Dr. Theodore Watkins was a 31-year-old resident physician from Roswell, New Mexico. He regularly
went to the gym, ate a plant-based diet, and practiced meditation - in many ways he was
the picture of healthy living. Theo, as his friends and family called him, lived in a
2 bedroom apartment with his girlfriend and their dog Misty. One night, while he was playing
with his dog, his alarm rang - he had a night shift in the Emergency Room. He scratched
Misty’s belly "Time to go! See you in the morning!”
The night shift was fairly routine - some laceration repairs, a gunshot wound, a woman
with severe panic attacks, and a mix of other complaints. The clock in the emergency department
showed 5:39am when a nurse announced that there was a 43-year old male with a sudden
onset of chest pain being carted in. Dr. Watkins quickly drank up the rest of the coffee and
replied: “Bring him in.” A few moments later, a man was wheeled in on a gurney. He
was breathing heavily, holding his chest, and turning and twisting in pain. Dr. Watkins
asked the man some questions as the team begin to set up monitors, get IV access, and give
pain medication. Through gasps - the patient explained the pain started abruptly when he
got out of the bed, and that he felt it everywhere including in his back.
Within moments information was flowing in. The blood pressure in one arm was lower compared
to the other one, the ECG was normal, and the lab work had been sent off. The nursing
team had also paged the overnight attending physician, Dr. Chapman, and when he called
back - the phone was handed to Dr. Watkins.
“Dr. Chapman on the phone,” said the sleepy voice from the other side. During the next
few minutes, Dr. Watkins explained that they have a 43-year-old patient with unusual chest
and back pain over the last couple hours, and that there was an irregularity in the
inter-arm blood pressures. He mentioned that the ECG showed no signs of a STEMI. Dr. Chapman
seemed a bit more awake and spoke with intensity. “Alright, listen up kid. Give him aspirin,
clopidogrel, and enoxaparin. I’ve seen plenty of cases like this. He has an NSTEMI and I’ll
see him in the morning. You got it?” Dr. Watkins was shocked, because Dr. Chapman seemed
so certain. Nevertheless he managed to blurt out some questions, “Are you sure we shouldn’t
consult a vascular surgeon or perhaps get some imaging study?” Dr. Chapman angrily
responded, “I know what I’m doing and I know my job. Do you know yours?” The call
ended on that note, and Dr. Watkins hung up and did what the attending physician told
him to do.
Over the next few hours, the patient’s condition steadily worsened, but Dr. Watkins wasn’t
willing to get yelled at again so he stuck to the plan they had put in place. He also
hoped that Dr. Chapman would come in soon so that he could take over. Unfortunately,
the patient’s condition worsened and a code blue was called. The patient died in the emergency
room that morning from internal bleeding due to an aortic dissection.
A few weeks later, Dr. Watkins received a letter stating that his hospital was being
sued and that he was being named specifically because he didn’t follow hospital protocols
that may have saved the patient’s life. The letter specified that he should have consulted
a vascular surgeon and obtained imaging more quickly. Dr. Watkins said that he specifically
followed the directions he got from his attending physician. But the attending physician Dr.
Chapman said that Dr. Watkins didn’t explain the severity of the patient’s condition
and that he wasn’t kept informed about what was happening in the emergency room.
Now - to rewind this back - let’s imagine that Dr. Watkins had asked Dr. Chapman to
document his plan and had also documented his concerns about it. In addition, let’s
imagine that Dr. Watkins had continued to call back and give regular updates with changes
in the patient’s clinical condition. It’s possible that Dr. Chapman would have agreed
to change the plan or that Dr. Watkins could have convinced him to come into the hospital
to see the patient. It’s very possible that the patient would have been correctly diagnosed
and treated sooner and that he wouldn’t have died. The moral: Document conversations
about critical decisions, and keep lines of communication open.