Posts filed under surgery

Man on fire!

Filed in Current Affairs, Health, Hong KongTags: , , ,

True story.

It was supposed to be a straight forward operation, a small one, a simple one. Cut a small hole above the bronchial airway, pull the large oxygen breathing tube out from the mouth and push the new smaller tube in through the hole.

My brother-in-law Joe had a stroke almost two weeks ago. A blood vessel in his brain had developed an aneurism and while walking the streets of Macau, it burst, streaming blood into his brain. He knew immediately that something was wrong and asked a nearby policeman for help. He was transported to a hospital and treated. He had lost consciousness well before getting to the hospital and his situation was serious.

Fast-forward a week. Joe has been transferred to the Prince of Wales hospital in Sha Tin and is resting and recuperating in the crowded and understaffed Neural ward on the third floor. He can open his eyes but cannot move any of his muscles. He has a long way to go before he'll be normal again. His mouth is perpetually open because his jaw muscles don't respond to commands. Consequently, he breaths through his mouth but cannot moisten it or control where the saliva and nasal fluids go allowing some of it to run down the trachea and build up in the lungs. According to the attending doctor, this may have been one of the causes of the secondary pneumonia infection noted a few days later.

The pneumonia produced massive amounts of phlegm in his lungs and without motor movement or coughing capabilities, the phlegm would remain in his lungs, significantly impeding his ability to breath. Without help, he would die, possibly of suffocation. An air tube was inserted down his throat to assist with his breathing but leaving the tube there long term would probably damage his throat. The doctors therefore decided to cut a small hole through his chest into his trachea and insert a small tube. For the immediate future, this would be a safer and more convenient solution to his breathing problems.

The procedure is relatively simple. Cut a small hole through to the trachea. Pull the large tube out through the mouth. Push the small tube in through the hole. To make sure that the patient doesn't suffer from a lack of oxygen during the procedure, almost-pure oxygen is fed to the patient through the large tube just moments prior to the operation. The extra supply of oxygen is supposed to keep the patient going while the tubes are being exchanged.

The procedure took place yesterday in an operation room. During the operation, instead of using a traditional scalpel, the doctor used an 'electric scalpel'. For reasons not yet explained to us, the 'electric scalpel' released sparks during the operation which ignited oxygen coming out of the hole. Joe was literally on fire; for approximately ten seconds. The fire was reportedly quickly put out with water (water??). Once the damage had been surveyed and evaluated, the tube procedure was completed and Joe was once again able to breath.

The fire was real. According to the doctor, it was an accident and it was the first such known incident in Hong Kong although according to the doctor, web searches revealed twenty or more similar cases overseas. The fire produced heat and smoke, and some of it may have entered Joe's bronchi, scorching the bronchial epithelial layers. Best case scenario; the bronchi will recover without further complications. Worse case scenario; the epithelial layers swell and result in thickened bronchial walls and narrower wind ways possibly leading to further serious long term complications.

The fire was an accident. We believe that. The question though is one of negligence. In my (admittedly inexperienced) mind, I can only see two possible reasons for the fire. First, the electric scalpel used was faulty, leading to the sparks that ignited the oxygen. Second, the procedure was flawed. With oxygen pumping through it, the larger tube was pulled up above where the hole was to be cut before the cut was made and oxygen was still pumping through the tube while the hole was being cut. This lead to direct contact between the almost pure oxygen and the electric knife hence the fire.

In either case, negligence is the cause of the accident; lack of maintenance and equipment inspection in the first case, and incorrect procedure in the second case.

If we were in the U.S.A., we'd be suing the hospital. Here in Hong Kong, suing is much more complicated. That said, it's far more important at the moment to keep an eye on Joe and make sure that his road to recovery is not hampered again. Hopefully, the nurses and doctors will pay more attention to his case.

In the end though, the real criminals here are the Hong Kong Government and the Hospital Authority. While happily advancing funds to large corporate contracts for extravagant projects, and while the Hospital Authority management staff joyfully award themselves high salaries and large unsubstantiated bonuses, they continue to cut financing to the hospitals. Public hospitals in Hong Kong are now overcrowded. Even the Intensive Care Unit looked like a refugee zone with beds camped hither and thither in the hallways and in the walking areas between beds. The staff are overworked, understaffed and underpaid. This can benefit no-one.

Similar situations are building in the public school system, situations which have recently led to multiple suicides in the teacher population.

Funding and expenditure need to be controlled but there's a limit to how much you can save on staffing costs and the lives of the people have to be considered. If the government doesn't work soon to remedy the situation in a sensible realistic way, the consequences will be dire; for everyone (except the rich which not surprisingly includes those same government officials and hospital authority management staff. Maybe the middle-class citizens should be the ones making the life-and-death decisions instead of the rich.)