Let me tell you a story…

I know an old lady who swallowed a fly, I don’t know why she swallowed a fly. She didn’t either, but she got scared and went to the doctor. Because she was a favorite patient of the doctor, she was worked into the very busy schedule. There were already 35 patients scheduled to be seen. The old lady arrived on time for her appointment and waited an hour to see the doctor, who seemed, “not his usual self.”

They chatted briefly about the problem. The doctor was worried that something bad would happen with that fly inside the old lady, so he prescribed a spider to get rid of the fly. She swallowed the spider, because the doctor prescribed it, she took it just like she was told.

That spider wiggled and wiggled and wiggled inside her. She felt so bad with all of that wiggling that she went back to the doctor. The doctor was very concerned that the remedy was making her feel worse. Wanting to help her to feel better, he prescribed a bird. “Take this bird and swallow it whole, it’ll take care of that spider.”

The the old lady went to pick up the bird prescription, she paid her co-pay and went home. The next day she swallowed that bird, following the directions to a tee. Now we are all thinking, how absurd to swallow a bird. But, she did it. She did it because her doctor told her to. She would never question her doctor and she felt so bad that she had swallowed that fly, the doctor was only trying to help.

Well, guess what, she did not get better, she felt worse. So much worse that she told her son, who took her to a different doctor. She told this doctor about the bird that the other doctor had prescribed and how bad it made her feel. The doctor didn’t ask and she didn’t tell why the doctor had prescribed the bird. Everyone knows why a bird would be prescribed and every doctor worth their salt knows how to fix “swallowed a bird”….prescribe a cat.

The prescription was written. The son was a little surprised, but took his mother to get the prescription filled. They both found it hard to believe how much the pharmacist charged for that cat. Fortunately, their insurance covered it and they only had to pay the co-pay.

The next day, the old lady swallowed the cat, all of it, with a gallon of water, just as prescribed. What a mess. She really had to work to keep that cat down, it was tough, but she managed. She waited a whole day, then another, waiting to feel better. She called the doctor’s office and told them that she was not getting better, that she actually felt worse.

She was told that the “medicine” took a while to work. Give it some time. A week went by and now she could hardly get out of bed. Her son was really scared, so took her back to the same doctor. It was obvious to the doctor that she was worse, pale, kind of grayish looking, short of breath, abdominal pain, heart racing. She sent the old lady to the hospital to be admitted.

She was admitted to the hospital directly, right to the ward, she was too sick to go to the admitting department. Her son did that, signed all the paperwork, while his mother was upstairs being tended to. She saw all manner of specialists. All with their own idea of how to make her better. One prescribed a dog, another prescribed a goat, still another a cow. A surgeon, of course, prescribed exploratory surgery. Ultimately she got the dog by IV, because by this time she could not eat. She got anti-nausea medicine, pain medicine, allergy medicine, a catheter to drain her bladder. Even by IV, a dog is pretty hard to take.

After a few days, she started to look a little better, she started to feel a little better. Soon she was ready to be discharged, but her son could not pick her up until the next day, so, because she was old, the doctor thought it best to keep her another day. That night she started having a little heart burn. Her nurse, wanting her to feel better, went to look at the electronic medical record to see what she could give the old lady to help.

While the nurse was checking she was called by another patient in pain. There were monitor sounds everywhere, bells chiming, lots of distracting noises, all the normal sounds that you hear in the hospital. This was the 11 hour of this nurse’s 12 hour shift on the third day of her schedule (in other words the 35th hour of work in 3 days). She grabbed the horse for pain and gave it to the old lady with heartburn. The old lady swallowed the horse, she’s dead, of course.

What could have made this story end differently? Many things, but if we had to pick just one: it has to be communication. Perhaps a little more inquiry into why she swallowed the fly would have helped — communication with the patient, a quick consultation with a Gastroenterologist about the effects of flies on the GI tract, communication with another doctor. Any of these routes could have stopped this train quickly.

If the first doctor had asked the old lady about fly swallowing, she would have found out that it wasn’t the first fly that she had swallowed, she did it all the time and nothing bad ever happened. This time she thought her son had seen her do it, so in order to not seem “crazy”, she went to the doctor and did not disclose all the relevant information.

Why didn’t she disclose? It may be simply because no one asked.

Communication. We are all responsible.