“To err is human; to forgive, divine.”
-
Alexander
Pope
It’s the
time of year when people start thinking about immunizations, especially for the
flu, and if you’re elderly or chronically ill, potentially a pneumonia vaccine.
I can see
in my medical record that it is saying I am due for a pneumonia vaccine, which
is typically administered every five years.
But when
it comes time, I’m going to refuse it. Don’t
get me wrong, as someone with a crappy immune system, I don’t want to die of
something like pneumonia. But on the
other hand, the vaccine almost killed me the first time, so maybe you’ll
understand my reluctance.
I’m
transported back to my first hospitalization.
I remember the details like they were yesterday.
My
rheumatologist told me to get a pneumonia vaccine. I’m not sure why I didn’t get at his office,
but I got it at the student health center.
When the nurse swabbed my arm, she did it lower than normal, and I
commented that I thought it was a weird place for an injection.
She passed
off my question like it was no big deal, and gave me the shot.
I went
home. That was Friday afternoon. On Saturday, I woke up feeling awful, and
noticed a red, painful welt the size of a quarter at the injection site. I slept most of Saturday. When I got up on Sunday, the quarter size
welt had turned into a welt the size of a fist (see picture below).
I called
the doctor on call at the student health center. First he quizzed me on the fact that I had a
flu shot rather than pneumonia shot, and then proceeded to question me about
why I had gotten a pneumonia vaccine. In
the end, he told me that what I was experiencing was “normal,” and that if it
wasn’t better by Monday, I should come in to the student health clinic to get
it checked out.
I happened
to be talking to one of my blogger friends who also has lupus, and sent her a
picture of my arm from my web cam (see picture below). She was very concerned, and suggested that I
call the rheumatologist on call at the hospital.
I
did. I received a call back from a
doctor with a heavy accent. The only
thing I understood was her telling me to get myself to the ER. And that’s what I did. By myself, because I thought they’d give me a
prescription and I’d be on my way.
But
no. Instead, I ended up in the hospital
for three days. At first, the doctors
could not stop the infection from spreading.
By the time I got to the hospital, my entire body hurt, and I had a
fever.
When all
was said and done, at one point, the infection went from my shoulder to my
elbow. My entire arm was inflamed and
felt like it was going to explode at any moment.
The
diagnosis was Cellulitis, an infection in the tissue of my arm, because in
reality, the vaccine had been injected into my tissue rather than the muscle. I was glad that no one had suggested to me at
the time that Cellulitis and Necrotizing Fasciitis (Flesh eating disease) have
very similar symptoms. In reality,
things could have been a lot worse.
I was
taking CellCept at the time, so I was put into reverse isolation. (That was the only saving grace of the
situation. I scored a private room. You have to focus on the positive, right?)
I was at a
major research hospital, and they were telling me that they had never seen a
vaccine reaction like mine before.
In the
back of my mind, I wonder what would have happened if I would have waited until
Monday, like the student health clinic suggested. Chances are, I may not be alive today.
And that’s
profoundly scary.
The
student health center refused to take responsibility for what happened. One nurse even accused me, telling me that I
should never have been told to get the vaccine in the first place. And the hospital never directly came out and
said that the injection was administered incorrectly. They agreed that the injection site was in a
strange place, but they also thought that I was experiencing some sort of
allergic reaction, as well.
Mistakes
happen. All. The.
Time. We are human. But medical mistakes can be deadly, even if
what caused it seemed so innocuous to begin with.
Like
getting an immunization at the urging of your physician to protect you from an
infection that could be deadly to someone with a compromised immune
system.
According
to an article put out by the Institute Of Medicine (1999), “At least 44,000
people, and perhaps as many as 98,000 people, die in hospitals each year as a
result of medical errors that could have been prevented…Even using the lower
estimate, preventable medical errors in hospitals exceed attributable deaths to
such feared threats as motor-vehicle wrecks, breast cancer, and AIDS.”
They
define four main types of error categories: Diagnostic, Treatment, Preventive,
and Other (IOM 1999). In a study of
family practices (outside the hospital setting), five types of errors were
identified: Prescription errors, Laboratory errors, Filing system errors,
Dispensing errors, and errors in responding to abnormal lab results (Dovey, et
al. 2003).
Patients
are not the only ones impacted by medical errors. Medical professionals are also impacted. Trust in the medical system goes down. And so does morale.
The IOM
estimates that these errors cost hospitals nationwide between $17 and $29
billion a year.
And medical
errors, specifically preventable ones, go directly against the Hippocratic
Oath, “First do no harm.”
Sometimes
the truth is scarier than fiction.
I never
imagined that something like this could happen to me. But it did.
I’m also
lucky that I made it through going to the emergency room by myself. But I truly thought that I’d be in and out
relatively quickly. I’m lucky, because
as the infection spread and I got sicker, the clarity of the details of my
story deteriorated. Thankfully, there
had been enough documentation in the process that this didn’t affect my care or
treatment.
If you
have any type of negative reaction from a vaccine, regardless of how minor, you
should visit http://vaers.hhs.gov/index,
and file a report with the Vaccine Adverse Event Reporting System (VAERS). You should also make sure that you read the vaccine
information sheet that is provided when receiving any vaccination.
VAERS receives 30,000 reports annually, of which 13% are
classified as serious, meaning they have lead to disability, hospitalization,
life-threatening illness, or death.
I think the best piece of advice I can give is to follow
your intuition as a patient. Ultimately,
I was right that the vaccine was being given in a weird place. Yes, medical professionals are supposed to
know what they are doing, and what is best for the patient, but in reality,
this doesn’t always translate.
And if you haven’t been on the receiving end of a medical
mistake, be grateful. You’re one of the
lucky ones.
Dovey, S., Phillips R., Green L., and Fryer G. 2003. “Types
of Medical Errors Commonly Reported by Family Physicians. Graham Center One-Pager #16.
Institute
of Medicine. 1999. “To Err is Human: Building a Safer Health
System.”
