Aborted operation

[Brian Ellis]

I have worn a succession of DDDR pacemakers since 1990. Initially, they were implanted in the right chest with coaxial leads entering the vena cava to the right atrium and ventricle. 4 years ago, a replaced gizmo was supplied with highly resistant bacteria, and I was sucking different antibiotics for 3 months. The infection got worse and I was hospitalised with a cocktail of over 8 different intravenous antibiotics to little avail. After about 4 weeks of this, the pocket of infection was actually eating away the flesh and, one morning, the pacemaker fell out through the gangrenous skin. The heart cart was at my bedside within 30 seconds, but I was able to keep the 'ground' return to the case in circuit by holding the gizmo clamped tight to the wound, so the heart worked normally. I was in ICU within 5 minutes and in the operating theatre 30 minutes later. They catheterised a lead from my leg into the right ventricle to attach an external pacemaker and disconnected the old pacemaker. They then opened up the infected wound, cut away all the gangrenous and infected tissue and washed out the whole wound several times with Betadine (iodine-based polymer) and, when it had dried out, they filled it with an antibiotic powder. The important point to this story is that the leads were left in, because removing them would cause tearing of the fibrosis anchoring them in the vena cava, which was felt to be too risky under the circumstances. Healing proceded normally after that. After all this was done, I was transferred to a gurney and wheeled into a different operating theatre to minimise the risk of re-infection and the team re-scrubbed and redressed in clean scrubs. A new DDDR pacemaker was implanted in the left side, just under the collar bone, after new leads were inserted through the subclavian vein, thence into the vena cava and into the heart, in parallel with the old ones, a normal routine procedure.

Now to the beginning of this story. Various cardiologists decided I'd be better off with a CRT biventricular pacemaker and on Wednesday at 18:00, I was wheeled in to have the DDDR removed and replaced by the CRT. The catheter lead was connected from the leg and I was opened up. This is a relatively minor procedure as the two leads remain and are continued to be used. Contrast X-rays showed the subclavian vein was OK to take a third lead, so this was inserted and pushed along, until it reached the vena cava. There, the four leads had developed a fibrosis that blocked the entry of the new lead into the vein. The lead was withdrawn, I was closed up, back to status quo, after 2½ hours in the theatre. GRRRRRRRRRRRRRR!

It now appears I'll have to have open chest surgery to have the third lead sewn into the heart muscle to an epicardial electrode. It will possibly be done in October.

[Dr Mordrid]

Huh?

How long was your white cell count elevated before they acted? Seems odd (being generous here) that they'd let it go long enough for the overlaying tissues to go necrotic and friggin' fall out. Here an infection around a device would have had you fitted with a PICC line full of Vanco doublequick and you'd have been in the cath lab soon as the schedule permitted, not weeks or (fer Chrissake!) months. Crazy.

Rant aside, good luck with your recovery. Say hello to your attorney for me.

[Dr Mordrid]

Huh?

How long was your white cell count elevated before they acted? Seems odd (being generous here) that they'd let it go long enough for the overlaying tissues to go necrotic and the hardware friggin' fall out. Here an infection around a device would have had you fitted with a PICC line full of Vanco doublequick and you'd have been in the cath lab soon as the schedule permitted, not weeks or (fer Chrissake!) months. Crazy.

Rant aside, good luck with your recovery. Say hello to your attorney for me.

[Greebe]

Sorry to hear Brian. Perhaps they should wash their hands more often.

Friend had eye surgery here and contracted MRSA. Doctor accused her of being filthy and needed to clean her house more often, when it's spotless and could eat off the floor. Months later it was discovered several of his other patients had MRSA infections after visiting his office in the same time frame.

[Brian Ellis]

Say hello to your attorney for me.

We don't have that attitude here. AFAICR, in the 17 years I've been here, there have been two civil cases where doctors were sued for malpractice. I don't remember the details of the first case, but it was a pretty bad one and it was simply thrown out of District and Supreme Courts on a legal technicality. The second case, fairly recent, a doctor had left an instrument and a gauze swab in the uterus after a caesarean. The poor woman complained of pain for weeks; her gynecologist simply said that it can happen, no X-ray even. The swab decomposed and infected, general organ failure. Very cut and dried case of total incompetence and, for once, the state forensic pathologist had some choice words. The widower and baby got €5,000 damages and his costs. In addition, the gyno (still practising) was told to return his fees for the care of the woman from pre- to post-natal.

The only cases where doctors have been duly punished here have been criminal. One gyno sedated about half-a-dozen of his patients and then took advantage of them. One was a minor. He got 10 years and was banned from practising medicine for life. The patients got only the satisfaction that he has reportedly been given a hard time in clink, by the other prisoners.