Saving a life being lazy

I had convinced an 47 year old male Alcoholic who refused detox admission into an overnight stay to replenish his electrolytes as he looked very malnourished and he was very fidgety. Something was not right with is presentation. He has quit drinking 10 days ago and per his sisters insistance, he had come to the clinic to be seen. During the exam he was coughing, looked very malnurished and thin and was visibly very sick looking. He was 10 days post his last drink so he should not be having delirium tremens now but he was very shaky and weak.

Thanks to our new computer system (EMR) crashing while I was entering admission orders, I ended up doing my orders verbally and forgot to re-order my chest x-ray studies. I sent him to the hospital from our satellite clinic and then went home at the end of the day. One of our nosy nurses called me later to ask me what I planned to do with this gentlemen's continuous coughs which reminded me that I had forgotten to get the chest x-ray. I order the chest x-ray and being lazy I told the nurse to ask for a stat read back, saving myself from having to drive to the hospital and look at the x-ray. Moments later, that same nosy nurse calls back telling me that x-ray looks so bad that even he knew what was wrong. I had to get off my lazy ass and drive to the hospital. The x-ray looked bad, alot of hazziness, worrisome for congestive heart failure (CHF). I added some blood work to see if it indeed was CHF and the results came back negative. Hmm. What is going on? I went back to the patient and he was having a hard time breathing in bed but denied any pains. I reviewed all the lab studies I had ordered and he did have marijuana recently, which could explain why he was not in any pain.

While I was trying to figure things out, my cell phone rings and it was the radiologist. Oh yes, thats' right, in my quest to NOT come to the hospital, I had told the nurse to send the x-ray report for stat read back. The radiologist confirmed what I had thought but had one particular point to add......there is a finding that is suspicious for an thoracic aneurysm. WHAT!#*&@! I ordered a STAT CT of chest which should there to be a Large 10 cm thoracic aneurysm as well as a Type A dissection (splitting open) of the Aortic arch (the major blood vessel leaving the heart). There is a 1-2% mortality rate per hour of delay with this condition.

To make a long story short...he was helicoptered out to a near by hospital and....he survived the surgery. He got lucky that I was lazy. Neither I nor our hospitals daytime radiologist found that aneurysm on initial viewing of the x-ray. Instead a nosy (good) nurse and a night shift radiologist saved this patients life. Thank goodness I was lazy that night and asked for the stat read back.

A good nurse see things a doctor misses. You cannot have a good outcome without a good nurse.