My day had began early that Friday. My spouse, Joanne, and I arrived at 7 a.m. for my 10-year comply with up colonoscopy with Dr. Smith. Though I had referred numerous my sufferers to his group, I hadn’t labored a lot with him and even met him. Because the nurse was going via her guidelines of duties, she casually talked about that he was retiring that day and a celebration was scheduled that night.
I used to be taken into the process room on time and Half-hour later I wakened within the restoration room.
“Dr. Mieczkowski, everything went well,” Dr. Smith advised me. “I removed one large polyp and a few smaller ones, but none of them concern me. My office will let you know the results in a few days.”
I thanked him and supplied finest needs on his retirement, pondering that I’d by no means see him once more. I used to be relieved ― no indicators of most cancers.
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Joanne and I went house to eat lunch. Since I felt properly, we drove to the workplace to do some paperwork. Round 2:45 p.m., I had an pressing want to make use of the lavatory and handed streaks of blood. I knew this was frequent after a colonoscopy, so I didn’t inform Joanne or name the physician’s workplace. Fifteen minutes later, I felt extra urgency and made one other hurried journey to the lavatory. There was extra blood ― much more blood.
“Oh shit! Damn it,” I mentioned out loud.
I advised Joanne what was occurring, and he or she requested, “Do you want me to call the EMTs? Are you feeling faint?” We determined to drive ourselves to a hospital only some miles away. I known as the doctor’s workplace with an replace whereas we had been on our approach.
Upon arrival, I used to be relieved to see that the ready room was empty. I checked in on the desk and some minutes later, a nurse opened the door. “Dr. Mieczkowski? Come on back,” she advised me.
I made it. I’m going to be all proper, I believed. I took a deep breath of aid as Joanne and I walked via the door and had been led to my room. The nurse did the standard check-in duties, linked me to the monitor monitoring my coronary heart price and blood strain, put an IV in my arm, and drew blood for testing.
“No running fluids?” I questioned. “That’ll be up to the doctor after he sees you,” she replied. As she completed, I felt an pressing want to maneuver my bowels and requested a bedside commode. I rapidly handed a number of pints of blood, which almost crammed the container. I had simply misplaced almost 20% of my blood quantity. I used to be surprised and knew that I used to be in hassle.
“So, you’re Dr. Mieczkowski,” Dr. Woods, the ER physician, mentioned sarcastically as he walked in. Nice! Right here we go, I believed. “Yup, that’s me,” I replied, attempting to scale back the stress. I identified the blood within the commode, however Dr. Woods didn’t appear impressed.
Whereas taking my medical historical past and doing a short examination, he was continuously trying up on the monitor, which confirmed a coronary heart price of 62 and a standard blood strain. (Sometimes, an individual’s coronary heart price goes as much as compensate for blood loss.) He commented on the low coronary heart price as a sign that I used to be secure. I used to be puzzled. “Dr. Woods, I’m on a high dose of a beta blocker for my blood pressure,” I advised him. “My heart rate is always around 50 and never gets above 80.” It didn’t alter his pondering. I requested whether or not he was going to start out operating IV fluids and order blood transfusions. “You look pretty stable,” he answered. “I think we can hold off for now until the labs come back. We’ll see how it goes.”
I used to be dumbfounded. I had 40 years of expertise. If I noticed that quantity of blood loss in a 62-year-old male with coronary heart illness on aspirin ― a potent blood thinner ― I’d have known as for a right away GI (gastrointestinal) seek the advice of, began IV fluids, and ordered blood to be prepared for transfusion. Sadly, he jumped to a conclusion that my bleeding couldn’t be critical since my coronary heart price was low. He was operating the present and damned if he was going to hearken to me.
I continued to go a considerable amount of blood each 20-Half-hour. Because the blood-filled commode had not been emptied, I used the lavatory throughout the corridor. I used to be not pondering clearly at this level and failed to notice the blood loss was not being measured. I at all times ordered nurses to watch a affected person’s blood loss and urine output. I turned weaker and paler with every episode, and I started to fret that I used to be going to bleed out. I held again on sharing my fears with Joanne.
Courtesy of Lawrence Mieczkowski
My situation deteriorated because the hours handed within the ER. The lab outcomes documented the drop in my blood quantity. My anxiousness degree grew ― one other signal of worsening shock. I buzzed the nurse’s station and requested to have Dr. Woods come again. When he arrived, I went via my checklist of issues. I requested once more about getting blood and platelet transfusions.
“Where’s the GI consult for a repeat colonoscopy?” I requested. Dr. Woods had had sufficient of my questions. He interrupted me and mentioned, “You know, Dr. Mieczkowski, you may have more grey hair in your beard than me, but this isn’t my first rodeo.” My spouse and I checked out one another surprised! He went on, “I think you’re overreacting, and I’m sure you’re anxious. Why don’t I give you some lorazepam to calm you down.” I used to be within the palms of a physician I didn’t know or belief, and he refused to hearken to my issues.
