"It's hard to kill a healthy 15-year-old."

By John Ballard

Lewis Blackman was a healthy fifteen-year-old when he bled to death in a hospital following a surgical procedure not considered dangerous. His story is reprinted at Health Beat with comments by Maggie Mahar.

�The article, first published in The (Charleston) Post and Courier and reprinted in The State, was glowing. It described "a revolutionary type of surgery at the Medical University of South Carolina" for patients like Lewis.

�The article quoted MUSC's Dr. Andre Hebra as saying he performed the surgery in an hour through two small incisions. His patient would be playing basketball and swimming �in a month or two,� Hebra said.�

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�Lewis is three days out of surgery and should be getting better. And this pain is in his stomach area - not in his chest, where he had the operation.

�The nurse tells Lewis and Helen the pain is gas. �There's nothing I can do for gas pain,"� she says, Helen recalls later.

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[Five days out of surgery] �Sometime Monday morning, Lewis' gut pain suddenly stops.

�In cases like Lewis', veteran doctors know sudden loss of pain can mean impending death.

�However, in reaction to Lewis' loss of pain, a nurse says, �Oh, good,� Helen writes later.

�When Helen asks a resident about Lewis' pale color - his lips are the same shade as his skin - she recalls the resident says cheerily, �Oh, that's just that low blood pressure. It pulls the blood away from the capillaries to protect the vital organs.�

�An aide takes Lewis' vital signs. She can't find any blood pressure.

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�The autopsy says Lewis bled to death internally because of a perforated ulcer. It shows his abdomen was filled with almost three liters of blood and digestive fluid.

�A child Lewis' size has 4 to 5 liters of blood. This means Lewis lost most of his blood supply into his abdomen.

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�Helen also sent Lewis' medical record to an old friend, Dr. Gregg Korbon, a veteran anesthesiologist and former assistant professor at both the Duke and University of Virginia medical schools. Korbon has participated in thousands of operations, taught hundreds of medical students.

�Korbon said he was appalled by what he saw. "Even a Boy Scout could have done better."

�Lewis probably could have been saved up through Monday morning, Korbon said. �It's hard to kill a healthy 15-year-old.�

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�Ours was a story of a family that believed too much in the myth of medicine. The irony is that we were skeptical and, we thought, well educated. We simply did not realize how great the gulf could be between marketing and reality, not only regarding the procedure itself but also the conduct of patient care. In some ways, these problems seem to have gotten worse in the past ten years. Rosemary Gibson covers many of the details of Lewis's case in her recent book, The Treatment Trap.

�There is much that I would advise patients to do. As you may know, my colleague Julia Hallisy and I have a little cottage industry in the production of (largely gratis) materials for hospital patients. They can be viewed at at this website. Our operating principle is that patients need detailed knowledge about what can go wrong and what they can do about it. So here's my list.

�We advise people always to have an advocate and a person with a health care power of attorney, of course. . . . Every advocate should look at the patient's medical record regularly and should know what medicines the patient is taking. They should know the signs of a deteriorating patient -- rapid change in vital signs, breathing, level of consciousness, or urine output, for starters -- and should keep a journal of what healthcare providers do and say and what treatments and tests the patient has. (We have a journal on our website that includes forms for these and other purposes, but a blank notebook will also do.)

�It is also important to know how the hospital works: who is in charge of whom, and how to get help when you need it. Patients should know the name not only of their bedside nurse, but also the charge nurse and nurse manager for their unit. They need to be sure they have a phone or beeper number for the doctor in charge of their care, and they need to know whom to call in order to get help in an emergency (in most hospitals, this would be how to activate the rapid response team). In South Carolina we passed a law in Lewis's name that requires hospitals to give patients this information. Massachusetts also requires that patients be given direct access to emergency care in hospitals.

�Patients should know they can always ask to speak to a higher level caregiver. This is faster with nurses than with doctors, who may not be readily available. You can ask for the charge nurse, the nurse manager or the nurse supervisor. If you don't remember any of those terms, you can just tell your nurse you want to speak to her supervisor.

Everyone owes it to themselves and their loved ones to be informed and pro-active about all aspects of medical care. As an Army Medic I am alert to indications that someone needs prompt professional medical attention and undiagnosed abdominal pain is at the top of the list. There is no first aid for unusual undiagnosed abdominal pain.

All caregivers, whether parents or those taking care of elderly relatives or neighbors, should invest the time it takes to be trained in CPR and first-aid. And one important part of first aid is knowing when to consult a doctor immediately, even when the person in need of attention is already a patient.