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Picking up the pieces: the aftermaths of three deaths
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‘What is myocardial infarction, Doctor?’
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The receptionist told me a patient on the phone wished to speak to an independent doctor in our practice about an urgent problem. The distressed woman’s opening words were: ‘What is a myocardial infarction Doctor? I simply have to speak to you about it; I’m too embarrassed to speak to the doctors there that I know.’
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The story unfolded. Her husband, aged 56, had been treated by Dr A for hypertension. Her doctor was Doctor B. Twelve months ago Dr C saw her husband at home early one morning because he had chest pain. Despite attempted resuscitation after a cardiac arrest in the ambulance, he was dead on arrival at the hospital.
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Everything happened so suddenly that she did not have an opportunity to speak to a doctor at the time but assumed her husband died from a heart attack. However, a copy of the death certificate that stated death was caused by ‘myocardial infarction’ confused her. She had mulled over this for the past year. Her catharsis began: ‘How could he have died in this modern day of wonder medicine? Why didn’t Dr A warn us this could happen? If only I could have spoken to one of the doctors. If only I’d known exactly how he died. I have felt like killing myself, I’ve been so depressed. I feel so bad about the way I looked after him’.
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An erroneous death certificate
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A patient consulted me last year, distressed and angry about the death certificate issued after her husband’s death. She said, ‘This certificate is wrong. It’s an illegal document. It’s a lie—Ted did not die from septicaemia after bronchopneumonia—he had a heart attack’.
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Ted, who had a history of ischaemic heart disease, was found semiconscious with a blood pressure of 80/40 and a temperature of 38 °C. When hospitalised, with a provisional diagnosis of septicaemia, he was treated with intravenous antibiotics. He developed heart failure and died 48 hours later; the resident doctor issued the death certificate. Later, a post mortem revealed an extensive myocardial infarction.
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Her grief and hostility towards the doctors at the hospital were profound. ‘Doctor, the diagnosis is wrong. The treatment was wrong—you will have to change it.’
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The unreal image of the great hospital
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‘Doctor, would you please call on Mum? She is in a terrible state over Dad’s death, although it was four months ago.’
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Dad was a 72-year-old farmer who developed pyloric stenosis after a long history of peptic ulceration. He was admitted to a major teaching hospital in the city, under the care of a surgeon. His postoperative course had been good until a tear developed in the lower oesophagus following ...