including liver transplant and possible death. Although it had already been several days since I had stopped the medication on my own, my LFT’s and INR were trending upwards. If it had not been for the GI doctor I had never met, I would not be alive today. Only knowing me by looking at lab data and trends that signified that I was in liver failure, he called my personal cell and admitted me to the hospital.
Second, every patient is a person first and foremost. Every physician is also a person; humanity is an inherent trait. Throughout this battle I’ve had medical personnel trivialize my fight for life by treating and speaking to me with utter disrespect. However, I am the only one who must live with the long-term physical ramifications health-wise. At one point, the physician responsible for the neglect accused me of being an excessive drinker to cover up her errors; however, this empty accusation was proven unfounded.
On the other hand, I have also seen the beauty of medicine. Nurse Ashley, one of the nurses in charge of bathing me, was quintessential to the restoration of my faith in humanity, as well as medicine. Although I lay infirm and ready to die, she spoke to me while looking in my eyes as she bathed me and allowed me to wipe the most intimate areas of my body in an attempt to maintain my dignity. She chatted with me about sports I played, shows I watched and my passions — the things that made me human. In another instance, I was taken by surprise when one of the residents came to visit me on his day off, held my hand, and spoke to me about his own medical adventure. The compassion and respect that I felt from some medical professionals reminded me of the innate humanness we possess as both patients and as physicians.
Third, never assume that the patient is at fault for their pain and never treat them like it is. Some of the stigma associated with liver disease haunted me as the follow-up’s piled and the number of specialists added up. One nurse commented during a follow-up visit while performing blood draw, “You have really been enjoying life.” She had already formulated an opinion that I was a drug addict or alcoholic, never stopping to think that maybe this was not my own doing. On the other hand, my team of doctors in charge of my recovery lifted my spirits when they praised me for having been as good to my body as I had before, during and after this debacle. In fact, they reminded me that had I participated in any of these past times I would have likely passed away.
Physicians practice in the hope of doing less harm than good. When it becomes salient, automatic and sterile, the profession needs an overhaul. It’s unfortunate that a few negligent physicians are representative of medicine as a whole to the public because as the patient, it leaves a bitter taste in my mouth. However, as a future physician, it empowers me to trust myself and to never have blind faith in the constantly evolving field of medicine. For the physicians responsible for the medical neglect in my case, medicine had become rote — hence the shortcuts in my level of care. The physicians initially in charge of my care failed me when they put me on a medication known to cause liver failure and never checked my liver function, even when I presented with classical symptoms. They failed to follow the Hippocratic Oath to do no harm.
Alternatively, I’ve witnessed a sense of camaraderie, compassion and affection from physicians and nurses I would never have known otherwise, that have helped keep me from deterring from my chosen career path. Nurse Jan was both stern and compassionate with my mother when she lost her composure at the first sight of her eldest child hooked to several machines with IV’s running in every direction. She looked at my mother and said, “You have to be strong.” At the end of the day, I have no ill-will against the “profession of medicine” and I look forward to being a great physician.
Contributing Writer Emeritus
George Washington University School of Medicine
Crystal is a medical student in the Class of 2016 at George Washington University School of Medicine.