It was round 5:30 p.m. at this level. Then, to my shock, Dr. Smith entered my room. He requested a number of questions, peeked into the bedside commode, listened to my coronary heart and stomach and poked round a bit. I reiterated my worries and requested instantly, “Are you going to do a repeat colonoscopy now?” He paused for a protracted whereas earlier than lastly answering, “Why don’t we wait this out and do a repeat colonoscopy tomorrow morning if you’re still bleeding. I’ll admit you to the hospitalist service.”
I knew from my very own experiences that physicians at all times need to weigh the professionals and cons of doing one other process versus shut commentary. He needed to know {that a} GI bleed is extra critical in an older affected person with coronary heart illness on a blood thinner. What was I imagined to do now? We clearly disagreed concerning the subsequent steps, however I couldn’t plead my case any additional. He was delaying a probably lifesaving process ― one of many main causes of significant opposed occasions. I couldn’t assist however suppose that the night retirement celebration influenced his choice.
Round 7 p.m., one of many hospitalists on responsibility visited me. He was thorough and, in contrast to Dr. Woods, he was respectful of my expertise. He gave orders for blood and platelet transfusions, began IV fluids and admitted me to a medical unit upstairs. Since he was ending his shift, he assured me the night time shift hospitalist would verify in on me. Joanne and I had been anxious to get out of the emergency room and off the palms of Dr. Woods. I used to be relieved.
Sadly, my bleeding continued in my new room. I famous that my nurse positioned a basin in the bathroom to measure my blood loss. When she noticed the amount, she was startled and requested if I had been experiencing that degree of blood loss all day. “Yes, and they never measured the blood loss,” Joanne advised her.
The hours handed, and I misplaced observe of time. I saved asking, “Where’s the blood?” The nurse saved replying, “It’s been ordered. We’re still waiting.” I used to be getting colder and fewer conscious of my environment. I drifted out and in of sleep however felt my spouse’s hand on me continuously. I knew she was scared. I used to be bleeding out, albeit extra slowly than an individual with a gunshot wound of their stomach.
It was round 11:30 p.m. when a way of calm began to come back over me ― it was an acceptance that I’d die peacefully in mattress. So that is what it feels prefer to die, I believed. I used to be now not afraid. “I’m going to die,” I mentioned in a whisper. I can’t think about how Joanne felt. My nurse received startled briefly, however she was skilled with critically sick sufferers and known as in her staff.
Inside seconds extra nurses arrived, they usually took management because the hospitalist was nowhere to be discovered. Two extra IV catheters had been positioned for speedy infusion of fluids and blood in an effort to hold me alive. My nurse phoned Dr. James, the on-call GI specialist and one in every of my buddies. She gave him an replace after which handed me the cellphone. “Larry, we need to do the colonoscopy now,” he advised me. “I’ll be there within the hour.”
Courtesy of Lawrence Mieczkowski
The blood and platelets had been delivered quickly after, and inside minutes it appeared the inner bleeding was slowing because the cramping and urgency had lessened. At 1:30 a.m., the nurses wheeled me right down to the endoscopy suite. Dr. James arrived, and I used to be asleep inside seconds of getting the anesthetic. He used 4 titanium clips to clamp an artery bleeding from the positioning of the place the big polyp had been eliminated. Lab testing confirmed that I had misplaced almost 50% of my blood quantity.
I used to be discharged later that Saturday morning. Sadly, the shock and blood loss had broken my coronary heart, kidneys, and affected my pondering and reminiscence. My situation worsened and after present process assessments regionally and on the Mayo Clinic, I used to be identified with congestive coronary heart failure, stage III kidney failure and power anemia. Regardless of adjustment in medicines, I nonetheless couldn’t deal with the rigorous necessities of training drugs and my every day life, and I used to be suggested by my PCP to cease working and pursue incapacity.
It was very tough to just accept this advice, and I used to be very indignant. I liked my work. I had simply moved right into a newly transformed workplace and, as a result of I used to be so sick, I didn’t have six months to barter the sale of my follow ― I needed to shut my enterprise. I attempted to get a malpractice lawyer to characterize me however after six rejections I used to be completed. Fortuitously, I had good incapacity insurance coverage.
Why do physicians miss a prognosis or screw up on remedy plans? What’s extra, why do too lots of them not hearken to their sufferers ― essentially the most primary factor that needs to be a elementary a part of their follow?
Dr. Woods didn’t actually wish to think about my issues, however he and Dr. Smith additionally did not put all of the items of the puzzle collectively, whether or not it was due to ego, placing an excessive amount of significance on my low coronary heart price, or being distracted by a retirement celebration. They each had loads of time for my analysis and may have thoughtfully weighed my worries.
