Whot would you do if a patient had coughed up blood?

Question

my mum was due to be discharged on the day that she vomited up clots she had been in for osophogus surgery, but when this happend to her all they did was to check her blood which came back ok.so they left her, then when it happend again they took her to surgery this time, but it was to late she died from massive gasrointesturnal hemorrhage caused by aortoenteric fistula. does any one no whot should have been done. the coroner said she probably would have lived for about a year.well a year is better than nothing.

Answer 1

Hi ya,

I'm not a doctor, I'm a pharmacist. I don't have anything to add to your investigation but a similar and unfair tragedy happened to my Dad. He developed a bowel obstruction and they treated it conservatively by suctioning out the GI fluids. The junior doctors were very caring but their team was dominated by the consultant, a guy called Martin O'donohoe, who was a very bizarre type of person and very dismissive of our concerns. After about a week my father was discharged as the consultant left orders with his team to do so ( He was now on holidays himself). Within 18 hours my father was dead, and like you we wondered what had gone wrong. Then we got a strange phone call a week later from Mr. O'donohoe's secretary saying he wanted to talk to us in his office. We went to his office and his attitude was totally changed as he explained to us our father had died of a heartattack. Then he mentioned about 15 minutes later he had pneumonia which brought on the heart attack probably caused by a few crumbs of food swallowed incorrectly. We were completely taken in by this and just as we were leaving someone asked him about the bowel obstruction being resolved. Suddenly, his voice took on a different tone: " Funny you should mention that. At our clinical audit someone mentioned the possibility that his bowel might have obstructed again and he vomited during the night and inhaled it...but everyone said they believed I'd done my best for him. Everyone agreed"....it turned out the real explanation was this only, he put a spin on it so that the bowel obstruction was resolved when his intern discharged him but reobstructed as soon as he was discharged. What rubbish! It was such an obvious lie. Nobody even remembered her checking his abdomen. At the Coroner's court he was represent by 4 solicitors!! He got up and said he wouldn't have done anything differently. Our Department of health in Ireland has recognised the reality that an awful lot of our hospital doctors are substandard and no longer uses an insurance company to insure the doctors who manage to settle claims without record- instead the state directly insures the doctors themselves and is looking for repeat patterns with a view to re-educating or eliminating substandard docs in the health system. This is a great idea from the publics point of view. About a year later a 53 year old diabetic patient of O'donohoes died after O'donohoe amputated his leg without reading of his MRSA status in his notes. The man was a journalist with the Evening Hearld newspaper so the case got lots of media attention. Once again his incompetence was not punished: he actually said he didn't bother reading the notes but if he could do it all again he wouldn't do anything differently. I would imagine the department of health is surely noting the pattern of deaths and he'll eventually be retired . He wasn't a bad person; just lacked something psychologically that would make him a good and caring doctor. I asked a barrister friend about sueing and she said the only cases you could win are maternity ones in Ireland. Plus all the doctors tend to support each other and it would require bringing in an expert witness from the UK or US.

But there came a day when I realised I'd simply lost the battle for justice and that it was a battle that was unwinable. I'm still bitter but I'm sure the Dept. of Health will slowly act to curb his practise and eliminate the risk to his patients or maybe get him some psychological support so he'll be clearer about making life and death decisions.Maybe its already happened? I think maybe go to your own GP and ask him/her. As a health professional myself, I know we tend to cover for each other but atleast you'd get a more reasoned explanation.I'm guessing the cancer surgery she got probably made the blood vessels more unstable. A good sign of active bleeding is usually a drop in haemoglobin so they probably thought they were safe once it didn't drop but it obviously was a ticking timebomb for your poor mother. A lady opposite my Mom in hospital in May died within seconds from something that sounded similar...she had a fistula from her oesophagus to her lungs and it seemed to bleed unexpectedly. She was a lovely lady and very very kind to my Mom . None of us realised how fragile she was and I think everyone was shocked. I think you gotta maybe go to your GP and talk it out and ask is there anything you can do. Even request her records under freedom of information act and maybe bring them to your own GP or a solicitor and see what they say. I think they'll tell you nothing more can be done but it will let you know you've done your best and maybe help you understand what went wrong. I think if your country is like ours and the doctors did something wrong some risk management officer will one day see a pattern and refuse to insure the team...they won't be allowed carry on too long. But you've got to look out for your own mental health too because you can go down a path too far and find you're suddenly lost. There's not a lot a lay person can do because its specialised medicine...even looking up aortoenteric fistula wasn't easy for me and all I got was its a complication of gastric surgery. In law, the old standard of a duty of care was that the doctor only had to offer the same level of care as another physician would have- i.e. follow standard procedures. This was updated in about 1991 to include them proving they did more than offer the standard of care...but that only meant they did one more test than was standard protocol.You could try putting your questions in the format " What is the standard of care for a 62 year old lady post-op surgery for oesophageal cancer who is being discharged but suddenly presents vomitting clotted blood" in the law section. You really need to establish if some form of endoscopy was standard protocol in this case. I gaurantee there is a standard protocol in surgery for dealing with this problem and I'd bet the lawyers would know.

BUT LOOK AFTER YOURSELF TOO AND DON'T BECOME BITTER and don't reduce your own life to nothing with grief. There is something after this life and you will receive rest and be united with your Mom one day.

Answer 2

I'm sorry that you lost your Mother. She must have been in a lot of pain to undergo the surgery. Cancer is a very painful disease. It sounds like your Mother's cancer had metastasized.

No doctor can tell you how long you have to live if you have Metastatic Cancer, they can only give you a rough idea.

If you retain a solicitor, I doubt he will have a very good case. A solicitor will tell you anything you want to hear if he knows he's getting paid for it. IF your solicitor is not going to charge you (take your case on contingency), then let him proceed with legal action.

Any patient with metastatic cancer, will do anything (including the surgery your Mother had), to try to live longer and HOPE that the doctors can get all the cancer excised. The patient knows there is a risk of death, prior to the surgery. Sometimes when a patient is opened up for surgery and then closed up, it just speeds the death along and it sounds like this is what happened.

Your Mother is at peace now, and no longer in any pain. It is sad to see the people we love suffer.

Read the following on metastatic cancer to help you understand it:

http://www.cancer.gov/cancertopics/facts...

Also, read this:

http://www.medscape.com/viewarticle/5589...

Generally 2 types of secondary aortoenteric fistula have been described. Type 1, termed a true aortoenteric fistula or graft enteric fistula, with or without a pseudoaneurysm, develops between the proximal aortic suture line and the bowel. This type of fistula is the most common and often initiates massive gastrointestinal hemorrhage. The main clinical manifestation of this type is always upper gastrointestinal bleeding (76%), which might be either hematemesis or melena with equal frequency. Sepsis and abdominal pain are relatively rare with this type of fistula. The present case appearing 6 years after aortic surgery was of this type.