Apology

After the near-overdose of 2-CdA (see Chemo), Gabrielle called a friend of ours, a distinguished professor at the hospital (and also a clinician), to talk about the incident. You should think about calling this in, he said. People die of chemo overdoses. Oncologists are very sensitive to these things. The incorrect drug order (about 12% more drug than I needed) probably wouldn't have hurt me too much. But the medical system needs to know about breakdowns like this, in case other people might get hurt by the same error.

Gabrielle called Dr. A's office the afternoon after the chemo hookup and told them what happened. The nurse said she would get an urgent message to the doctor. Around 8 PM, he called back, from his home phone. (His name showed up on the caller ID.) He immediately apologized for the mixup, and took full responsibility. He'd been looking at my chart on Careweb, the UM electronic patient record system. Somehow, when he went to check my weight, he'd looked at another patient's record without noticing. (!!)

After the mistake, he'd gone back to check my record. My hypothesis of a pounds-to-kilos conversion error — something that might have been systemic, not unique to my case — was wrong. My record correctly listed my weight at 76 or 77 kg at each visit; nowhere did the number 84 kg appear. He apologized again, several times, very gracefully. We make mistakes, he said. We are not God.

Dr. A went on to say that he thought trust between a doctor and his patient was extremely important. He hoped my trust in him would not be undermined by this episode. I said yes, it did undermine our trust, but we accept your apology. He said he'd understand if I decided I wanted another doctor now, and he would help set that up if I asked him to.

All this was entirely correct, as the French would say. Impeccable behavior. But not the end of the story. Gabrielle pointed out that he only called to apologize after we called him; he'd known about the mixup the previous afternoon, since he'd had to revise the drug order.

Also, this was not Dr. A's first mistake. At the second visit, when he gave us the diagnosis and the treatment plan, Gabrielle had asked about foods I should and should not eat. Dr. A basically said I could eat anything, except supplements.

This is not true. Patients with neutropenia (low neutrophil count) in the 0.5-1.4 range should not eat raw foods, especially meat, sushi, and fruits that can't be peeled, due to the risk of infection. I'm at 0.7 right now. He should have given me this advice immediately. And once chemo started and my neutrophil count began to drop further, below the 0.5 "severe risk" threshold, I can't eat fresh fruit at all (only canned).

There are a lot of other, very specific things to know about foods to avoid, and also foods to consume: lots of protein, garlic, ginger... I won't go into it all here. If Dr. A didn't know about this, he should have. If he did know but couldn't remember details, he should have sent us to the nurses or the Oncology Dept. dietitian right around the corner from his office.

Dr. A's apology was menschlich, for sure. But this second error amplifies my concern that he's treating this case too cavalierly: an easy cancer, good prognosis, easy treatment. No big deal.

He might also have been trying to avoid having our concern about the near-overdose escalate into what the hospital calls an "incident report." So far, it's all between him and us and the nurses. Were I to file a formal report, that could damage his reputation. Anybody's to be excused for self-preserving instincts, but all this adds up to me wanting to find a new doctor. I'll sit on this a few days before I decide. Dr. A offered us an easy way out, and we can certainly take it.