Sadly, my expertise is frequent since opposed occasions happen in a reported 25% of hospital admissions. If you end up in one in every of these opposed occasions like I did, right here is a few recommendation that could be helpful:
1. Resist yelling on the nurse or doctor. It doesn’t assist, and chances are you’ll get labeled as “a difficult patient,” which might make issues worse.
2. In case you are not being heard, get the unit’s cost nurse or supervisor concerned early within the battle since any delay could also be a life-or-death subject. As a result of sufferers are randomly assigned to a hospital-based doctor, these nurses can organize a switch to a different doctor’s care or get different specialists concerned.
3. When you’re very sick and at a small group hospital, you need to think about pushing for a switch to a bigger hospital and, if crucial, contact the hospital’s high quality, danger administration, or medical director’s workplace. This nearly at all times ensures motion since no hospital desires to be sued.
4. Outpatient medical follow may be very totally different from hospital-based care. The previous is now quantity pushed and likewise rife with missed diagnoses, delays in remedy and unsatisfactory workplace visits. Nurse practitioners (NP) and doctor assistants (PA) have comparable outcomes as physicians, typically have extra time to spend with their sufferers and have excessive satisfaction rankings. Nevertheless, ask to schedule a go to with the doctor in the event you’re dissatisfied with the care of the NP or PA.
5. Bettering communication along with your supplier could also be aided by bringing one other individual with you to your appointment and having them function an advocate.
Courtesy of Lawrence Mieczkowski
6. Since computer systems at the moment are normal in most examination rooms, a supplier might solely spend 8-10 minutes head to head with you throughout a 20-minute appointment. Put together on your go to by studying about your drawback. For instance, the Cleveland Clinic’s web site has an incredible graphic depicting which organs could also be inflicting belly ache. Kind an inventory of your issues however hold it centered, as, sadly, most physicians don’t have time to totally deal with a protracted checklist of points. Overview your checklist with the medical assistant and ask them to scan it into your information.
7. Major care suppliers might not think about a prognosis they don’t typically see. Requesting an ultrasound if the ache is extreme or not bettering might save your life. If the supplier says that you simply don’t want it, you will get a self-funded ultrasound for lower than $200 in lots of states. Take your issues to the workplace supervisor or a director overseeing the follow.
8. Sadly, I don’t see a return to the occasions when medical doctors spent Half-hour with a affected person. Paying PCPs extra for his or her time would rapidly change the system, however it’s not going to occur. Drugs has morphed into large enterprise with trillions of {dollars} spent every year. Discovering an incredible supplier could also be a problem however there are well-trained medical doctors, NPs and PAs on the market who will hearken to you. Phrase of mouth referrals are sometimes the very best. Opinions of physicians on hospital web sites should not useful in my expertise, so try impartial websites when potential.
9. View your first couple of visits with a brand new follow as an interview and transfer on if it’s not a match. Keep in mind, you possibly can at all times finish a long-standing relationship with a follow. When you resolve to divorce your supplier, ship a licensed letter to the administrator of the follow explaining why you’re leaving.
We physicians know the healthcare system is damaged. Hospital executives are overpaid. Since PCPs are paid on common $180,000 versus the $500,000 an orthopedic surgeon makes, the very best and brightest medical college students typically pursue extremely paid specialty positions. Physicians are overbooked, overwhelmed, drained and burned out. Computerized medical information have made it worse. The top result’s typically poor affected person outcomes. Since you possibly can’t change the system, it’s important to learn to navigate via its waves utilizing among the options that I’ve made.
After my expertise, I used to be sure that I wouldn’t survive a 12 months however it’s now been over 5 years. My kidney perform and anemia have improved. I’m nonetheless dealing every day with my coronary heart failure, limiting salt, resting for hours at a time and lowering my actions. I used to be capable of resume {golfing}. By way of my physicians’ help and the love and tender care of my spouse and others, I’ve accepted what occurred to me. It’s not what I had envisioned a decade in the past, however I’ve high quality of life. In the long run, I survived, however I got here too near demise that ought to have been simply prevented.
Be aware: Names and a few figuring out particulars have been modified to guard the privateness of people talked about on this essay.
This piece was initially printed in April 2023 and is operating once more now as a part of HuffPost Private’s “Best Of” collection.
Lawrence Mieczkowski, M.D., aka Dr. Mitch, practiced drugs from 1982 till he closed the enterprise in 2018. His ebook, ”The Room on the Proper: A Memoir of Despair, Hope and Reckoning within the Face of Abuse, Trauma, and PTSD,” was printed on June 3, 2025. He had additionally printed numerous articles in scientific journals, a collection of op-ed items within the Dayton Day by day Information selling healthcare reform, and a latest article on Doximity about PTSD. You may learn extra about him on his web site, LawrenceMieczkowski.com.
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