A Sea of Broken Hearts
John T. James, Ph.D.
$14.99
153 pages
Here is why this book is so important: It begins with medical errors that kill people whose deaths could be prevented.
It reminds us to think about the medical errors that do not lead to death in one person, but could kill someone else.
It reminds us to apply our knowledge as widely as possible. At the very least – and it is small compensation indeed – it is possible that knowledge gleaned from the circumstances of a preventable death might save someone else’s life.
It reminds us that the preventable death of a child, a parent, a dear friend cannot generate an outcome that brings justice to the dead child, parent, or dear friend.
Alex James was an athlete – a 19 year-old runner. He was apparently in top physical condition when he fainted during a run under a hot August Texas sun.
He was taken to a local emergency room. He received saline solution by IV. Many cardiac procedures were administered, including painful, intrusive, wounding, expensive (profitable) studies. He recovered.
Three weeks later, he collapsed while running. He died three days later in a Texas hospital.
When I read what happened and what did not happen with Alex’s care, I had to put the book down and walk around the house for a few minutes. I got myself a glass of water. I was remembering a time in 2003:
Millie aka Spork Major was chronically-ill. Something hurt all the time, and so it was a challenge to differentiate serious signals of disaster from daily severe pain. On this day, we were in Rochester, NY, attending a digital poetry presentation by a vispo artist, Jim Andrews, whose work both of us admired, but he was mainly Millie’s friend, and she had not met him in person before.
So this was a big deal, and we were invited to dinner afterward at a Thai restaurant that Millie really liked.
But then she couldn’t eat. She could barely get out of her chair and make it to the car.
Do you need an ER? I asked.
I hate ERs, she answered.
But do you need one? I asked.
By then, Millie had already been to several ERs in NYC where she was still spending most of her time. Neither one of us knew anything about the ERs in Rochester or the Buffalo area.
Yes, but I don’t want to go where there are people with gunshot wounds and drug overdoses.
How would we know which ones?
Maybe the ER near our house?
I drove the hour back to Buffalo as fast as I could. We pulled into the small community hospital’s ER entrance. We could see the sign-in window through the double glass doors at the entrance. It was a very small hospital…
Nope, she said. I can’t do this.
We went home. I made some phone calls to find out where the best ER was.
Downtown. Gates Circle.
My informants were right. After a couple of ER visits where Millie was triaged as Urgent and blood was drawn, and lab tests were read, the low potassium was immediately found, proper medications administered, she was sent home once or twice with written orders to see docs, return if symptoms worsened (which they did), was received gently and then admitted to the coronary unit where she received more potassium IVs, and then magnesium IVs when the potassium levels weren’t going up fast enough, continuous ECG monitoring, lots of discussion about electrolytes and what causes them to go awry, and, following recovery, referral to the best primary care doc Millie ever had. Once her electrolytes were balanced, she had an echocardiogram and MUGA just to be sure that everything else was OK. And for the next few years, it was.
This happened at almost the same time as Alex’s utter disaster in Texas.
Alex also had blood chemistries drawn. The ER doc sent the results to the cardiology team on the unit where Alex was sent after the first fainting episode.
He was a runner, he was running at the time, it was a very hot day. Most people know that electrolyte imbalances can result from that combination.
The ER doc seemed to know that. But the cardiologists apparently didn’t.
So, first there was the terrible death. And then there was the equally terrible response to the death from the medical and legal communities. And then there was still the puzzle.
Alex’s father, John James, is a toxicologist and pathologist. He cares about the research status of clinical care. He cares about ethics.
He was profoundly disappointed – and Alex was betrayed – by the lack of either medical competence or research awareness or, for that matter, ethical sensitivity in Alex’s case.
What threw me out of my chair as I began reading Alex’s story was the realization that if we had pulled into Alex’s first hospital the August night he fainted, Millie probably would have died in 2003, not six years later from hospital-acquired-infections and misdiagnosis in 2009.
It was the thought of losing those precious six years with my daughter that brought me to my feet.
That is exactly the reaction that is important for all of us to have when we read a book like A Sea of Broken Hearts.
For some reason, even people fairly well-versed in public health policy are able to shake their heads over 99,000 – 200,000 (depending on which study you read) preventable deaths from medical mistakes each year without having that breath-stopping reaction:
It could happen to me. Or even, it could have happened to me.
John James, Ph.D. makes full use of his resources as a trained medical scientist and also as a father to help his readers strip away the self-destructive wall that keeps us from comprehending that medical disasters do not happen to “other people.” They happen to us.
In fact, if we think about it, we may have escaped one of the bullets already, as Millie did those nights in the ER.
As I did when my doctor attempted to bully me into taking aspirin immediately after a stroke before the imaging studies were performed. Fortunately, I was not having a stroke that caused cognitive or serious speech difficulties.
I’m a bleeder, I said.
It makes no difference, she said. Most strokes are from a clot, she said.
Well, 20% are from a bleed, I said. And no aspirin.
After the CT scan, she phoned. Don’t take any aspirin, she said. It’s a bleed.
I thought so, I said. I didn’t take any.
I fired the doctor, because I feared the next time she made a mistake, I might not know that she had.
James actually sets out to inoculate his readers against cardio care mistakes. In the introductory chapters of his book, he writes a comprehensible description of the heart and its functions complete with clear diagrams. Next, he provides a toolbox filled with tools an educated medical consumer can use to determine how cardiac care is provided.
It is a credit to James’s competence as a scientist and a writer that these chapters are as readable as the family story he tells. He has managed to balance the vision of a seasoned scientist with the emotions and wisdom of a father.
After the explanations and research, after the application of his findings to his son’s medical records, after exposing the self-protective, profit-making responses of doctors and lawyers, James lays out two final chapters on Patients’ Rights. His proposals should be required reading for anyone contemplating hospital admission.
