Medicine For People!

August 2015

Emergency Room after a trauma

Death in the Wrong Place

  • The Nurse from Guadalcanal
  • Epilogue
  • Take Care of Yourself

This story starts in Ilwaco, Washington, a small town with few physicians. In 1983 I was covering for a family practice doctor so he could get some time off.

The Nurse from Guadalcanal

Phil was usually in a hurry to get out of town for his vacation; our handoff conference was brief.

Among the items he detailed was the story of a worrisome patient currently in the hospital. Dorothy Furness was well-known and well-loved by all, having worked as a nurse in Ilwaco for decades. She was also old enough to have worked as a nurse in the Second World War, most notably taking care of injured Marines on the island of Guadalcanal in 1942. Malaria had been as deadly an enemy as the Japanese, and she had cared for our struggling soldiers while ill and feverish herself.

I don't recall what had brought Dorothy into the hospital, but it necessitated an abdominal operation. This was followed by an infection that led to rupture of her 6-inch-long abdominal incision, known to doctors as "dehiscence." Dehiscence means that the suture line has failed and the edges of the wound have separated. Infection is the usual cause, as was the case with our nurse. In botany, dehiscence refers to the breaking open of the bud to reveal the flower petals inside. This must be why the term is used in surgery, for in the case of this abdominal wound, Dorothy's abdominal cavity had opened to expose all its contents to the outside world.

No patient and no medical team greets this development with anything other than alarm. Ilwaco is a very small town and the hospital is sized to match. There was one surgeon who drove across the bridge each day from Astoria, Oregon; he had performed Dorothy's operation.

As I went to work that Saturday morning, there was admiration and pride that he and other members of the medical team had pulled Dorothy through two other life-threatening complications (kidney failure and blood clots). No doubt there had been a good deal of midnight page turning and phone calls to specialists to pull her through these brushes with death. Success had so far been achieved; she had survived.

What my colleague told me, that Friday night, was that they felt Dorothy was finally stable enough to transfer to a major medical center in Portland for further treatment and recovery. The only problem was, she'd told the entire medical team she'd rather die in Ilwaco than be transferred to Portland. So here I was on a Saturday morning, briefed by my predecessor and charged by the nurses in the inpatient unit with the task of making sure this respected and well-loved nurse got onto the ambulance that was to transport her to Portland.

When Dorothy kept insisting that she did not want to go, it was my task to go into her room and convince her otherwise. She had a strong will, but she was also worn out from her three-week-long medical ordeal. I don't recall what I told her, but I suspect I mentioned that every nurse and physician who had been caring for her was also exhausted. They were grateful that their efforts and Dorothy's own heroic fortitude had gotten her this far through the valley of death. But they were concerned that their good luck could not continue. They felt that they needed to get out of the way and let the varsity team in Portland complete the medical work.

Whatever I said, she relented and shortly thereafter departed our hospital. Of course she had no choice.

The rest of that weekend made no impression that I remember. But I do recall going back again a few weeks later only to learn that this heroine of Guadalcanal had died at the major medical center in Portland.

Looking back, I think that Dorothy knew more than the rest of us. True, Ilwaco General was a one-surgeon hospital. Ilwaco had no intensive care team and no battalions of specialists and subspecialists.

But Ilwaco had something they did not have in Portland, and that was the friends, neighbors and colleagues of this nurse who had fought her own battles on Guadalcanal. Ilwaco was the home team and had earned Dorothy's trust.

Epilogue

We have a dismaying habit these days of criticizing those in the fray. Sit at a dinner table or read comments on the Internet and you hear the same complaint. The football player might have caught that pass if less clumsy; the politician might have achieved success had she pushed harder; the medical team might have saved the patient had they been competent.

In medicine, failure can bring injury or death to the patient and lawsuits and shame to the caregivers. I do not doubt that these fears lurked somewhere in the awareness of Dorothy's worn-out medical team that Saturday morning.

Dorothy much preferred to leave her fate in the hands of those with whom she had lived and worked for so many years. Even had success turned her face away from Dorothy and her medical team, I know Dorothy would much rather have died surrounded those she loved than as an anonymous geriatric patient in a generic intensive care bed a hundred miles from home.

My hope is that we can return to a world where people and our legal system can be trusted not to view that as negligent.

Take Care of Yourself

You are not too young to complete a power of attorney for health care matters, a living will, or a POLST form. Read more.

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Medicine for People! is published by Douwe Rienstra, MD at Port Townsend, Washington.