From Internal Bleeding: Handoffs and Fumbles

Robert Wachter, MD; Kaveh Shojania, MD

In This Article


Excerpt: Internal Bleeding: The Truth Behind America's Terrifying Epidemic of Medical Mistakes
By Robert Wachter, MD, and Kaveh Shojania, MD
Rugged Land, LLC
Copyright 2004
441 pages
ISBN: 1590710169
Price: $24.95, paperback

Chapter 10: Handoffs And Fumbles


Gentlemen, it is better to have died as a small boy than to fumble this football.
-- John Heisman (1869--1936), legendary football coach for whom the Heisman Trophy is named

Tung Jan was a slightly built, taciturn man of seventy-one. Born in Taiwan, he immigrated to the United States to find a better life. The lines on his thin face were a résumé of years of struggle. He seldom displayed emotion--not even irritation at the sometimes maddening bureaucracy of the nursing home where he, like 1.6 million other elderly Americans, was living out his final years. Bound to a bed or wheelchair, he saved what smiles he had left for his grandchildren, who came to visit him regularly. They sat in his lap and ran like puppies behind the wheelchair as his nurse wheeled him from room to room, showing off the bright-eyed legacies he knew he would soon leave behind.

Jan, a lifetime smoker, had end-stage emphysema. His lungs, once fluffy with millions of lacy air pockets, now sagged like a sooty blacksmith's apron inside his sunken chest. With luck he might live to see his grandkids finish grade school.

Jan had always been a careful planner. He'd thought seriously about his care in these final years and put his wishes in writing. When the end came, he wanted no heroic measures--no "Code Blue," no CPR--just a little medication to ease the pain and enough care to keep him clean and comfortable until he drifted off. These advance directives--which appointed his son as surrogate medical decision-maker should he slip into a coma, and made clear his desire to avoid heroic, life-sustaining procedures--were dutifully placed in his nursing home chart. He knew how hard it would be for his family to make these life-and-death decisions when the time came, and, by documenting his preferences in advance, he hoped to spare them this wrenching ordeal. As with everything else in his life, Jan had thought about the needs of others, been realistic and practical, and tried to do the right thing.

Still, it wasn't enough.


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